Is Therapy Covered by Insurance?

The Affordable Care Act requires plans offered through the health insurance exchanges to cover services for mental health and substance use disorders. Most health insurance plans cover at least some forms of mental health care, including therapy, but few health insurance plans are not required to provide any mental health benefits. In general, usually only treatments considered “medically necessary” by a mental health provider are covered by insurance.

If you are without health insurance, there are still affordable therapy options available to you. Our team at Mira can help you find low-cost therapists in addition to discounts off your prescriptions and flat fee doctor’s visits. Check out our other benefits today.

Is Therapy Covered by Insurance?

If you have health insurance, it is likely that your policy provides some level of coverage. However, your coverage will depend on the type of insurance you have.

Mental Health Parity Law

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (also known as the mental health parity law or federal parity law) requires insurance companies to charge the same copay for therapy as other medical offices visits. It doesn’t require coverage of mental health services; it prevents insurance companies from inflating the cost of seeing a mental health practitioner. The parity law also eliminated annual mental healthcare coverage limits.

The Mental Health Parity Law applies to Employer-sponsored health insurance plans; coverage purchased through the ACA health insurance exchanges, Children’s Health Insurance Program (CHIP), and most Medicaid programs. Some government plans, including Medicare, are exempt from the parity law. Additionally, some state government employee plans may opt out. However, the ACA doesn’t specify which types of counseling or therapy off-marketplace plans cover or how much of the costs. Many plans have some mental health coverage, but the benefits vary in provider networks, level of coverage, and type of mental health provider.