You did it - you finally made the decision to get seek external help and speak with a therapist. That's great news!
But now you're probably asking yourself:
"Will my insurance cover this?"
Mental health care is essential, but navigating insurance policies to understand what is covered and not can make the process overwhelming. We've created this guide to help clarify your options, break down the process, and empower you to access the care you need.
Checking Therapy Coverage Through Different Insurance Plans
Therapy coverage can vary significantly depending on the type of insurance you hold. Here's how to determine your coverage across major insurance types:
Employer-Sponsored Insurance
If your insurance is provided by your employer, you’ll likely have access to mental health services. Key steps to determine coverage include:
Review Your Plan Documents: Your insurance provider typically offers an online portal where you can access documents outlining your plan’s benefits. Look for terms like “behavioral health” or “mental health services.”
Contact Your Insurance Provider: Call the customer service number on the back of your insurance card to get a clear understanding of what therapists are in-network and what services are covered.
Employee Assistance Programs (EAPs): Some companies offer EAPs, which can include short-term counseling sessions at no cost as part of your benefits.
Health Insurance Marketplace Plans
If you purchased your insurance through the Health Insurance Marketplace, therapy is likely included in your plan. Mental health services are one of the ten essential benefits required under the Affordable Care Act. Here’s how to verify:
Login to Your Marketplace Account: Check for details of your plan under "Mental Health or Behavioral Coverage."
Reach Out Directly: Contact your insurance company to confirm if your therapist is in-network and what your copayment or coinsurance costs may be for therapy.
CHIP (Children’s Health Insurance Program)
CHIP generally covers mental health services, including therapy for conditions like anxiety, depression, and trauma-related issues. Coverage details can vary by state and provider, so it’s important to check your child’s specific plan.
To learn what mental health services are available:
Contact Your CHIP Provider Directly: Call the number on your child’s CHIP card or visit your state’s CHIP website for assistance.
Visit Your State’s CHIP Website: Visit your state’s CHIP website to find contact information, learn about covered services, and access mental health resources. You can also search for in-network providers directly through the site.
Medicare
Medicare provides mental health benefits under Part B, covering therapy with psychiatrists, clinical social workers, and similar professionals. Be sure you:
Look for a Medicare-Approved Therapist: Only therapists who accept Medicare will be covered.
Understand Coverage Limits: Part B usually covers 80% of the approved cost, with the remaining 20% being your responsibility unless you have supplementary coverage.
Steps to Apply for Insurance or Verify Coverage
If you don’t currently have insurance, applying can seem complex, but resources are available to help.
Visit Healthcare.gov: Review available plans through the Health Insurance Marketplace.
Contact Your State Medicaid Office: Medicaid often includes mental health services for eligible low-income individuals or families.
Ask Your Employer: They may offer assistance or resources if you’re unsure of your coverage.
Consult Your Therapist: Some therapists will verify insurance on your behalf or offer sliding-scale fees if you aren’t covered.
For those who already have insurance but aren’t sure about therapy coverage:
Ask your insurance provider questions like, “What mental health services are covered?” and “What’s my copay for seeing a licensed therapist?”
Double-check that the therapist you're considering is in-network.
We’re Here to Help – Insurances We Accept at TRSAZ
At TRSAZ, your mental health matters, and we want to make it as easy as possible for you to access care. We proudly accept the following insurance plans:
If you're currently insured under one of these plans, rest assured that we can help guide you in confirming details about your therapy coverage.
You Deserve Support for Your Mental Well-Being
Starting therapy is one of the most important steps you can take toward improving your mental health and overall quality of life. Remember, help is available—and you don’t need to face the complexities of insurance alone.
If you’re uncertain about your coverage or need assistance navigating the insurance process, contact TRSAZ today! Our compassionate team is here to support you every step of the way and ensure you can access the care you need to thrive.
You deserve to feel empowered, supported, and cared for.