Is therapy covered by insurance? Yes, very often it is.
In this blog, we want to help you decode complicated insurance terminology to make sure it’s not a barrier to seeking therapy or treatment, even if you have health insurance coverage.
If you’re new to using health insurance, questions like “What’s your co-pay?” or “Have you met your deductible?” can feel especially confusing. You may already be navigating anxiety, depression, ADHD, or a major life transition. Trying to understand insurance jargon can add another layer of frustration.
The good news: You don’t need to become a health insurance expert to understand the most important, basic information about your mental health insurance benefits. Keep reading to learn how co-pays and deductibles work and get tips on what questions to ask before scheduling your first therapy appointment.
What Is a Therapy Co-Pay?
A co-pay, or co-payment, is a fixed amount you pay for a covered healthcare service. When a therapy visit has a co-pay, you generally pay that set amount for each session, often at the time of your appointment.
For example, your health plan may require a $25 mental health co-pay for each therapy session. If the service is covered under your plan, you would typically owe $25, while your insurance pays the rest directly to the practice or the therapist you saw.
Co-pays vary from one health plan to another. Having a co-pay listed on your insurance card does not necessarily tell you everything about your therapy insurance coverage, so it’s a good idea to contact your insurer to confirm a few details before scheduling your first appointment. (More on that below.)
What Is a Therapy Deductible?
Unlike a co-pay – which is a set amount (usually small) that you pay each visit – a deductible is an annual threshold. A health insurance deductible is the total amount of healthcare-related costs that you pay out-of-pocket before your insurance kicks in.
For example, if your plan has a $2,500 deductible, you must pay out of pocket until you have reached $2,500 in eligible expenses. After that, your insurance plan covers expenses moving forward.
Deductibles are usually annual, meaning they reset at the start of a new coverage year.
Many people schedule their more expensive healthcare services around their deductible reset date in one of two ways:
If they’ve already met their deductible, most people make sure to schedule expensive appointments before it resets.
Conversely, some who haven’t met their deductible near year-end will elect to wait until shortly after the reset date to schedule expensive services. That way, they proactively meet their new deductible as early as possible, so the remainder of the coming year is already covered.
A specific therapy deductible may apply to behavioral health services, but this varies by plan. Additionally, some plans may have separate rules for office visits or behavioral health care.
Meeting your deductible does not mean therapy becomes free from that point forward. You may still have a co-pay or coinsurance responsibility even after meeting your deductible.
Did you know?
Building Resilience Counseling Services accepts health insurance for mental health therapy for clients in North Carolina. Forms of payment include private pay (if you don’t have insurance or don’t want to use your health insurance), Aetna, Cigna, Blue Cross Blue Shield, Humana, MedCost, Medicare Part B, UMR, and United Healthcare. We also accept payment via a Flexible Savings Account (FSA) and Health Savings Account (HSA).
Quick Recap: What’s the Difference Between a Therapy Co-Pay and a Deductible?
The easiest way to understand the therapy co-pay vs deductible question is to think of a deductible as a yearly threshold and a co-pay as a set amount you may pay for an individual visit.
Here’s a simplified example:
In January: A new insurance year begins, and you have not met your deductible. If your plan applies the deductible to therapy, you may be responsible for covered therapy services until your out-of-pocket costs reach or go over the deductible.
Later in the year: Hypothetically, you’ve had doctor visits, lab work, exams, and perhaps several therapy sessions, and you have met your deductible. Your insurance begins paying a larger share of covered costs.
Don’t forget the co-pay: Even though you met your deductible, you may still owe a fixed co-pay for each therapy appointment. Additionally, you may owe coinsurance, which is a percentage of the covered cost. (We touch on coinsurance in the terms section below.)
Your actual expenses will depend on the details of your plan. This is why the out-of-pocket cost of therapy with insurance can sometimes vary during the year, depending on details like deductibles and coinsurance.
Other Mental Health Insurance Terms to Know
When you’re using insurance for therapy, you may come across a few other terms:
In-network provider: A therapist who has a contract with your insurance company. Using an in-network provider often means lower out-of-pocket costs.
Out-of-network provider: A therapist who does not have a contract with your insurance company. Your plan may still provide coverage, but different reimbursement and cost-sharing rules may apply.
Coinsurance: The percentage of a covered healthcare cost that you are responsible for paying after applicable requirements, such as a deductible, have been met.
Out-of-pocket maximum: The maximum amount you generally pay during a plan year before the plan pays 100% of covered costs.
Familiarizing yourself with these terms can help you better understand your behavioral health insurance benefits and can help you determine whether therapy is covered by insurance under your specific plan.
READ NEXT: Does My Insurance Cover Therapy?
Questions To Ask Your Insurer Before Starting Therapy
Before your first appointment, consider calling the number on your insurance card and asking:
Is this therapist in-network?
What is my mental health co-pay?
Does therapy apply to my deductible?
How much of my deductible have I already met?
Are telehealth appointments covered?
Do I need a referral or authorization?
Is there a limit on the number of covered therapy sessions?
You can also ask whether your plan has separate behavioral health benefits and whether there are any exclusions or requirements you should know about.
Many health plans include mental health or behavioral health services, but the details of coverage, cost-sharing, and eligibility can vary.
Don’t Let Questions About Insurance Keep You From Getting Support
Confusing insurance terms can feel overwhelming when you’re trying to find support. Taking a few minutes to understand your benefits can help reduce unexpected expenses and smooth the process of using insurance for therapy.
Building Resilience Counseling Services provides support for anxiety, ADHD, burnout, life transitions, and other challenges that can affect your emotional well-being. We believe that understanding the practical side of seeking care, like insurance, can make the first step a little easier.
If you’re ready to explore therapy, please feel welcome to contact us to schedule a free consultation and learn more about how we can support you.
Schedule your free consultation here.
Building Resilience Counseling Services accepts health insurance for mental health therapy for clients in North Carolina. Forms of payment include private pay (if you don’t have insurance or don’t want to use your health insurance), Aetna, Cigna, Blue Cross Blue Shield, Humana, MedCost, Medicare Part B, UMR, and United Healthcare. We also accept payment via a Flexible Savings Account (FSA) and Health Savings Account (HSA).
Interested in learning more? Sign up for a free 15-minute consultation here.