Therapy in the USA: Why Insurance Doesn't Cover Psychological Help.

According to Vox: One in three Americans decided to start therapy in 2025. If you are among them, you have probably faced difficulties obtaining information about your treatment coverage from your insurance.

Determining whether your insurance plan covers therapy can be challenging. According to a 2024 survey, over half of Americans reported that mental health expenses seriously hinder access to help. Four in ten noted a lack of specialists as a significant barrier. A third of psychologists do not accept insurance at all, and even those with medical insurance through work often have to go out-of-network for care.

As noted by Hannah Wesolowski, Chief Advocacy Officer at the National Alliance on Mental Illness (NAMI), "people with mental illnesses get a worse share of the pie." "We wait longer, pay more, and have less choice in providers." This situation makes understanding how to maximize insurance benefits for mental health, especially important.

Do most insurances cover therapy?

For the last 15 years, the Mental Health and Substance Use Disorder Parity Act has been in effect in the USA. It requires most health insurance plans to cover mental health expenses at a level comparable to physical health. This law prohibits insurance companies from charging more for visits to mental health specialists than for visits to other types of doctors and limits the number of those visits.

However, this regulation has not been a panacea. Insurance companies often pay low rates to mental health providers, resulting in many therapists refusing to work with them. People seeking help often encounter 'phantom networks' where registration looks promising, but many specialists do not actually accept new patients.

A law passed in September 2024 aims to address the issue of scarce networks and may encourage insurance companies to expand their provider networks in the coming years.

What do all these insurance terms mean?

People trying to obtain therapy coverage through insurance often face various types of costs:

• Co-payments and co-insurance: These are costs you incur during visits to a therapist or when purchasing medication. A co-payment is a fixed amount, such as $30 for each visit, while co-insurance means paying a certain percentage of the cost; for example, 30% of the cost of each visit.
• Deductible: This is the amount you need to pay out of pocket each year before your insurance starts covering costs. For example, if your deductible is $2000, you will pay the full cost of all medical services until you reach that amount.
• Maximum out-of-pocket expenses: This is the largest amount you can spend on all services covered by your insurance within a year.

If you are choosing a medical plan with regard to therapy coverage, pay attention to the section of the document about mental health, focusing on the subsection 'outpatient care'. Look for wording that describes visits to the therapist, such as 'office visits', 'individual, family, or group psychotherapy', 'medication management', or 'remote assistance'.

Many plans may require you to pay the full cost for therapy visits until you reach the deductible, and then cover a certain percentage of the cost until the end of the year. Others may require a co-payment for each visit, leaving the remainder to the insurance.

What to do if I don’t have insurance? Or I can’t afford therapy?

If you don’t have insurance, it is worth exploring options for participating in government programs such as Medicaid or Medicare, or trying to purchase your own insurance.

If medical insurance is available, you still have options. You can reach out to a therapist, paying for services out of pocket. This can be costly, with session prices usually ranging from $100 to $200. Some providers offer therapy at sliding scale prices, so it's worth asking.

There are many free and confidential 'hotlines' where you can get help over the phone: NAMI runs a national helpline, and many states have their own 'hotlines'. These lines help people find resources for further treatment.

Remember that you are not alone in your efforts to find help.

Update, November 3, 10:00 ET: This article was first published in 2023 and has been updated several times to include the latest data.