How Many Therapy Sessions Does Insurance Cover and How to Maximize Benefits

Insurance coverage for therapy sessions varies widely, but most plans cover 20 to 40 sessions per year.

The exact number of sessions covered depends on the insurance provider and the type of plan you have. Some plans may require a copayment or coinsurance for each session.

You can maximize your benefits by understanding your insurance plan's specifics and communicating with your therapist about the coverage.

Insurance coverage for therapy varies depending on your specific plan, but most health insurance plans cover a wide range of mental health treatments, including talk therapy, psychotherapy, and substance abuse treatment.

Many PPO insurance plans require preauthorization for mental health treatment, including virtual IOPs, to ensure that the treatment is medically necessary and aligns with the individual's mental health needs.

Your insurance plan's summary of benefits and coverage document should tell you how much your copayment or coinsurance is for mental health services, so be sure to review it carefully.

Some of the mental health treatments that are most often covered by insurance include co-occurring behavioral health and medical conditions, psychiatric emergency care, and addiction treatment.

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

Keep in mind that coverage specifics can vary depending on the insurance provider and the individual's policy, so it's essential to review your insurance plan's benefits to understand the extent of coverage for mental health services.

If you're unsure about what's covered, you can contact your health insurance company, HR department, or the Centers for Medicare and Medicaid Services for more information.

To maximize your insurance benefits for therapy, start by reviewing your policy to understand the coverage details, including session limits and preauthorization requirements.

You should also communicate with your mental health provider to ensure their treatment plan aligns with the insurance requirements. This will help avoid any unnecessary delays or denials of coverage.

Keep detailed records of your treatment, including session dates and provider communications, to facilitate any necessary claims or appeals with the insurance company.

Employee Assistance Programs, or EAPs, offer immediate, short-term counseling at no cost to the employee. These services are usually separate from standard health insurance benefits, allowing you to access therapy without using your regular health insurance coverage.

The average cost of therapy in 2022 was reported by Bankrate, but understanding your insurance benefits is key to minimizing out-of-pocket expenses.

Mental health providers play a crucial role in helping individuals navigate the complexities of insurance coverage for virtual IOPs. By working collaboratively with their mental health providers, individuals can ensure that their treatment plans are well-documented and aligned with insurance requirements, increasing the likelihood of coverage approval.

You can also call your insurance provider directly to ask about the types of therapeutic coverage your plan offers. Look for the toll-free number on the back of your insurance card, and be sure to ask about out-of-pocket costs.

Preferred Provider Organization (PPO) insurance plans, for example, generally cover a wide range of medical services, including mental health treatment. However, coverage specifics can vary depending on the insurance provider and the individual's policy. It's essential to review your insurance plan's benefits to understand the extent of coverage for mental health services.

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

Mental health providers play a vital role in helping individuals navigate the complexities of insurance coverage for virtual IOPs. They can assist in obtaining preauthorization, documenting medical necessity, and communicating with insurance companies on behalf of their patients.

Providers can help ensure that treatment plans are well-documented and aligned with insurance requirements, increasing the likelihood of coverage approval. This is especially important for individuals seeking virtual mental health IOPs, as session limits and coverage specifics can vary widely based on the insurance provider and plan.

According to Example 3, if you have group health insurance through work, contact your HR department to confirm coverage for mental health services. If you have an ACA marketplace plan, you can find out more about mental health benefits on healthcare.gov.

Mental health providers can also help individuals understand their plan's benefits and coverage for mental health services. For example, a PPO insurance plan may offer a fixed number of sessions per year, while others may provide coverage based on medical necessity (Example 1).

Here are some key roles that mental health providers can play in helping individuals navigate insurance coverage:

By working collaboratively with their mental health providers, individuals can increase the likelihood of coverage approval and access the mental health services they need.

Curative is a top health insurance company that offers access to $0 therapy, connecting you with in-network therapy at zero cost to you.

The company provides a no-hassle approach to mental health care, removing the challenge of searching for a therapist.

Curative gives members access to rapid medication delivery, helping you find an in-network pharmacy and guidance on transferring and filling prescriptions.

Their care team will help you stay on track with your care through one-on-one check-ins, working around your schedule and providing support as frequently or seldom as needed.

Other notable companies that provide similar benefits include Teladoc and Televero, which offer remote therapy options through partnerships with Curative.

Government programs can be a great source of support for mental health treatment, but it's essential to understand what's covered and what's not.

Medicaid assists individuals and families with low-income and limited resources, and coverage for therapy can vary significantly depending on the state, but generally, Medicaid must cover essential health benefits, including mental health services and substance abuse services.

Medicare, primarily serving individuals who are 65 or older, as well as some younger individuals with disabilities, offers mental health coverage through several parts of its program, including inpatient behavioral healthcare, outpatient services, and prescribed medications.

Medicare Part A covers inpatient behavioral healthcare and substance use services, but you may be responsible for deductible and coinsurance costs if you're hospitalized.

Medicare Part B provides coverage for outpatient services, including individual and group therapy sessions, psychiatric evaluations, and preventive services, such as depression screenings.

Medicare Advantage (Part C) covers therapeutic services at least at the level of your original Medicare plan or better.

Medicare Part D includes coverage for prescribed medications that may be necessary alongside therapy.

Talkspace therapy is also covered by Medicare in certain states, with more states being added soon, but Medicare Advantage does not cover Talkspace at this time.

Online therapy is a convenient and private option for those seeking mental health care. Many health plans cover telehealth mental health visits, allowing members to obtain online therapy or over the phone.

Online therapy offers more than just convenience, it's also an incredibly private experience that many people thrive in. Most plans are covering telehealth and online services now, making getting therapy as simple as logging onto a platform or app.

Talkspace is covered by a number of mental healthcare providers and insurance companies, including Cigna, Anthem, Optum, TRICARE, and more. To see if your employer or health plan will cover your therapy, check with your specific insurance provider and plan.

The Covid crisis caused more people to seek therapy online versus in-person. Before the pandemic, insurers typically didn’t cover or promote online therapy, preferring that members visit a behavioral health specialist in person. But that’s changed.

Most insurance providers cover at least some form of telehealth services, including online therapy. If you have Medicare, you can receive telehealth therapy at any location in the country through December 31, 2024, including your home.

Online therapy can be a great option for people who are nervous about getting mental health help, or for those who are busy and lead hectic lives. It's also a good option for those who prefer a more private experience.

Most health insurance plans cover a wide range of mental health services, including therapy sessions.

The average cost of therapy with insurance typically ranges from $20 to $50 per session, depending on your insurance coverage plan.

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

The Mental Health Parity and Addiction Equity Act (MHPAEA) ensures that health insurance plans cover mental health services equally to medical services.

You can check with your insurance provider to see what types of therapy sessions are covered and how much you'll pay out-of-pocket.

Here's a rough estimate of therapy costs with and without insurance:

Keep in mind that these costs can vary depending on your location, therapist's expertise, and insurance plan.