How to Pay for Therapy and Deal with Insurance
See also, “Low-Cost Alternatives to Therapy” for additional options.
Paying for therapy is one of the biggest obstacles for many people. In the US, a single session of in-person therapy can cost anywhere from $60-$300, though the average is closer to between $80-$120. If this is more than you can afford, don’t give up yet! Whether you have insurance or not, there are many options to explore that may help you pay for therapy.
Paying with Insurance
If you have health insurance, all or part of your visits to a therapist may be covered; or, they may not. It can be difficult to tell. There are three ways to find out; you may need to pursue more than one.
- Ask your therapist. The first and simplest step is to ask your therapist if they accept your insurance. If they do, that’s half the battle; the other half is finding out if your insurance has co-pays or limits on coverage. If your therapist is experienced with your insurance company, they may be able to help you figure out what the insurance company is likely to cover, and what you’ll be responsible for.
- Look at your plan’s Description of Benefits. If you have a “Description of Benefits” from your insurance company, look for “Outpatient Psychotherapy” or “Outpatient Counseling”—this means any therapy that doesn’t require being admitted to a hospital, and is what going to a therapist will be counted as for billing purposes. If you don’t have a copy, insurance companies are required to provide you with a “Summary of Benefits and Coverage,” a concise statement of what the plan does and does not cover. You can contact your insurance company and request one.
- Call your insurance company. You can ask your insurance company for a list of in-network therapists in your area, or ask if they’ll cover a specific therapist you’d like to work with. Some insurance will still cover part of the cost even if you want to see an out-of-network therapist. You can also ask your insurance company about co-pays and whether there are limits on the number of visits they’ll cover.
It’s worth checking, even if you’ve been denied coverage in the past, because the Affordable Care Act has significantly expanded the range of mental health services that insurance companies are required to cover.
If you do find that insurance will cover your visits, it’s also good to take the opportunity to ask whether you or your therapist will be required to submit the claim for reimbursement.
If you’re nervous about calling the insurance company, that’s understandable! Here are a few tips:
- You’ll find the number for your insurance company on the back of your benefits card or on your benefits statement. If you can’t find these, you can search by the company’s name online.
- Have your benefits card handy when you call: You’ll need your member number and plan number (often called member ID and plan ID) handy. This information may also be on your benefits statement.
- You may be on hold for a while. Have a book, some knitting, a tv show, or something else you can do while you wait ready.
However you go about it, make sure you’re clear on whether insurance will cover you, won’t cover you, or might cover you, before you start your sessions. If insurance won’t cover it, you’ll have to pay out of pocket, and that’s something you want to know ahead of time.
Paying with Medicaid
Medicaid is a federal and state program that provides health coverage to people with very low income. Medicaid does cover a wide range of mental-health services, and the number has been increasing recently due to policy changes such as the Affordable Care Act. However, the actual benefits vary from state to state.
If you’re on Medicaid, the best thing to do is ask your therapist if they accept Medicaid. A therapist experienced with Medicaid clients may be able to give you advice on what your state will cover. Be aware that, even if your therapist accepts Medicaid, co-pays may apply. To find out, call Member Services for the plan you’re on—the number should be on the back of your enrollment card, or go to the Medicaid web-site for your state.
- Check here for a directory of state Medicaid sites and contact info
- Check here for current info about state-by-state coverage.
Paying with Medicare
Medicare is federally-provided insurance for those 65 or older, or with severe disabilities. It is not dependent on income.
Medicare Part B covers mental health-care, though you will likely have to pay a deductible of 20%. Medicare only covers mental health care when the therapist is willing to accept “assignment,” which means the amount of money Medicare is willing to pay the doctor.
Ask therapists if they work with Medicare clients, or if they’re willing to. You can find more detailed information about Medicare and mental health services here.
Medicare also pays for one depression screening per year from your primary care physician.
Other Ways to Pay
There are a number of options besides insurance for getting help paying for therapy.
Paying Out-Of-Pocket and Discounts If you must pay out-of-pocket, don’t despair! Most community agencies or clinics have sliding scales, which means the cost of a session varies according to your income and number of dependents, etc., and many therapists in private practice do as well. It doesn’t hurt to ask! Be prepared to bring in a copy of a recent tax return or pay stub to verify your income.
It’s also good to ask therapists if they offer a cash-discount. Some therapists will offer a discount if you pay in cash, because of the time and money they save not dealing with insurance.
Some people even find that, if financially possible, paying out-of-pocket gives better results; when you’re paying your own hard-earned money, you’ll be all the more motivated to put in the work to get the results you want. And, you don’t have to worry about when the insurance company thinks you’ve been to enough sessions and stops paying.
Employee Assistance Programs Some employers, usually larger companies or organizations, have Employee Assistance Programs (EAPs) or wellness programs that may cover mental health visits. The programs are often limited—they may only cover a certain number of visits, or visits for a certain reason—but it’s worth checking out. It may cover a significant amount of therapy.
If You’re in School If you’re a college student, you should have access to campus health services, often called college counseling centers, which will typically provide some range of mental-health services at no cost as a part of your tuition and fees.
If you’re in high-school or earlier, you probably have access to tax-funded counseling options through your school district. Your guidance counselor can tell you what resources are available for you.
Health Care Savings Program These are a kind of savings account offered by many employers. They allow you to put money aside, tax-free, to be used for medical expenses, including mental health services. Though this doesn’t directly make therapy any cheaper, it saves you some money by making what you spend on therapy tax-free.
So, if you know you’re going to be paying for therapy out of pocket, or have significant co-pays, and your employer offers these kinds of accounts, it makes sense to set aside the amount you expect to be spending. (Of course, you have to have the money ahead of time to do this.)
Getting Insurance (if you don’t already have it) Getting insurance can be a great help in paying for therapy. Though not all insurance covers mental healthcare, the Affordable Care Act expanded mental health coverage, so the chances of getting covered are better than they were.
One of the first things to figure out when considering insurance is whether you qualify for any reduced-cost options. These are Medicare, Medicaid, and lower-cost premiums on the Health Insurance Marketplace.
- Information on Medicare (you may be eligible if you are 65 or older, or have severe disabilities) (if you meet certain income requirements)
- Information on Medicaid (you may be eligible if you have low-income, have children, are pregnant, or have a disability)
- Information on the Health Insurance Marketplace (you may be eligible for lower-cost premiums)
If those don’t apple to you, you still have a few options:
- Buy health insurance from the Health Insurance Marketplace at Healthcare.gov.
- Buy health insurance directly from an insurance company or through a broker.
- Get health insurance through your employer if it’s offered.
If you need help applying for insurance, try one of these:
- Find an in-person Health Care Navigator: these people are specially trained to help people apply for insurance. Often they are available at local tax-help centers or community organizations. Their help is free.
- Use the Marketplace call center] and a live representative will answer questions and help you apply for coverage.
If you’ve been feeling down, it’s worth it to explore your options for feeling better. Quality mental health care is an expense that pays off in the long-run. With greater wellbeing comes greater strength in old age, fewer heart issues, faster recovery after a major medical event, and a longer life.
Besides the health benefits, high wellbeing is a desirable state in its own right. If the above options don’t work, don’t give up! Check out “Low-Cost Alternatives to Therapy” for more ideas.