How to Use Your Health Insurance for Mental Health Care

Navigate mental health insurance coverage, costs and treatment options. Learn how to understand your benefits, find providers and access care with or without insurance in 2026.

Written by Erin C. Perkins

Updated: December 19, 2025

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Mental health shapes how people think, feel, handle stress, interact with others and make decisions. Yet many people who want help struggle to get it because of confusing insurance rules, limited provider networks and high out-of-pocket costs.

Recent national data show that about 1 in 4 U.S. adults (23.4%, or roughly 61.5 million people) experienced a mental illness in 2024. Demand for mental health services continues to climb. Medical claims for mental health treatment have increased 83% since 2019.

This guide offers practical tips to help you understand how your health insurance covers mental health care, compare in-person and virtual options and find support if you're uninsured or still having trouble accessing treatment.

A CLOSER LOOK AT THE IMPACT OF MENTAL ILLNESS

These statistics show the scope and barriers:

About 1 in 4 U.S. adults (23.4%) experienced a mental illness in 2024, and 5.6% experienced a serious mental illness
Among adolescents ages 12 to 17, about 15.4% had at least one major depressive episode in the past year, and families often report trouble finding in-network child and adolescent mental health providers even when they have insurance. Our research on youth mental health by state shows where families can find better access to child and adolescent providers.
Only about half of adults with any mental illness receive treatment, and many report cost, lack of in-network providers or long wait times as barriers to care. Young adults ages 18-25 have especially low treatment rates. Finding affordable health insurance as a young adult can help improve access to mental health care.
Mental health-related medical claims have increased 83% since 2019, highlighting how rapidly demand for services has grown
Research estimates show an average delay of 11 years between symptom onset and first treatment

Access to mental health care varies widely by location. Our analysis of the best states for mental health services shows how state policies and provider availability impact treatment access.

Finding the Right Mental Health Care

When determining what type of mental health care provider is right for you, choose a professional who is licensed to provide mental health services and understands your insurance benefits. Federal mental health parity law requires most group and individual health plans to cover mental health and substance use disorder services on terms comparable to medical and surgical care.

Choosing the Right Mental Health Professionals

A huge component to achieving successful mental health treatment is choosing the right mental health provider. Here are pointers to guide you to the right fit for your needs.

1
Determine what you need
Start with a physician for a physical exam to rule out other conditions or illnesses with symptoms that may present similar to mental illness symptoms.
2
Talk to your health insurance provider
If you already have insurance, call your provider and find out what your plan provides for mental health coverage. Most insurance plans cover therapeutic services. Start with your insurer's network of mental health providers and note if they have a subspecialty relevant to your needs, such as depression or bipolar disorder, and their approaches to care.
3
No insurance? Get recommendations
Check with the psychiatry or psychology department at a local university and ask for recommendations of people trained in that program. Call a large clinic for recommendations there. And don't be shy about checking with friends and family.
4
Make an appointment
If it'll be a while before a mental health specialist can see you, ask if you can join the waiting list for cancellations so if another patient cancels, you can get that appointment. Need help sooner? Check if your primary care doctor can provide treatments and support to tide you over. If it's an emergency, go to a hospital emergency room or contact the 988 Suicide & Crisis Lifeline (call or text 988, or chat at 988lifeline.org).
5
Ask plenty of questions
In your first session, learn as much as you can about the mental health professional to determine if they make sense for your long-term goals and needs. Here are some questions to consider asking:
- How long have you been in practice?
- Have you had patients with similar issues as me, and what were the results?
- How will you work with me and evaluate my progress?
- What are your policies and fees? If concerned about the amount, ask if you can pay on a sliding scale or at a discount.
If cultural considerations are important, ask if the therapist is familiar with your community:
- Do you have experience treating others from my cultural background?
- If not, are you willing to learn about my cultural background and respect my perspective?

Treatments Health Insurance Can Cover

Mental and behavioral health services are considered essential benefits in many health plans, and most large group, individual and public plans must follow mental health parity rules. This means your plan cannot impose more restrictive copays, visit limits or prior authorization rules on covered mental health and substance use disorder services than it does on comparable medical services.

Specific mental and behavioral health benefits will depend on your state and the health plan you choose, but here are some treatments that may be covered:

Psychotherapy and counseling: Also known as "talk therapy," this can help patients cope with daily life, trauma, grieving the loss of a loved one or specific mental disorders like depression or anxiety.
Psychiatric emergency services: This may include attempted suicide, substance abuse, depression, psychosis, violence or other sudden changes in behavior that result in needing urgent attention.
Telehealth and online therapy: Virtual visits by video or sometimes phone make it possible to see a therapist or prescriber from home. Many plans now cover telehealth mental health visits similarly to in-person care, though coverage rules, copays and provider network requirements can differ. Check with your insurer about virtual visit coverage, whether providers must be in-network, and if any copay differences apply.
Addiction treatment: Helps those battling substance abuse stop compulsive drug seeking and use. Treatment can include cognitive-behavioral therapy as well as medications, or a combination.
Co-occurring medical and behavioral health conditions: This refers to those dealing with a dual diagnosis such as coexisting addiction and depression.

Paying for Mental Health Care Using Insurance

Cost is one of the biggest barriers to mental health treatment. Unlike Medicare, which the government funds and sets pricing, costs for private insurance vary as each insurer negotiates pricing with health care providers.

Current Therapy and Psychiatry Costs

Individual therapy sessions range from $100 to $250 per session, with many private-pay rates falling between $120 and $200, depending on the provider's credentials, location and specialty. Your actual out-of-pocket cost will usually be much lower if you see an in-network therapist and pay only your plan's copay or coinsurance amount.

If you need to see a psychiatrist for medication or an evaluation, you may pay additional costs, and prices can vary widely by drug. For example, fluoxetine (the generic form of Prozac) can cost as little as a few dollars per month at some pharmacies with discounts, while brand-name versions can cost much more. Using a pharmacy discount program or comparing prices at different pharmacies can lower your costs.

MONEYGEEK TIP

Tools like GoodRx and similar prescription discount programs let you compare cash prices at nearby pharmacies and apply coupons, which can substantially reduce what you pay if you're uninsured or your plan has a high deductible.

Medication-management follow-up visits with a psychiatrist usually last 15 to 30 minutes and usually cost roughly $100 to $250 before insurance, though prices vary by practice and location. If your psychiatrist is in-network, your plan may charge only a specialist copay or coinsurance. Confirming their network status and your mental health copay before your first visit can help you budget.

The best health insurance policies can make receiving and paying for mental health services more manageable. Those who have coverage tend to pay less. For people without coverage or with high deductibles, paying for mental health care can still be stressful, but there are options such as community clinics, sliding-scale providers, virtual therapy platforms and prescription discount tools that can help lower costs.

Understanding Your Mental Health Insurance Coverage

Research shows many people find understanding and choosing health insurance difficult, especially when they're also managing mental health symptoms. Learning basic insurance terms, reviewing your mental health benefits and doing some simple math can make your coverage more predictable.

1
Understand the common insurance terms
Learning the basic health insurance terms can help you find your way through health insurance benefits. Here's a quick rundown:
- Deductible: How much you pay out of pocket before your insurance kicks in coverage.
- Copay: A fixed amount you pay for a health-care visit or service.
- In-network: Refers to the set of health-care providers (physicians, hospitals, clinics, etc.) who accept your insurance.
- Out-of-pocket maximum (OPX): The most you have to pay in a year for covered services before your insurance starts to pay 100%.
Understanding how deductibles and out-of-pocket maximums work together and the difference between copays and coinsurance can help you budget for mental health care.
2
Get a clear understanding of your coverage
Review your schedule of benefits, which outlines the costs associated with all of the health-care services covered by your plan. This will give you a realistic sense of your plan offerings and what the cost might be. You can also call your insurance. This is helpful for anything you have specific questions about, like "What does my plan cover?", "Is there a maximum number of mental health visits?", "How much will I pay if I see an out-of-network provider?"

When you call your insurer, consider asking questions specifically about mental health and substance use coverage, such as:
- "Do you cover virtual (telehealth) therapy and psychiatry visits, and are they billed the same as in-person visits?"
- "Is there a limit on the number of covered mental health visits per year, and what happens if my provider says I need more?"
- "Do I need prior authorization for therapy, intensive outpatient programs or residential treatment?"
- "What should I do if no in-network therapists or psychiatrists are accepting new patients near me?"
3
Nail down the cost
Figuring out the math upfront will help you understand what your actual out-of-pocket cost is so you'll be less caught off guard and budget-stricken when you receive a health provider's bill or owe a copay. Determine how many sessions you may have in a year's time, along with any prescriptions. That, including your insurance premium, should give you a good idea of what the plan will cost you in a year.
4
File a claim correctly
Claims will often be filed on your behalf by your health care provider, and they will usually bill you what's not covered by your insurance. But in some instances, policyholders may be required to submit their own claims. In that case, get an itemized bill from your health care provider with the reason for the visit and service date and include your policy number. Obtain the claim form, review it carefully before submitting and make copies for your records.

Choosing the Right Health Insurance

There are three key factors to consider when choosing health insurance that makes sense for your needs and budget.

Coverage level: If you're buying on your own from the health-care marketplace, you can choose from four categories of health insurance plans: Bronze (insurance covers 60%), Silver (insurance covers 70%), Gold (insurance covers 80%) and Platinum (insurance covers 90%).

Total costs: It's easy to focus on your monthly premiums. But for a more accurate picture, consider the total costs, including your monthly premium, deductible and potential out-of-pocket costs. Think about the entire cost when shopping for a plan to help you budget for your health care.

Plan and network types: Know the plan and network types: HMO vs. PPO, PO and EPO. Based on your plan type, you may be able to use almost any mental health provider. Some plans limit your choices or charge you more if you use out-of-network providers.

Common Health Insurance Questions Answered

Most people have questions about how insurance covers mental health care and what to do when coverage falls short.

If I don’t have health insurance, how does that affect my access to mental health services?

People without insurance have less access to mental health care than people who are insured. In national surveys, only about half of adults with any mental illness receive treatment in a given year, and uninsured adults are far less likely to get care than those with coverage. Lack of insurance and high out-of-pocket costs are consistently cited as reasons for delaying or skipping needed mental health care, which can worsen symptoms and other health conditions over time.

Why is medical coverage for mental health issues complicated?

Mental health coverage can feel complicated because of the way insurance plans are structured and how mental health services differ from other medical care. While federal parity law requires most plans to cover mental health and substance use disorder services comparably to medical services, the practical application varies widely. Plans may have different networks of mental health providers, varying prior authorization requirements and different copays for in-network versus out-of-network care. Provider shortages in many areas add another layer of complexity, as it can be difficult to find an in-network therapist or psychiatrist accepting new patients.

What should I keep in mind when trying to choose the right mental health professional?

Start by checking if the provider is in your insurance network and accepting new patients. Ask about their experience treating your specific concern (anxiety, depression, trauma, etc.) and their approach to treatment. Consider practical factors like location, appointment availability and whether they offer telehealth options. During your first session, pay attention to whether you feel comfortable and understood. The therapeutic relationship matters as much as credentials. Don't hesitate to try a different provider if the first one isn't a good fit.

What You Can Do if the Insurance Won’t Pay

Health plans may deny all or part of a claim for reasons such as missing information, coding or billing errors, questions about medical necessity or because a service is not covered. You have the right to ask for a clear explanation and to appeal the denial. The Affordable Care Act and federal parity law give most people in private health plans the right to an internal appeal and, in many cases, an external review by an independent reviewer.

1
Check whether the denial might violate mental health parity rules
Parity rules say your plan cannot make it harder to get covered mental health or substance use disorder treatment than comparable medical care. For example, it cannot use stricter prior authorization rules, tighter visit limits or narrower networks. If you suspect the denial reflects unequal treatment of mental health services, save all documents and ask your plan to explain how its rules for your mental health benefit compare with those for similar medical/surgical services.

Important context on parity enforcement: In May 2025, federal agencies paused enforcement of strengthened 2024 parity regulations while litigation proceeds, but the underlying Mental Health Parity and Addiction Equity Act (MHPAEA) statute and earlier 2013 regulations remain in full effect. Many state insurance departments continue to enforce parity protections actively. You still have the right to challenge denials that appear to treat mental health services less favorably than medical services, and you can file complaints with your state insurance department or the U.S. Department of Labor (for employer plans) even during the federal enforcement pause.
2
Contact the insurance company to ask for a thorough explanation of the denial
You can also ask your HR benefits representative or insurance agent for help understanding claims, appeals and benefits, as well as contacting the insurance company for you.
3
Contact your state’s insurance division
If you complete the insurance company's internal appeals process and aren't satisfied, your state's insurance division can help.
4
Do you have a self-insured plan?
You can enlist the help of a benefits advisor in a regional office of the U.S. Department of Labor (DOL) who can enforce parity.

An illustration of two women hugging each other.

Getting Affordable Mental Health Care Without Insurance

Concern about paying for mental health care is not uncommon. Many people need help and worry that they can't afford it. A 2024 national survey found that tens of millions of adults experienced a mental illness in the past year, and many reported unmet needs for care. Though some insurance companies don't provide much mental health coverage and often have expensive copays and deductibles, there's still affordable and even free mental health care or support. If you don't currently have coverage, learn how to get health insurance through the marketplace or other programs.

Government Support for Mental Health

The federal government has options and multiple resources for those seeking mental health support. It regulates systems and providers, protects consumers' rights, provides major funding for services and supports research. It also establishes and sets standards the states can build on.

Medicare: Covers multiple treatment services for those with mental illness and substance abuse disorders, including psychological counseling, preventive screenings and outpatient treatment programs. Special rules limit coverage. Get started by letting your doctor's office know you want to schedule your "Welcome to Medicare" preventive visit.

Important 2025 Medicare mental health updates:

$2,000 annual out-of-pocket cap on Part D prescription drugs took effect in 2025, significantly reducing costs for many people taking psychiatric medications
Medicare now covers services from Licensed Mental Health Counselors (LMHCs) and Marriage and Family Therapists (MFTs), expanding your provider options beyond psychiatrists and psychologists

Medicaid: Care under Medicaid can vary by state and county, but it generally covers counseling services, therapy, medication management, social work services and substance abuse treatment. Contact your state to determine if you qualify.

Affordability note: Recent federal legislation reduced Medicaid funding, and enhanced marketplace subsidies that lowered premiums in the early 2020s expired December 31, 2025. These changes may affect coverage availability and costs. If you currently have or are considering Medicaid or marketplace coverage, re-check your eligibility and compare plan costs during each open enrollment period, as your options and premiums may have changed significantly.

If you're unsure which program you qualify for, learn about the differences between Medicare and Medicaid.

Social Security Disability Insurance Benefits (SSDI) and Supplemental Security Income (SSI): Certain mental disorders can qualify you to receive monthly benefits from SSI or SSDI. Each requires that your impairment prevents you from working. Children with an impairment can also receive SSI benefits. Regardless of the type of mental disorder, you have to show that you're receiving and complying with treatment.

Substance Abuse and Mental Health Services Administration (SAMHSA): This agency works to improve substance abuse and mental health treatment services. As of March 2025, SAMHSA was consolidated into HHS's new Administration for a Healthy America (AHA), a consolidated HHS agency overseeing behavioral health programs. Key resources continue to operate: The Behavioral Health Treatment Services Locator at FindTreatment.gov, The National Helpline for mental or substance use disorders (1-800-662-HELP), and The 988 Suicide & Crisis Lifeline.

U.S. Department of Veterans Affairs Mental Health Resources: This agency provides an array of information about mental health and support services, both locally and nationally, specifically for veterans, including Treatment Works For Vets and the National Center for PTSD.

Employee Assistance Programs

Employee Assistance Programs (EAPs) are work-based programs that offer confidential, free support to employees struggling with mental health issues, substance abuse and grief. Most EAPs provide a limited number of free counseling sessions per issue (often around 3 to 6, and sometimes more) along with 24/7 phone access to counselors and referrals for longer-term care. While most EAPs don't offer long-term counseling, they can refer an employee to services for long-term solutions. Check your employee benefits to find out if you have one or ask your HR benefits department.

Free Clinics and Nonprofit Options

Luckily, there are options, like free clinics and nonprofits, that can provide support.

Contact any local facility to find out if they offer the free mental health service that you seek.
The National Association of Free and Charitable Clinics has a search tool for finding health services clinics.
Contact a university training clinic near you as they often have free or low-cost options for therapy. The Association of Psychology Training Clinics has listings.
The 988 Suicide & Crisis Lifeline can provide recommendations for nearby mental health services.

Virtual Therapy

Over the past several years, online and virtual therapy have become a mainstream way to receive mental health care, not just a temporary option during the COVID-19 emergency. Research and professional organizations report that, for many conditions, online cognitive behavioral therapy and other structured treatments can be as effective as in-person therapy, and virtual care can help people who have transportation, scheduling or mobility barriers.

Before signing up for any virtual therapy platform, check whether it accepts your specific insurance plan, whether its providers are in your network, or whether it provides documentation you can use to submit out-of-network claims. Coverage and reimbursement vary widely by insurer and plan type.

Insurance coverage varies by platform and your specific plan. Here are a few options to consider:

MDLive: Providers available via phone and video for mental health consultations. Check with your insurance to see if MDLive is covered.

Teladoc: Virtual care appointments available seven days a week with flexible scheduling. Many health plans include Teladoc coverage.

Talkspace: Offers therapy for individuals, couples and teens. Talkspace accepts many major insurance plans including Aetna, Cigna, Optum/UnitedHealthcare and many Blue Cross Blue Shield plans, with typical copays often $30 or less when using in-network benefits, depending on your policy.

BetterHelp: Large network of therapists available for online sessions. BetterHelp is gradually adding insurance partnerships and now accepts insurance in some states through select major carriers. Coverage and copays vary, so you'll need to go through BetterHelp's sign-up flow to see if your plan is eligible. Many people can also use HSA or FSA funds for payment.

Pride Counseling: Specializes in therapy for the LGBTQ+ community with therapists experienced in LGBTQ+ issues.

An illustration of a young woman meditating.

Ways to Practice Self-Care at Home

Taking care of yourself is essential to your mental health and quality of life, and self-care can play a role in supporting your treatment if you're dealing with mental health issues. It's not a replacement for professional care, but even small acts of self-care incorporated into your daily life can help manage stress, lower your risk of illness and boost your mood.

Exercise regularly. It naturally produces stress-relieving hormones in your body and improves your overall health.
Eat well. Whole grains, vegetables and fresh fruit can help lower your risk for chronic diseases and boost your energy and mood.
Get enough sleep. Experts recommend seven to nine hours of sleep. Practice good "sleep hygiene," like avoiding using computers and digital devices before bed.
Practice deep breathing and meditation. This is a quick way to reduce stress and gives you space to seek clarity about conflicts and problems. Apps like Simple Habit and Headspace provide easy-to-follow meditations.
Set aside time for yourself. Just five minutes a day can be a meaningful reminder of who you are and that you matter.
Recognize the positive. Try writing down one thing each day or week that was positive. It will start to change how you experience life. Apps that help promote optimistic perspectives and activities like Happify or Moodfit include several therapeutic tools such as a gratitude journal.

Resources for Mental Health Care

Most people face mental health issues at some point in life. Getting help by seeking professional care is OK. There are resources, groups and programs available to assist you, whether you need a short-term or long-term solution.

Here are some organizations to get you started:

988 Suicide & Crisis Lifeline: For urgent help with suicidal thoughts, a mental health or substance use crisis, or emotional distress, call or text 988, or chat at 988lifeline.org. Support is free, confidential and available 24/7. Note: The "press 3" option that previously connected LGBTQ+ youth to specialized counselors through the 988 system ended July 17, 2025. However, The Trevor Project (see below) continues to provide dedicated 24/7 crisis services for LGBTQ+ young people through its own phone, text and chat services.

Crisis Text Line: Text HOME to 741741 to connect with a trained crisis counselor for free, confidential support 24/7.

FindTreatment.gov: Find a provider treating substance use disorders, addiction and mental illness.

SAMHSA's National Helpline: Call 1-800-662-HELP (4357) for free, confidential, 24/7 treatment referral and information service for individuals and families facing mental health or substance use disorders.

National Council on Alcoholism and Drug Dependence: This advocacy group provides information on local resources for getting help for substance abuse, along with support for friends and family members.

The Trevor Project: This nonprofit provides 24/7 crisis support specifically for LGBTQ+ young people. Call 1-866-488-7386, text START to 678-678, or chat at TheTrevorProject.org for free, confidential counseling on issues including coming out, LGBTQ identity, depression and suicide. The Trevor Project continues to operate independently after its connection to the 988 system ended in July 2025.

American Psychiatric Association Foundation: This organization promotes high-quality care for individuals with mental illness, including substance use disorders. They provide a search tool for finding psychiatrists.

American Academy of Child and Adolescent Psychiatry: This organization's online research tool helps adults find psychiatric care for their children.

Make the Connection: This campaign raises awareness on mental health symptoms, conditions and treatment for veterans. It also has a search tool to find local support.

National Empowerment Center: The center provides information and advocacy resources for those diagnosed with a mental illness.

National Alliance on Mental Illness (NAMI): This nonprofit provides resources on mental disorders that are helpful for people who have experienced mental illness and their families, including support groups, education and training. NAMI HelpLine: 1-800-950-NAMI (6264) or text "NAMI" to 62640.

Freedom From Fear: This nonprofit provides information, screening tools and other resources on many types of anxiety disorders.

Mental Health America: This organization promotes prevention, diagnosis and treatment for people at risk of mental illness.

Soaring Spirits International: This group offers peer-based support programs to people coping with grief.

Dual Recovery Anonymous: This group conducts meetings for people who have both substance addiction and a mental illness.

Many of these organizations can also help you understand options if you have limited or no insurance and can connect you to local providers or crisis services.

About Erin C. Perkins

Erin C. Perkins is a finance writer at MoneyGeek, with 15 years of experience in the media industry. She has covered topics about money, including banking, insurance and budgeting for several publications over the years.

Perkins has a master's degree in magazine journalism from Kent State University and a bachelor's degree in mass communications from Winston-Salem State University.

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sources

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National Institute of Mental Health. "Mental Illness." Accessed December 19, 2025.
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Mental Health America. "Federal Agencies Pause Enforcement of 2024 Mental Health Parity Rule." Accessed December 19, 2025.
Medicare.gov. "Medicare Part D Drug Coverage Costs." Accessed December 19, 2025.
U.S. Department of Health and Human Services. "HHS Restructuring." Accessed December 19, 2025.
UCSF. "Strong Insurance Laws Help Kids Get Access to Mental Health Care." Accessed December 19, 2025.
The Trevor Project. "Trump Administration Orders Termination of National LGBTQ+ Youth Suicide Lifeline Effective July 17th." Accessed December 19, 2025.
SAMHSA. "SAMHSA Statement on 988 'Press 3' Option." Accessed December 19, 2025.