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How much does therapy cost? It seems like such a simple question, but the reality of modern-day healthcare makes the answer complicated. We did extensive research and tried to answer the question once-and-for-all. Read on to get answers to all your questions.
Some organizations offer free therapy as a service to members of their communities. You can use OpenCounseling and other online tools to research free or low-cost providers where you live. Many counselors and clinics offer sliding-scale fees based on your income and ability to pay. You're more likely to be assessed a minimal fee or be able to get counseling for free at a local non-profit or public clinic if your income is at or below the Federal Poverty Level.
Note that many programs listed as offering free therapy limit it to people from specific groups, such as veterans or trauma survivors. Depending on your area, any of the following programs or provider types may offer therapy for free or for significantly reduced costs:
There may be therapists in your area who participate in Give an Hour, a national organization that enlists therapists to provide pro bono sessions to veterans and trauma survivors. Some therapists offer pro bono sessions independently through their own practices. Most limit the number of free sessions they offer each month, and most offer pro bono slots to people who meet specific income or clinical criteria. You'll need to call potential providers to ask who qualifies and if they currently have any pro bono slots open.
If you can't find or don't qualify for free therapy at local specialty programs, you may have other means to find therapy for a more affordable price than the rates you see private practice therapists charging for your area. Some specialized networks exist to help offset therapy costs. One of them, the Open Path Psychotherapy Collective, offers a lifetime membership for $59, after which you can see any therapist in their network for $30 to $60.
BetterHelp (a sponsor of OpenCounseling) currently charges $320 a month to see a therapist online through their platform. They also offer financial aid between 10% and 40% for those who qualify. The weekly charge includes live phone or video sessions as well as messaging services. In addition to participating in BetterHelp or other online services, some therapists independently offer online video sessions for less than they charge for in-person sessions.
At OpenCounseling, we recognize that our mental health system has serious gaps and that cost is a real and significant barrier to therapy for a growing number of Americans. However, we also know that there are more options for affordable therapy than many people realize, and our mission to make it easier for you to find those options. We hope this article has sparked some ideas and helped you locate potential resources for mental health support where you live. Even if it takes a while, don't give up—the help you need may be closer than you think.
If you pay out-of-pocket, therapy costs an average of $60 to $150 per session. Sites like Thervo and Thumbtack that list rates for local professionals agree on this range, though the true range is even wider. While the average cost for therapists listed on Thervo is $60 to $120 per session, this means that people who find a therapist through the site pay anywhere from $20 to $250 per hour. The cost range for therapy on Thumbtack changes based on the zip code you enter and may be higher or lower than the national average.
The low end of this scale is debatable. National therapist directory TherapyDen reports that only 13 percent of therapists charge $60 or less per session even as a low fee on a sliding scale. TherapyDen reports a national average low sliding-scale fee of $112 and a national high or full-cost fee of $157. The site acknowledges that these numbers may seem low or high depending on where you live. In some places it's unusual to find therapists charging less than $150 an hour, while in others it's unusual to see people charging more than $100.
For people who have insurance with mental health coverage, the cost of a therapy session is the average co-pay to see a specialist, or about $30 to $50 per session.
Federal regulations including the Mental Health Parity and Addiction Equity Act (Parity Act) and the Affordable Care Act require insurance companies to charge equitable rates for mental health and medical services. This means they can't assign higher co-pays to mental health specialists than they assign to medical specialists. However, some plans are exempt from these laws, and others simply don't follow them.
Some insurers try to skirt around these requirements by finding other ways to limit the number of mental health claims they pay. For example, your insurance company may deny your therapy claims if it determines that your therapy is medically unnecessary. This means you'll have to appeal your denied claims to try to get your insurance provider to pay them.
If your plan has out-of-network benefits, you don't have to see an in-network provider to have your sessions covered by insurance. However, you'll usually pay significantly more to see an out-of-network therapist than you would pay to see an in-network therapist. If your plan doesn't offer out-of-network coverage, it won't pay for your therapy sessions unless you can find an in-network therapist. Some people believe insurance companies are actively trying to limit the number of therapists in their networks so that people have to pay out-of-pocket or out-of-network rates.
If your plan is a grandfathered plan that's exempt from parity requirements, you may have to pay higher co-pays for mental health care than you do for medical care. You'll also have to pay more if you have a high deductible plan. Plans with high deductibles require you to pay the deductible before the plan will cover any costs, so if your deductible is $5000, you'll be paying a therapist's standard per-session rate until you have paid $5000 toward your deductible for the plan year.
The biggest factor affecting the price of therapy is the cost of living where a therapist works. Therapists who live in more expensive locations have to pay higher office rents and higher prices for other professional expenses. Therapists who live in more competitive areas have to invest more in marketing than therapists in less competitive locations. They may also have stricter requirements for licensure and have to pay higher licensing and continuing education fees.
Another reason for the wide cost range for therapy is that many therapists offer sliding-scale fees, or adjustable session rates based on clients' incomes. The same therapist may charge some people $75 a session and others $200. Some therapists choose not to offer sliding-scale fees out of concern some clients may not feel comfortable paying more or less than others. They may instead provide a certain number of pro bono sessions per week or other ways to reduce costs.
Some therapists who want to serve clients from a wider range of socioeconomic backgrounds choose to offer some or all of their sessions through a local clinic. Clinic-based therapists can often charge lower fees than therapists in private practice because they are not responsible for as many costs. Non-profit and public clinics may also receive money from state or federal grants or from charitable donations, which offsets their costs and allows them to charge clients less.
When you see that a local therapist charges $150, $200, or even more per session, it can seem unfair or greedy. A lot of people can't afford to pay $600-$1000 per month to see a therapist! However, most therapists don't want to exclude clients based on income. This is why many choose to use a sliding scale, offer pro bono sessions, or spend some time each week providing therapy at an affordable local clinic.
Why not just charge lower rates? After all, many people make a living earning significantly less than $150 per hour! One reason for seemingly high therapy rates is the degree of professional investment, training, and study required to become a therapist. Many therapists undergo a similar amount of education as medical doctors who charge even higher fees for their services. Mental health is a demanding field and therapists want to make sure they're fairly compensated.
The main reason is even simpler. Therapists in private practice have to shoulder similar costs as people who run small businesses. They have to cover rent for their offices as well as pay for their own insurance. They either have to pay assistants or spend unpaid time attending to various clerical and administrative tasks like filling out insurance paperwork. After all of these costs are factored in, therapists take in significantly less per hour than what they charge.
Medicare Part B pays 20 percent of the Medicare-approved amount for therapy sessions after you meet your deductible ($198 in 2020). Medicare-approved amounts tend to be lower than the amount private insurers pay (80 percent lower, according to CNN). You can search for the Medicare-approved amount for therapy in your area by using the CMS Physician Fee Schedule Look-Up Tool (the HCPCS code for 60 minutes of individual therapy is 90837).
Therapists who accept Medicare assignment can't charge more than the Medicare-approved amount, while providers who accept Medicare but don't accept assignment can charge up to 15 percent more per session. So while you're only responsible for 20 percent of the Medicare-approved amount when you see participating providers, you're responsible for 35 percent of the Medicare-approved amount for non-participating providers. This means that if the Medicare-approved amount for a therapy session where you live is $150, you'll pay $30 coinsurance to see a participating provider and $52.50 to see a non-participating provider.
Medicaid co-pays for therapy are as low as $4.00 or less for people whose income is at or below the Federal Poverty Level (FPL) and are a little more for people whose income is up to 150 percent of the FPL. Per Medicaid cost-sharing requirements, co-pays for Medicaid subscribers are not allowed to exceed 5 percent of a person's individual or family income.
Because Medicaid reimbursement rates are relatively low, it's rare for private practice therapists to accept Medicaid. Clinics, especially those run by non-profit agencies or the public mental health system, are more likely accept Medicaid than therapists in private practice.
The cost of therapy with TRICARE is the co-pay for a specialist visit, or about $30. There are some variations in co-pays, deductibles, and premiums based on what type of TRICARE plan you have. TRICARE publishes a fact sheet listing its costs and fees annually, and you can confirm what your copay would be based on 2019 amounts by reviewing this PDF. Note that TRICARE only covers therapy for the treatment of a diagnosed mental health or substance use disorder.
There are many factors that determine how much you'll pay to see a therapist if you don't have insurance or if you choose not to use insurance:
In other words, what you pay depends on the average cost of private practice therapy where you live and whether you have affordable alternatives to private practice therapy. For example, while you might have to pay $115 a session to see a private practice therapist in your area, you may find that you can pay $65 at a local non-profit clinic and $50 at a community mental health center in your state's public mental health system.
In some areas, costs for therapy may not vary that much between these different care settings, but it's always worth looking into a wide range of local therapy providers to see if there's a low-cost option available to you. You can also call therapists you're researching to find out if they offer sliding-scale fees or other cost-saving methods.
Rather than paying a fee for every service you receive, you can sometimes pay a single fee for all the care you receive each month at an integrated healthcare clinic. Federally qualified health centers (FQHCs) are integrated healthcare clinics that are specifically designed to help people in underserved areas with limited income access both physical and mental health care. You can use the online search tool on the U.S. Department of Health and Human Services website to find out if you have a FQHC near you.
