The world of health insurance can be daunting to navigate. If you’re like many people, you might be wondering, Does Medicaid cover therapy for adults?
From whether therapy is covered by insurance to what coverage you have for behavioral health under your plan, there’s a lot to figure out.
You might be left wondering if Medicaid covers therapy. Most insurance companies offer some level of coverage for mental health treatment. But health insurance plans have varying levels of coverage.
We’ll break down whether Medicaid covers therapy for adults, as well as ways to get mental health care.
Psychiatry has come a long way in recent decades to tackle mental health care. Therapy has been shown to provide several benefits to those facing mental health concerns, such as building self-esteem, reducing anxiety and teaching coping mechanisms.
A 2006 study, for example, found that cognitive behavioral therapy (CBT) had lasting effects in reducing the risk of symptoms returning, especially from anxiety and depression — even after treatment ended.
Psychiatrists and other mental health professionals use various types of therapy. The particular approach depends on the patient’s specific illness, unique circumstances and preferences.
Therapy is often recommended as a treatment option for several different mental health conditions. According to the National Institute of Mental Health, nearly 53 million American adults experienced depression, anxiety or another mental disorder in 2020.
Unfortunately, people with lower incomes might not know if they have access to mental health services and may be left wondering if Medicaid covers therapy.
The good news, however, is that individuals who qualify for Medicaid services may be able to receive therapy and other forms of mental health care under the program’s benefits.
If you’re wondering if Medicaid covers therapy for adults, the answer is it depends.
The Medicaid program covers mental health, behavioral health and substance use disorder services, including therapy. If your healthcare is through Medicaid, take note of this benefit.
The Affordable Care Act (ACA) adjusted Medicaid requirements to ensure members have access to more comprehensive mental health care. Not only that, but the enactment of the Mental Health Parity and Addiction Equity Act (MHPAEA) prevents limitations on mental health benefits for those enrolled in managed care organizations and state alternative benefit plans.
In other words, Medicaid members now have access to more mental health services than ever.
Medicaid covers in-person and online services, as well as group therapy and family therapy. Your health insurance provider should cover your therapy as long as you have a diagnosis and a medical prescription for a specific type of therapy.
Health coverage can include some evidence-based therapies such as:
Mindfulness-based cognitive therapy (MBCT)
Dialectical behavioral therapy (DBT)
That said, couples therapy, career counseling or coaching, massage therapy, acupuncture and other holistic treatments are not covered by Medicaid.
Medicaid is administered on a state-by-state basis, so the amount of coverage for therapy may differ depending on where you live. States don’t have to include certain optional benefits. Further, defining what constitutes therapy and the need for therapy can impact whether a service is covered.
Your mental health care coverage may vary depending on what state you live in and what local benefits are available.
Here’s what to consider as you begin therapy or mental health treatment:
Your plan may require a copay or coinsurance, the percentage or dollar amount you have to pay out of pocket.
To get coverage, you need to choose a provider in your network.
The number of therapy sessions covered may be limited by your plan.
You may need to get a referral from your primary care provider before seeing a therapist.
If the specific type of therapy isn’t covered, you’ll be expected to pay the full cost out of pocket.
Since coinsurance rates vary by state, we recommend finding out what is and isn’t covered by your healthcare plan before scheduling a therapy session.
If your therapy session or treatment isn’t covered by Medicaid, you can appeal to your provider. If they’re unwilling to pay for the service, you’ll have to consider alternative options for affordable therapy.
Here’s what you can do:
Consider community health centers or free clinics in your area.
Check available community mental health service programs in your state.
Contact a local National Alliance on Mental Illness (NAMI) representative to find affordable mental health care in your area.
You can also check out our guide on how to find affordable therapy.
If you’re enrolled in Medicaid, you may be eligible for federal or state-run programs, along with free or low-cost services. Check with your state’s Medicaid program to see what’s available.
If you’re suffering from anxiety or depression or want to improve your mental health, there are ways to get help. Many cost-considerate providers are willing to offer low-cost services to those in need.
If you’re unsure where to start, our mental health resources guide can be a good first step. You can also schedule an evaluation on the Hers online counseling platform or use our other telepsychiatry services.
Whatever choice you make, finding help is possible.
Kristin Hall is a board-certified Family Nurse Practitioner with decades of experience in clinical practice and leadership.
She has an extensive background in Family Medicine as both a front-line healthcare provider and clinical leader through her work as a primary care provider, retail health clinician and as Principal Investigator with the NIH.
Certified through the American Nurses Credentialing Center, she brings her expertise in Family Medicine into your home by helping people improve their health and actively participate in their own healthcare.
Kristin is a St. Louis native and earned her master’s degree in Nursing from St. Louis University, and is also a member of the American Academy of Nurse Practitioners. You can find Kristin on LinkedIn for more information.
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