Healthy Living with Dr. Hall: Decoding Mental Health Benefits

Do Most Insurance Plans Cover Therapy? Yes — most do. Since 2008, federal law has required that mental health care be covered just like physical health care. That means your insurance can’t charge more for therapy visits or limit how many times you can see a mental health provider each year. However, that doesn’t mean the system always works perfectly.

Many insurance companies pay therapists very low rates, which is why a lot of providers don’t accept insurance. And when you check your insurance company’s “network,” you might find that many of the therapists listed aren’t taking new patients. The good news: new rules passed in 2024 aim to make networks larger and easier to use in the coming years.

Common Insurance Terms (Made Simple)

Understanding these will help you read your plan and know what to expect:

• Co-pay: A set fee you pay each time you visit your therapist — for example, $30 per session.
• Co-insurance: Instead of a flat fee, you pay a percentage of the cost (like 20% or 30%).
• Deductible: The amount you must pay out of pocket each year before your insurance starts covering costs.
• Out-of-pocket maximum: The total amount you’ll spend in a year before your insurance covers 100% of your care.

When reviewing your plan, look for sections labeled “Outpatient Mental Health” or “Behavioral Health.” That’s where you’ll find details about what’s covered and what you’ll pay.

In-Network vs. Out-of-Network

Using an in-network therapist usually means lower costs because those providers have contracts with your insurance company. If you see an out-of-network therapist, your insurance may only cover part of the cost — or none at all. If you’re unsure, call the number on your insurance card and ask:

• “Is this provider in network?”
• “How much will I owe per session?”
• “Do I need pre-authorization?”

Should You Find a Therapist or Choose a Plan First?

It depends on your priorities. If keeping costs low is your main goal, start by picking an insurance plan with good mental health coverage and then find a therapist who takes that insurance.

If you already have a therapist you’d like to see, ask which insurance plans they accept before choosing your coverage. Be specific — sometimes therapists only accept certain plans from a company, not all of them.

If you don’t have insurance or can’t afford therapy, you still have options.

• Check for government programs: You may qualify for Medicaid, Medicare, or a plan through the Affordable Care Act marketplace.
• Ask about sliding-scale fees: Many therapists lower their rates for people with financial need.
• Try online therapy: Virtual therapy options are often more affordable, and research shows they can be just as effective for many issues.
• Look into university programs: Graduate schools that train therapists often offer free or low-cost counseling
from supervised students.
• Consider group therapy or support groups: These can be more affordable and equally helpful for many people.

Free and Low-Cost Resources

If you need someone to talk to, there are also free options:

• NAMI Helpline: Offers information and support (not a crisis line).
• 988 Suicide and Crisis Lifeline: For immediate crisis help.
• State or local warmlines: For emotional support and community resources.
• Mental Health America and NAMI websites: Great places to find affordable therapy options, support groups, and education.

Final Thoughts

Finding mental health care that fits your budget can be frustrating — but it’s worth it. Whether you use insurance, pay out of pocket, or find free community support, taking care of your mind is just as important as taking care of your body. Remember: You don’t have to figure it all out alone. Help is available, and every small step toward getting support is a step toward a better you.

Dr. David Hall is the owner of Hall Chiropractic Center. With over 40 years of experience, Dr. Hall is proud to serve the residents of Tega Cay and Fort Mill.