Is therapy covered by insurance? How to find out and save on care

You’re ready to start therapy, but then the questions hit: Will my insurance actually cover this? How much will I end up paying? What if I get stuck with a massive bill I wasn’t expecting?

These concerns are completely valid. Health insurance can feel like it was designed to be as confusing as possible, with all the terms like deductibles, copays, and coinsurance that are often used without much explanation.

The good news: Therapy is covered by insurance more often than you might think. But the details matter—a lot. Let’s break down exactly how insurance works with therapy so you can get clear answers upfront and go into your first session focused on getting better, not worrying about costs.

Does Insurance Cover Therapy?

In most cases, yes, insurance covers therapy. Federal law requires all insurance plans to include mental health benefits, but coverage details vary significantly by plan.

The Affordable Care Act (ACA) and the Mental Health Parity and Addiction Equity Act require insurance companies to treat mental healthcare the same way they treat any other medical specialty. When it’s medically necessary to see a cardiologist, insurance covers it. The same goes for therapy: When a therapist determines it’s medically necessary, insurance must cover treatment.

“A common misconception is that therapy is expensive or not covered by insurance,” says Charity Minerva, vice president of strategy at Thriveworks. “The reality is that every insurance plan backed by the ACA includes mental health benefits.”

That said, how much insurance covers varies significantly. Most plans require you to pay some costs out-of-pocket, depending on the type of therapy, your provider, and your specific policy details.

What Types of Therapy Are Covered by Insurance?

The type of therapy you need affects your coverage, so it’s worth understanding what’s typically included. Generally speaking, most insurance plans cover individual therapy and psychiatric services, as well as some couples and family therapy options. This applies whether sessions are virtual or in-person.

Here’s how coverage typically works for different types of therapy:

Individual Therapy

Individual therapy must be covered under federal law when deemed medically necessary. “As long as you have something you’re working on that meets medical necessity, it should be covered,” says Amy Pearlman, MSW, LICSW, senior vice president of clinical strategy at Thriveworks. “It could be something related to your depression, anxiety, or increasing your coping skills.”

Family and Couples Counseling

This gets trickier. Family and couples counseling is covered by many government-funded programs like Medicare and Veterans Affairs when medically necessary. Some private insurance plans follow suit, covering these sessions when they’re tied to treating an individual’s diagnosed mental health condition.

However this isn’t universal. Before booking family or couples counseling, check whether your plan considers these sessions medically necessary.

Telehealth and Online Therapy

Good news here: Various clinical studies show that online therapy is as effective as in-person sessions. As a result, insurance companies typically cover telehealth and in-person sessions the same way, as long as services are provided by a licensed mental health professional.

Psychiatric Services

“Psychiatric services, such as medication management and periodic check-ins with the prescribing provider, are typically included in mental health benefits, just like therapy sessions,” Minerva says.

Pearlman adds an important caveat: While medication management services are usually covered, most insurance companies won’t cover talk therapy with a psychiatrist. This means if you want both medication and talk therapy, you’ll likely need to see a psychiatric provider for medication management and a separate therapist for counseling sessions.

What Your Insurance Plan Typically Requires

Understanding these key components of your policy will help you avoid surprises:

In-Network vs. Out-of-Network Providers

In-network providers have contracts with your insurance company, making billing smoother and your costs lower. Insurance plans usually pay a much higher portion when you see an in-network provider.

Out-of-network providers don’t have contracts with your insurer. This means higher out-of-pocket costs for you, or you might need to pay upfront and file for partial reimbursement later. Some plans don’t cover out-of-network therapy at all.

Copays and Coinsurance

Most plans require a copay—a set fee, often between $20 to $50, for each therapy visit. Others require coinsurance instead, where you pay a percentage of the appointment cost.

Here’s how this plays out: Say two people are considering the same therapist who charges $400 per session. If one person has a $30 copay, they pay $30 per visit. If the other has 20% coinsurance, they pay $80 (20% of $400) per visit.

Deductibles

Depending on your plan, insurance might not pay anything until you’ve reached your deductible, a set amount you must pay out-of-pocket before insurance kicks in for certain services.

This is becoming more important to watch. “High-deductible health plans (HDHPs) are becoming more common,” Minerva says. “While these plans often offer lower monthly premiums, they require individuals to pay 100% out of pocket for care until the deductible is met, which can make accessing therapy or medical services difficult.”

Session Limits

Some plans cap the number of therapy sessions covered annually—like 20 sessions per year. Knowing any limits helps you and your therapist plan treatment appropriately. 

If you exceed the session limit, you can continue therapy, but you’ll be responsible for additional out-of-pocket costs until your benefits reset the following year.

Referrals

“Many commercial insurance plans do not require a referral for mental health care,” Minerva says. “You can typically visit a therapist for an evaluation without your primary care provider’s recommendation.”

Some plans—like HMOs (where you have a primary care doctor who coordinates your care) and government-funded plans like Tricare or the Community Care Network (CCN)—do require a referral from your primary care provider. When in doubt, call your insurance company to double-check—it’ll save you from any surprise delays down the road.

How to Find Out if Your Insurance Covers Therapy

With so many variables at play, it’s normal to feel confused about your specific coverage. Pearlman recommends starting by asking your potential therapy provider two simple questions:

1. Are you in network with my insurance plan?
2. Can you verify that for me before we work together?

If a therapist can’t verify your coverage, your next step is calling your insurance company directly. “It is almost always better to call a human being at insurance companies instead of looking on their website,” Pearlman advises.

Call the number on the back of your insurance card, and then follow these steps to make the call productive:

Step 1: Provide information to verify you’re the policyholder.

Step 2: Ask these specific questions:

• Is mental health coverage included in my plan?
• Is a referral required?
• What would my out-of-pocket costs be for therapy?
• If my plan has a deductible, does that need to be met before therapy coverage kicks in?

Alternatively, you can work with a therapy provider who helps clients navigate insurance. At Thriveworks, for example, you can call or visit our website, provide your insurance information, and we’ll explain your coverage details and identify in-network providers.

What to Do if Your Insurance Doesn’t Fully Cover Therapy

If you discover your insurance doesn’t fully cover therapy—or only covers part of it—here are three ways to make counseling more affordable:

1. Use HSA or FSA funds.

Health Spending Accounts (HSA) and Flexible Spending Accounts (FSA) let you set aside pre-tax money for healthcare costs. Since these accounts reduce your taxable income, they effectively make any out-of-pocket therapy costs less expensive.

2. Ask about sliding scales or reduced rates.

Some providers offer sliding scale fees or payment plans for self-paying clients. Pearlman recommends looking at larger providers rather than smaller practices for these options. “Smaller practices often cannot afford a reduced rate or payment plan, while bigger places can better manage any lost or delayed income.”

3. Check your employee assistance program.

Your employer might offer free mental health support through an employee assistance program (EAP), which is separate from your regular insurance. “EAPs typically require a referral and include a set number of free therapy sessions with a licensed provider,” Minerva says.

Check with your HR department to see if you have an EAP and how to access it. Just remember to tell your provider you’re using EAP benefits “so they don’t bill your regular insurance by mistake,” Minerva adds.

How Thriveworks Can Help

Insurance questions shouldn’t stand between you and getting help. At Thriveworks, we eliminate the guesswork by verifying your benefits and explaining your costs before you start. We’re in-network with more than 155 insurance providers, so there’s a good chance we can work with your plan—about nine out of ten of our clients used insurance for their sessions in the last six months.

If you want to learn more or have questions about how to get started, contact us at (855) 204-2767. We’re here to help!

Frequently Asked Questions

1. How many therapy sessions does insurance typically cover?

It varies significantly by plan. Most insurance plans cover therapy when medically necessary. Some plans may cap annual sessions at the lower end (20 sessions), while others allow up to 60 sessions or more. The exact number depends entirely on your specific plan.

2. Does insurance cover therapy without a mental health diagnosis?

Usually, yes—but a diagnosis may be required during treatment. For insurance to cover therapy, treatment must be deemed medically necessary. During your initial appointment, a therapist can assess whether treatment falls within this category and provide a diagnosis if appropriate. This initial evaluation is usually covered by insurance regardless.

3. Will insurance cover therapy for grief or loss?

Yes, insurance typically covers grief counseling. Under the Mental Health Parity and Addiction Equity Act, insurance companies must offer behavioral health coverage, which includes treating the emotional and behavioral impacts of grief and loss.