Does Insurance Cover Therapy?
With roughly one-fifth of the U.S. population living with a mental illness, everyone likely knows someone who goes to therapy. Anxiety disorders, for example, affect over 18% of the adult population and over 25% of teens. Treating mental illness just as we do physical illnesses allows us to be fully healthy. And to properly treat mental health issues, whether short-term or long-term, we need to know: does health insurance cover therapy?
Is Therapy Covered By Insurance?
Specific treatments, methods, specialties, and offerings depend on the patient’s insurance plan and provider. So is therapy covered under insurance? Yes, many providers cover therapy. According to the mental health parity law of 2008, the following insurance plans include therapy:
Employer-Sponsored
Companies with over fifty employees are required to offer health insurance which includes mental health services. Employers may provide coverage from large companies, like Anthem Blue Cross Blue Shield, Kaiser Permanente, Cigna, Aetna, or United Healthcare. Many smaller companies offer great coverage as well.
Medicaid
Low-income people are eligible for Medicaid. Each state has different eligibility requirements, but the website makes it easy to apply. Medicaid includes a variety of mental and physical health benefits, such as crisis intervention and psychiatric rehabilitation.
Medicare
Medicare is for people 65 and older. It can also be for those with End-Stage Renal Disease and younger folks with disabilities. There are multiple parts to Medicare. Medicare Part B covers mental health services that do not require hospital visits. Part A covers hospitalization. Both parts include coverage for prescription drugs.
Children’s Health Insurance Program (CHIP)
It is crucial to address children’s mental health needs as they arise. CHIP is designed for families with children whose income is too high to qualify for Medicaid. It can also provide coverage for pregnant women in some states.
Insurance Purchased from a Marketplace Under the Affordable Care Act
This could be a good option for people whose income is too high to qualify for Medicaid or who have adult children in need of coverage. Long-term ACA plans will cover people regardless of pre-existing conditions and will not raise the cost because of it. Plus, coverage will not suddenly run out.
Browse the Marketplace, also called the Exchange, to see which plans are available for different regions and needs. Note that signing onto a new plan through the Marketplace can only be done during open enrollment periods. Certain states have different websites for their health coverage.
Types of Treatment Typically Covered By Insurance
At a minimum, insurance typically covers the following mental health needs:
- Outpatient treatment
- Hospitalization
- Prescribed drugs
- Care in the case of emergencies
Other plans may offer more specific services tailored to specific age groups, state offerings, and other criteria.
Are therapists covered by insurance?
Yes. This includes talk therapy for mental illnesses, including anxiety disorders, the most common mental illness in the United States.
Is counseling covered by insurance?
Yes. However, couples’ counseling might not be covered. Insured patients should check with their providers.
Does health insurance cover a psychiatrist?
Yes. Psychiatrists can offer therapy, refer patients to psychologists and counselors, and prescribe medication.
Note that some nontraditional options, such as hypnotherapy, are not typically covered by insurance. Additionally, personal growth topics and niche methodologies might not be covered by most insurance companies.
Pros and Cons of Using Therapy Covered By Insurance
It may seem like a no-brainer to use therapy covered by insurance. In many cases, it is. But there are both benefits and drawbacks to opting for in-network practices and treatments.
Pros
- Lower costs. Having insurance drastically reduces the copays for therapist visits, which can add up over time. Insured patients may end up paying nothing out of pocket.
- No surprises: insured patients know they are covered, regardless of how often they use it or how severe their mental health condition is.
- Using therapy covered by insurance requires less research for the patient: just go to the most convenient in-network therapist.
If money is no object, asking “does insurance cover therapy?” might not matter. Here are a few more reasons why insurance should not dictate the choice of therapist:
Cons
- Sometimes, if a desired type of therapy or a specific therapist is out of network, it may be worth it not to use insurance.
- It will go on a patient’s insurance record that they require therapy. To avoid being classified as having a pre-existing condition, paying out of pocket may be a better option.
- If the in-network options do not work with a patient’s schedule, going out of network may offer more convenient options.
How Do I Know If My Insurance Covers Therapy?
When you’re asking, “Does my insurance cover therapy,” you want a quick and clear answer. If it is still unclear if your therapist takes your insurance, here are some actions to take:
- Ask your insurance provider in person or via phone call or contact form. The answer may also be on their website.
- Ask the therapist’s practice in person, over the phone, or via email. The answer may also be on their website.
Eden Health members can receive answers to questions regarding insurance coverage by speaking with a Healthcare Navigator over the app.
Does Insurance Cover Therapy? The Bottom Line
Eden Health is here to help when your employees need a therapist for their mental health needs. Our team of licensed therapists can address a variety of mental health needs, from general anxiety to grief counseling and more. Our clinicians also screen for mental health issues at each primary care doctor visit.
Eden Health works with many insurance providers to get companies the best physical and mental employee health services for their valued team members. As a direct-to-employer medical provider, we offer a new, collaborative approach to employee health. Plus, we can integrate with any medical or insurance plan, making it easy for you to provide your employees with the quality health care they deserve.
Want to see how our collaborative care model works to address the physical and mental health needs of your employees? Request a demo with a member of our team today.
