Are Health Plans Required to Cover Therapy?
Yes. Under the ACA and the Mental Health Parity and Addiction Equity Act (MHPAEA), health
insurance plans that cover mental health services must do so at parity with physical health
services. For most ACA-compliant plans, mental health and substance use disorder treatment
is one of the ten essential health benefits that must be included.
This means your plan must cover outpatient therapy, inpatient psychiatric care, and substance
use disorder treatment — and cannot impose stricter limits on mental health visits than
it does on comparable medical/surgical visits.
What Does Therapy Actually Cost With Insurance?
Your out-of-pocket cost for therapy depends on three things: whether your therapist is
in-network, whether you have met your deductible, and your plan’s copay or coinsurance
for outpatient mental health visits.
- In-network, after deductible met: A copay of $20–$60 per session
is typical for most plans.
- In-network, before deductible met: You pay the contracted rate for the
session until your deductible is satisfied. This can run $80–$150 per session at
in-network rates for a standard 45–53 minute session.
- Out-of-network: Much higher — therapists often charge $150–$300
per session, and out-of-network reimbursement from your plan may be minimal or nonexistent
on HMO and EPO plans.
The Therapist Network Problem
The biggest practical challenge with mental health coverage is finding an in-network therapist
who is accepting new patients. Mental health provider networks are often narrower than medical
networks, and many therapists choose not to accept insurance at all due to administrative burden
and low reimbursement rates. This creates “ghost networks” — lists of providers
who are listed as in-network but are not actually available.
Before selecting a plan based on mental health coverage, call 3–5 therapists listed
in the plan’s directory to verify they are in-network and accepting new patients.
Platforms like Psychology Today (psychologytoday.com) and Headway allow you to filter by
insurance accepted.
Telehealth Therapy and Insurance Coverage
Telehealth mental health services saw a major expansion during and after the COVID-19 pandemic.
Most ACA plans now cover telehealth therapy at the same cost-sharing as in-person visits.
Platforms like Teladoc, MDLive, and Talkspace contract with many major insurance carriers.
This has significantly expanded the effective network of available therapists, especially in
rural areas where in-person options are limited.
Frequently Asked Questions
Does health insurance cover therapy?
Yes. ACA-compliant plans are required to cover mental health services including outpatient
therapy, at parity with physical health benefits.
How many therapy sessions does insurance cover?
Under parity rules, insurers cannot impose visit limits on mental health services that are
stricter than those for comparable medical services. Most plans do not impose a hard session
limit, though prior authorization may be required for extended treatment.
What if I can't find an in-network therapist?
Ask your insurer for a Single Case Agreement to see an out-of-network provider at in-network
rates. You can also request that your insurer help you find an in-network provider through their
care management line. Some states have laws strengthening network adequacy requirements for
mental health.
Does insurance cover online therapy apps like BetterHelp?
Generally no. BetterHelp and similar direct-to-consumer platforms are not typically covered
by insurance. However, many insurers cover telehealth therapy through contracted platforms
like Teladoc, MDLive, and Talkspace.