Almost 20% of adults in the United States seek treatment for mental health issues, with 9.5% receiving some counseling or psychotherapy, according to a recent research. But for many people, access and cost of therapy are genuine obstacles to treatment, found a 2020 study. Neither of these things should be a barrier to getting help. In this article, we outline counseling costs and strategies to help you find low-cost or free therapy.
How much does therapy cost?
“Typically, the average cost of therapy [without insurance] is somewhere between $100 and $250 [per session],” according to Ashley McGirt, MSW, therapist, author, and the founder of WA Therapy Fund Foundation.
Online therapy programs are generally less expensive than in-person therapy, depending on what you need and want. And the cost can vary by region. For example, therapy in New York would generally be more expensive than in Idaho. The mental health professional’s education, training, or specialization could also influence therapist costs—and so does the length of the session. Most sessions are 45-50 minutes; some can be 30 minutes long while others are 90 minutes or longer, according to Roseann Campanna-Hodge, Ed.D., psychologist and founder of The Global Institute of Children’s Mental Health.
Does insurance cover therapy?
If you have a health insurance plan, your insurer might help pay for therapy sessions. Most plans offered through health insurance exchanges through the Affordable Care Act are required to provide mental health coverage. Private insurance companies not under the umbrella of the ACA may offer—but aren’t necessarily required to—mental health benefits. If your plan does, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (also known as the mental health parity law) requires that mental health and addiction coverage is comparable to their physical health coverage, according to the American Psychological Association. For example, if you pay a $20 copay for most physical health visits, your copay can’t be higher for mental health services. The law also prevents insurance companies from placing a firm limit on the number of visits per year. However, they can request a review after a certain number of visits to determine if the care is still needed, or they may require prior authorization.
It’s important to note that the reimbursement rates insurance companies pay therapists is quite low, which is held over from the time before mental health parity laws. Unlike so many other branches of medicine, a disproportionate number of mental health professionals simply do not accept insurance.
How much you will pay for mental health care depends on your plan and your mental health provider. Some factors that can affect health insurance payments, according to the American Psychological Association, include:
- Whether your therapist is an in-network provider: Many insurance companies pay a certain amount for providers in their network. For providers outside the network, the amount they pay the provider is less.
- You have a deductible: If you have a deductible on your plan, you might need to meet it before receiving benefits. Contact your insurance company to determine how much your deductible is, and what medical services go toward it. Once you meet the deductible, the insurance company pays according to your plan benefits.
- Your therapist does not work with your insurance company: Not all providers accept all insurance plans. As explained above, many do not.
To find a therapist in network, you can request a list of in-network providers from your insurance company. You can often find whether a provider takes insurance and what plans they accept on psychologytoday.com.
Once you’ve found a therapist you’d like to try, make sure to call and ask about their policies regarding insurance. You will want to find out:
- Does the provider accept your insurance? If so, will they bill the insurance company directly with you paying the copayment, or do you need to submit their bill for reimbursement?
- If they do not accept insurance, what are their payment policies? Is payment expected at the time of service, or are you billed for the visits? You could also inquire about sliding scale rates based on your income.
Some therapists accept only cash or credit card payments and prefer not to accept insurance at all. One reason is the low reimbursement rates. When a therapist decides to take insurance, they must accept the rates set by the insurance companies. “Another reason is the restrictions insurance companies place on care,” explains McGirt. “Health insurance companies require therapists to have a legitimate diagnosis to provide you with reimbursable treatment.” That can be a problem because not every reason for seeing a therapist is considered a mental illness.
How to find affordable therapy without insurance
If you don’t have insurance for mental health treatment, consider online therapy. “Online therapy has changed because of COVID-19,” says Brittany A. Johnson, LMHC. “Before that, many people couldn’t access therapy because of the need to take time off work and process their emotions. Now, people can access therapy during their lunch hour. Numerous online therapy programs can be affordable, such as Talkspace and BetterHelp. Therapists who have traditionally offered only in-person therapy are now offering online sessions at a lower cost.”
Other affordable options include:
Employee assistance programs
Some employers offer counseling and assistance for problems that interfere with their employee’s well-being. These include therapy sessions for emotional issues, relationships, or substance abuse issues. These are often provided at no cost to the employee and can be in-person, online, or by phone. There is usually a set number of sessions. Talk to your human resources department to find out if your company offers these types of therapy programs.
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Local universities and colleges
If you attend a college or university, check with the health center to find out what counseling services they offer. If you don’t attend but have universities and colleges in your area, call to see if they have a psychology department. They might provide a reduced rate or a sliding scale therapy with clinician-supervised students training to become psychologists or therapists.
Contact therapists in private practice in your area and ask if they work with a sliding scale fee program based on income—the less you make, the less you pay. If they don’t have a sliding scale program, ask if they work with clinician-supervised interns that provide counseling for discounted rates. Therapy practices, rather than individuals, are more likely to have interns.
When you participate in a clinical trial, your care is usually free. The National Institute of Mental Health completes research studies on a variety of mental health conditions. Check on clinicaltrials.gov for mental health-related trials.
Locate a federally qualified health center
These health centers usually offer mental health care and work on a sliding payment scale. You can search the HRSA Data Warehouse to find a health center in your area.
Research health insurance options
There are several options for people and those without insurance coverage. When looking for a plan, make sure they include mental health treatment.
- Medicaid is health care coverage offered by the federal government and your state government. You can apply for Medicaid through your state or fill out an application through the Health Insurance Marketplace.
- Medicare is a health insurance plan run by the federal government for people who are over the age of 65 or disabled. To apply for Medicare, visit Social Security’s website.
- Check to see if you qualify for health insurance through the Affordable Care Act, which bases premiums on income. You can find plans and apply for coverage at the Health Insurance Marketplace.
Community mental health centers
Look for community mental health centers in your area. They usually offer emergency mental health support, therapy, and psychiatric care—and some even fill prescriptions on-site. Typically, you will have an initial intake interview to determine the level of care and services you need. You will also be asked about your income to determine if you are eligible for free or discounted treatment.
Health-centered non-profits sometimes offer care with therapists or psychologists who volunteer their time. Search for “health non-profits” along with the name of your town or city.
Free mental health services
In order to find free mental health services in your area, you can start by calling 211. Specialists can connect you with local or regional resources. You can also check the following resources for free mental health care.
- Drop-in centers: Mental health drop-in centers are usually run by people living with mental health issues. They are considered peer-to-peer assistance and offer support, advocacy, self-empowerment, socialization programs, and a safe haven. Your county department of health should know the location of drop-in centers.
- Support groups: Support groups can be in-person or online. In-person groups might meet at a church, school, or community health center. Mental Health America provides resources for locating support groups for many different mental health topics. NAMI also offers resourcing for mental health support groups.
- Hotlines: Hotlines are numbers you call in an emergency, such as the Suicide Prevention Hotline. You can find a list of numbers on the Hotline Directory. Some useful hotlines include:
- Suicide Prevention Hotline: 1-800-SUICIDE
- Eating Disorders Center: 1-888-236-1188
- GriefShare: 1-800-395-5755
- LGBTQIA+ Helpline: 1-800-398-GAYS
- Drug Abuse National Helpline: 1-800-662-4357
- Warmlines: Warmlines are peer-run and provide emotional support to callers. You can find a list of numbers on the Warmline Directory. Some useful warmlines include:
- An Ear to Listen: 1-844-755-4673
- The Crisis Line: 1-615-244-7444
- MH Empowerment Project: 1-800-643-7462
- Peer to Peer Support Line: 1-877-760-4987
- Compassionate Ear:1-866-927-6327
- Free clinics: Free community mental health clinics provide pharmacy and mental health care to people for free or at a reduced rate. You can search for a clinic near you at freeclinics.com.
- Other local resources: Contact your county health department and ask about resources in your area that offer mental health care for free or at a reduced cost. Check the Directory of Local Health Departments to find one in your county.
If you have trouble locating mental health assistance you can afford or are currently experiencing a crisis, visit your nearest hospital emergency room. They must evaluate you. By law, emergency rooms cannot turn you away, even if you don’t have insurance or the money to pay for care. If you are admitted to the hospital for treatment of a mental health condition, the hospital is responsible for ensuring you have a reasonable plan for outpatient treatment once you’re discharged.