Does State Insurance Cover Therapy and Other Mental Health Services

Most state insurance plans cover some form of therapy and mental health services, but the specifics can vary greatly.

Some states require insurance companies to cover a minimum number of therapy sessions per year, while others may not have such requirements.

Many states also have laws that mandate coverage for certain types of therapy, such as marriage counseling or family therapy.

In some cases, state insurance plans may cover alternative forms of therapy, like art or music therapy.

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If you're wondering whether state insurance covers therapy, understanding your insurance coverage is key.

Many health insurance plans, including employer-sponsored group plans and ACA health insurance marketplace plans, provide coverage for mental and behavioral health therapy, services, and medications.

Your plan's summary of benefits and coverage document can help you determine what's covered and how much you'll pay. You can usually find this document online or by contacting your insurance company.

Contact your HR department if you have group health insurance through work. They can provide more information about your plan's mental health benefits.

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If you have an ACA marketplace plan, you can find out more about mental health benefits on healthcare.gov.

In general, mental health insurance typically includes coverage for emergency psychiatric care, inpatient hospitalization, medications, partial hospitalization, psychotherapy, and substance abuse treatment.

However, health plans may not cover every type of mental health service, including addiction or mental health treatment deemed medically unnecessary, educational programs, experimental therapies, genetic testing for psychotropic medication, halfway houses, long-term mental health or addiction treatment, and treatment requested by a third party.

Here are some types of mental health services that are typically covered by health insurance:

And here are some types of mental health services that may not be covered:

There are various types of mental health care providers, each with their own area of expertise. A licensed professional counselor, like Dr. Carl Nassar, can provide mental health therapy, but may not be able to prescribe medication.

A therapist is a broad term for a clinician who treats mental health concerns, and typically involves an advanced degree, training, and licensure. Psychologists have a doctoral degree in clinical psychology or another specialty, and are trained to evaluate a person's mental health using clinical interviews, psychological evaluations, and testing.

A psychiatrist, on the other hand, is a licensed medical doctor who has completed psychiatric training, and can diagnose mental health conditions, prescribe and monitor medications, and provide therapy.

Here are some of the different types of mental health providers and their specializations:

Mental health insurance typically includes coverage for emergency psychiatric care, also known as crisis intervention, which may extend to overdose treatment.

Inpatient hospitalization is also covered, involving more intensive mental health treatment within a hospital or facility, with patients receiving continuous support through individual and group therapy, medication management, and coping strategies.

Medications are usually covered for mental health disorders, as are partial hospitalization programs, which are less intensive alternatives to full inpatient care.

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Psychotherapy, including various therapeutic approaches such as general counseling, cognitive behavioral therapy, and dialectical behavioral therapy, is typically covered by insurance.

Substance abuse treatment, addressing drug and alcohol addiction through specific protocols, is also covered, including talk therapy, medication management, 12-step programs, or medical detox.

Here are some typical covered treatments:

Mental health care encompasses a wide range of services and providers, each with their own unique approach and qualifications.

Counselors specialize in specific areas, such as marriage, addiction, or grief, and tend to focus on shorter-term, goal-oriented treatment.

Therapists are a broad term for clinicians who treat mental health concerns, requiring an advanced degree, training, and licensure.

Psychologists have a doctoral degree in clinical psychology or another specialty and are trained to evaluate mental health using clinical interviews and psychological evaluations.

Psychiatrists are licensed medical doctors who have completed psychiatric training and can diagnose mental health conditions, prescribe medications, and provide therapy.

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If you're unsure about which type of provider to choose, consider your specific mental health concern or condition, as some providers specialize in certain areas.

Some mental health providers are not licensed to prescribe medicines, so you may need to see more than one provider to get comprehensive care.

Here's a breakdown of the types of mental health providers and their qualifications:

The cost of therapy can be a major concern, especially if you're not sure if your state insurance covers it.

Therapy costs an average of $21 for a copay for in-network care and $60 for out-of-network care.

Having health insurance can significantly reduce your out-of-pocket costs, with many plans covering mental health services.

If you don't have health insurance, you can expect to pay between $75 to $135 or more for a talk therapy visit.

Many therapists don't accept health insurance and can charge upward of $200 per session, so it's essential to check beforehand.

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You may be eligible for no-cost Medicaid coverage or subsidized coverage through the ACA marketplace based on your income.

In Florida, individual therapy sessions with a licensed therapist or psychologist average between $100 to $200 per hour.

Treatment with psychiatrists typically ranges from $150 to $300 per hour, and inpatient psychiatric treatment averages between $1,000 to $2,000 per day or more.

It's worth noting that some health plans come with a health insurance deductible, which you must pay before mental health coverage kicks in.

Health First Colorado, Colorado's Medicaid program, covers behavioral health services, including mental health and substance use disorder care, for all its members.

Most health insurance plans, including employer-sponsored group plans and ACA health insurance marketplace plans, provide coverage for mental and behavioral health therapy, services, and medications, as long as the treatment is considered medically necessary.

You can confirm that your insurance covers therapy by contacting your health insurance company and requesting a copy of your summary of benefits and coverage document.

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A wide range of mental health-related treatments, such as psychotherapy, are covered by health insurance plans, but only if the therapy provider can diagnose the condition and document the medical necessity of the treatment.

Health insurance plans may not cover every type of mental health service, though. You may be denied coverage for addiction or mental health treatment deemed medically unnecessary, educational programs, experimental therapies, genetic testing for psychotropic medication, halfway houses, long-term mental health or addiction treatment, or treatment requested by a third party.

Here are some examples of medically necessary treatments likely covered by your insurance plan:

If you have group health insurance through work, contact your HR department to confirm your coverage. If you have an ACA marketplace plan, you can find out more about mental health benefits on healthcare.gov. If you're on Medicare, get more details on mental health coverage from the Centers for Medicare and Medicaid Services. If you're on Medicaid, learn more about behavioral health benefits on the Medicaid and CHIP Payment and Access Commission.

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Insurance providers have made a significant shift in covering online therapy. Almost two-thirds of all telehealth appointments in the fourth quarter of 2022 were for behavioral health.

Many health plans now cover telehealth mental health visits, allowing members to access online therapy or over the phone. This change is largely due to the Covid crisis, which caused more people to seek therapy online.

You can receive telehealth therapy at any location in the country through December 31, 2024, if you have Medicare, including your home.

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Online support can be a great option, especially if you prefer the comfort of your own space or have a busy schedule.

Many health plans cover telehealth mental health visits, so you can obtain online therapy or over the phone. This has become more common since the pandemic, and now almost two-thirds of all telehealth appointments in the fourth quarter of 2022 were for behavioral health.

Some online therapy platforms, like Talkspace, accept insurance from various providers, including Aetna, Cigna, and Optum. This can help make online therapy more affordable, with many members paying less than $30 for copays.

Online therapy can be a convenient option, but it's essential to choose a provider that fits your needs. For example, if you have a severe mental health concern, you may need to see a provider with more expertise and training.

The federal Health and Human Services says most insurance providers cover at least some form of telehealth services, including online therapy. This means you can receive telehealth therapy at any location in the country, including your home, through December 31, 2024.

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Health insurance plans typically don't cover couples therapy because relationship issues aren't considered a mental health disorder.

If you're in a relationship and struggling, consider talking to your employer about an Employee Assistance Program, which may cover couples counseling.

Insurance coverage for couples sessions might be available if there are underlying health issues or mental disorders like depression, anxiety, or adjustment disorder.

You might need to have a diagnosis before insurance will cover couples therapy.

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Most state insurance plans cover some form of mental health services, but the specifics vary depending on the state and type of plan.

You'll need to check your policy to see what's covered and what's not.

In general, state insurance plans cover therapy sessions with licensed therapists, but the number of sessions and frequency may be limited.

Some states, like California, offer more comprehensive coverage for mental health services, including therapy sessions and medication management.

You may need to pay out-of-pocket for services not covered by your plan.

Some state insurance plans may also have a waiting period before you can start receiving therapy services.

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Curative offers a comprehensive healthcare plan that prioritizes providing patients with access to healthcare, not just cost.

Their health plan delivers better health through affordability, engagement, and simplicity.

You can access $0 therapy with Curative, which can be a challenge to find on your own.

Their pharmacy services allow for rapid medication delivery and can help you find an in-network pharmacy.

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The care team at Curative will help you stay on track with your care through one-on-one check-ins that work around your schedule.

Florida members can also tap into remote therapy through their partnership with Teladoc, which is hassle-free to schedule and get connected to a therapist within a week.

If you're in a critical situation or experiencing a mental health crisis, you can call 988 for immediate support.

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