Does Health Insurance Cover Therapy? How to Know What’s Included in Your Plan

Finding a therapist you trust is a big step. The next question many people have is just as important: does health insurance cover a therapist, and if so, how much?

In many cases, yes — health insurance does cover therapy and other mental health services. But the details can be confusing and vary widely based on your plan, where you live, and the type of therapist you see.

This guide walks you through how mental health coverage usually works, what to look for in your policy, and practical steps to use your insurance for therapy with fewer surprises.

Does Health Insurance Cover a Therapist?

Most modern health insurance plans include some level of mental health coverage, often referred to as behavioral health or mental health and substance use services.

However:

• Coverage is not unlimited
• You may have out-of-pocket costs like copays, coinsurance, or deductibles
• Some therapists do not accept insurance or may be “out of network”
• Your plan may have rules (like requiring pre-authorization)

So the more accurate question is:
“How does my specific health insurance cover therapy?”
Let’s break down what typically matters.

Common Types of Plans and How They Cover Therapy

Employer Plans and Marketplace Plans

Most employer-sponsored and Affordable Care Act (ACA) marketplace plans:

• Treat mental health care as an essential benefit
• Generally cover therapy similarly to medical visits
• Often include both in-person and virtual therapy options

Coverage can include:

• Individual therapy
• Couples or family therapy (sometimes with conditions)
• Group therapy
• Psychiatric evaluations and medication management

Medicaid

In many states, Medicaid includes mental health benefits, which can cover:

• Therapy sessions
• Case management
• Psychiatric services

Coverage, session limits, and which providers you can see depend on your state’s Medicaid program and whether it uses managed care plans.

Medicare

Medicare generally covers:

• Therapy with certain types of mental health professionals
• Psychiatric evaluations
• Medication management

Parts B and C (Advantage Plans) handle coverage differently, so you’ll want to check:

• Which providers are covered (and whether they accept Medicare)
• What you pay in copays, coinsurance, or deductibles

Which Types of Therapists Are Usually Covered?

Insurance plans often cover therapy when it’s provided by licensed mental health professionals. These can include:

• Psychiatrists (MD or DO) – medical doctors who can prescribe medication
• Psychologists (PhD or PsyD)
• Licensed Clinical Social Workers (LCSW / LICSW)
• Licensed Professional Counselors (LPC / LPCC / LCPC)
• Marriage and Family Therapists (LMFT)

Plans may specify which license types are eligible for reimbursement.

Some common issues that people seek therapy for — such as anxiety, depression, stress, or relationship struggles — are typically within the scope of covered mental health treatment, but coverage depends on:

• The diagnosis code the provider uses
• Whether the service is considered medically necessary by the plan

In-Network vs. Out-of-Network Mental Health Coverage

A major factor in how much you pay is whether the therapist is:

• In-network: Has a contract with your insurance plan
• Out-of-network: Does not have a contract with your plan

In-Network Therapy

With in-network therapists, you usually:

• Pay a fixed copay (for example, $20–$50 per session)
  or
• Pay coinsurance (a percentage of the session cost) after meeting your deductible

Plans often make in-network providers easier to find through:

• Online directories
• Customer service support lines

Out-of-Network Therapy

Out-of-network coverage depends heavily on your plan type:

• Some plans do not cover out-of-network therapy at all (you pay full cost)
• Some offer partial reimbursement after a higher deductible is met
• You may have to pay upfront and request reimbursement with “superbills”

If you want to see a specific therapist who’s out of network, it’s important to:

1. Ask your therapist whether they can provide superbills
2. Ask your insurer what your out-of-network mental health benefits are
3. Confirm your deductible and reimbursement rates

What Mental Health Services Are Usually Covered?

While exact coverage varies, many health insurance plans include:

1. Individual Talk Therapy

This is the most common type of coverage and may include:

• Cognitive behavioral therapy (CBT)
• Psychodynamic therapy
• Other evidence-based talk therapies

2. Family or Couples Therapy

Coverage may:

• Be limited to when there is a diagnosed mental health condition
• Require that the session is focused on one covered individual’s treatment

3. Group Therapy

Often covered when:

• The group is led by a licensed professional
• The group is focused on a specific mental health condition or need

4. Psychiatric Care

Many plans cover:

• Initial psychiatric evaluations
• Follow-up appointments for medication management

5. Online / Telehealth Therapy

Many plans today include:

• Video therapy sessions
• Sometimes phone sessions, depending on policy rules

Coverage for telehealth can mirror in-person benefits, but not always. It’s worth confirming:

• Whether telehealth is covered
• Whether the same copay/coinsurance applies

When Therapy Might Not Be Covered (or Only Partially Covered)

There are some situations where insurance may limit or deny coverage, such as:

• Non-licensed providers (e.g., some coaches, unlicensed counselors)
• Therapy without a diagnosable condition, depending on the plan
• Certain types of specialized services, like:
  • Life coaching
  • Career counseling
  • Some forms of couples counseling when no covered diagnosis is involved
• Missed appointments or late cancellations (often not covered)
• Therapy for non-medical personal development (e.g., growth coaching)

Some plans also:

• Limit the number of sessions per year
• Require treatment reviews to continue coverage

Costs to Expect: Copays, Deductibles, and Coinsurance

Even when your health insurance covers therapy, you’ll often share the cost. The main pieces are:

• Deductible: What you pay out of pocket each year before your plan starts paying more
• Copay: A set amount you pay for each therapy session
• Coinsurance: A percentage of the session fee you pay (for example, 20%) after the deductible

Example: How Costs Might Work

💡 Tip: Sometimes mental health visits are subject to the same deductible as medical care; sometimes they have different rules. Checking your Summary of Benefits and Coverage can clarify this.

Pre-Authorizations, Referrals, and “Medical Necessity”

Some plans set conditions before covering therapy:

Pre-Authorization

Your plan may require:

• Approval before starting therapy
• A treatment plan from your therapist
• Periodic updates to continue coverage

Referrals

Certain plan types (especially HMOs) may require:

• A referral from your primary care provider to see a therapist or psychiatrist

Medical Necessity

Insurers often only pay for services they deem “medically necessary.” This usually means:

• There is a recognized mental health condition or concern
• Therapy is considered helpful and appropriate for that condition
• The type, frequency, and duration of therapy match accepted standards

If coverage is denied, you typically have the right to:

• Ask for an explanation in writing
• Appeal the decision
• Provide additional documentation from your provider

How to Check If Your Insurance Covers Therapy (Step-by-Step)

Here’s a practical way to find clear answers about your own plan:

1. Review Your Insurance Documents

Look for terms like:

• “Mental health”
• “Behavioral health”
• “Substance use services”
• “Outpatient services”
• “Telehealth”

Pay attention to:

• Whether coverage is in-network only, or includes out-of-network
• Copay or coinsurance amounts
• Any session limits or maximums

2. Call the Customer Service Number

Call the member services number on your insurance card and ask:

1. Do I have coverage for outpatient mental health therapy?
2. What is my copay or coinsurance for in-network therapy?
3. Do I need a referral or pre-authorization?
4. What are my out-of-network benefits, if any?
5. Are telehealth sessions covered the same way as in-person visits?

Have a pen and your member ID handy, and write down:

• The date of the call
• The representative’s first name
• The details they share, in your own words

3. Ask Your Therapist’s Office

When you contact a therapist, you can ask:

• Do you accept my insurance plan?
• Are you in-network for my specific plan?
• Can you verify my benefits before I start?
• What would I pay per session with my insurance?

Some offices will:

• Check your benefits for you
• Explain your expected costs
• Help you navigate authorizations

What If You Don’t Have Insurance, or Your Plan Won’t Cover Therapy?

If your health insurance doesn’t cover therapy the way you’d hoped, there are other routes people commonly explore:

• Sliding scale therapists: Some licensed therapists adjust fees based on income
• Community mental health centers: Often provide lower-cost or subsidized care
• University training clinics: Supervised graduate student therapists at reduced fees
• Employer assistance programs (EAPs): Sometimes offer a limited number of short-term counseling sessions at no cost
• Non-profit organizations: Some offer free or low-cost support groups or counseling services

These options work outside of traditional insurance billing, so costs and eligibility can vary.

Key Takeaways: Does Health Insurance Cover a Therapist?

To summarize the most important points:

• Many health insurance plans do cover therapy, especially employer, marketplace, Medicaid, and Medicare plans.
• Coverage usually includes licensed mental health professionals and can extend to individual, family, group, and online therapy.
• Your actual cost depends on:
  • Whether the therapist is in-network or out-of-network
  • Your plan’s deductible, copays, and coinsurance
  • Any referral or pre-authorization requirements
• Some services — like coaching, non-licensed providers, or sessions not tied to a diagnosable condition — may not be covered.
• The most reliable way to know what’s covered is to review your plan documents and call your insurer, then confirm details with the therapist’s office.

Understanding how your health insurance covers therapy can make it easier to choose a provider, plan for costs, and get support with more confidence and fewer surprises.