Although most insurance plans do cover therapy, not all plans do and it is dependent on where you purchase your insurance plan from. If you have an insurance plan from the federal Marketplace, your insurance does cover therapy. If you have an insurance plan provided to you by your employer, it is important to do your research within your own insurance plan to determine if therapy is covered.
The Affordable Care Act and Therapy
Since the Affordable Care Act took effect, all federal marketplace insurance plans are required to offer some sort of coverage for therapy and mental health treatments. The Affordable Care Act enacted “mental health parity” which treats mental health care as effectively as any physical health care would be. In other words, federal marketplace insurance plans cannot raise costs for therapy any higher than they would for physical health practices. The exact details about your coverage would depend on the plan you have chosen.
Is Therapy Covered By All Health Insurance Plans?
The mental health parity law applies to all federal insurance plans, such as all the plans offered through the federal marketplace. However, many insurance plans are privately owned and do not need to follow these guidelines, such as insurance plans offered by many employers. These insurance plans are still required to cover preventative care which does cover mental health screenings, but are not required to cover any therapy or mental health treatments after the initial consultation. Many privately owned insurance companies still offer coverage for mental health so it is important to contact your insurance company directly to know your benefits.
Does My Insurance Plan Cover Therapy?
Whether you have a marketplace insurance plan or one offered to you through your employer, it is important to contact the company directly to see what behavioral health or mental health services are included under your plan. To figure out what resources your plan includes, contact your insurance company’s human resources representative or call the insurance company directly to ask about your specific plan.
Are Deductibles Included In My Plan?
Deductibles for therapy and mental health resources can vary from plan to plan. Some plans require you to spend the entire deductible out-of-pocket before your insurance will pay any claims. This depends on the deductible you selected initially. However, there are some insurance plans that offer separate deductibles for physical health treatments and mental health treatments. It is important to contact your insurance company to determine which deductible setup they have.
Should You See Your In-Network or Out-of-Network Therapist?
With federal marketplace plans, you will have the option to visit an in-network or out-of-network therapist. Both physicians have their benefits and consequences but it is based entirely on your personal needs whether or not seeing an in-network or out-of-network therapist is best for you.
Having an in-network therapist is useful in terms of dealing with insurance claims and payments. Many in-network therapists are already covered through insurance plans and they will contact them directly. This saves you the hassle of dealing with insurance claims, reimbursements, and deciding whether or not the therapist will accept your insurance coverage. However, in-network therapists are picked solely based upon your insurance company. They may not be in close distance to you or be your preferred therapist.
If your insurance covers out-of-network therapists and your preferred therapist or current therapist is out-of-network, you may choose to continue your treatments that are out-of-network. However, you will need to pay out-of-pocket and send the claim to your insurance in order to get your reimbursement. It is important to note that not all insurance companies provide coverage for out-of-network medical practitioners, which can include therapists. If your insurance company does not offer coverage for out-of-network therapists, they will not reimburse any fees you pay. It is crucial to figure out what your insurance plan offers to avoid any hefty fees.
Are All Mental Health Professionals Required to Accept Your Insurance?
Just as any other medical practitioner, therapists are not required to accept your insurance. Some insurance plans are not applicable to mental health treatments and are not accepted by therapists as well. Mental health professionals may be less inclined to accept some of these insurance plans because they have to go through further lengths to accept and file claims with them if they are not already in connection with their office.
What You Should Do If You Don’t Have Coverage
If your insurance plan does not offer coverage for therapy or mental health treatments there are many other affordable options you can choose that do not require health insurance. Below are a few options you can look into if you are in need of mental health treatments.
- Community Treatment Centers – If you are looking for a low-cost or even free option, make sure to contact your local community centers or therapists. Many offer low-cost individual sessions or group sessions that can be free of charge.
- Private-Pay Counseling – Many therapists offer payment plans that are based on out-of-pocket costs, but you can create your own treatment plan based on the number of visits and length of visits. On average an individual 45-minute session averages around $160. Contact your local therapists or mental health clinics for a consultation.
U.S. Department of Veteran Affairs – If you are an eligible veteran, many local veteran affair offices will have resources and clinics that offer low-cost or free options for therapy. These are offered to veterans as a benefit regardless of their health insurance plans. To learn more visit: www.va.gov/health.