3 min read

Open enrollment: Your chance for affordable therapy

Open enrollment is the PERFECT time to select an insurance plan that will enable you to work with a great therapist you can actually afford.
Written by
Mor Goldberger, MFT, MBA
Published on
November 3, 2023

Have you been wanting to work with a therapist but have been discouraged by how challenging it can be to find one that accepts your insurance?

With open enrollment right around the corner, this is the PERFECT time to select an insurance plan that will enable you to work with a great therapist that you can actually afford.

Ok, so what do you want first- the good news or the bad?

The bad news: Unlike other healthcare providers such as primary care physicians or dermatologists, most therapists (approximately 70%) DO NOT accept insurance.

The good news: Just because a therapist doesn't accept your insurance doesn't mean YOU can't have insurance that covers your therapy costs!

How to chose a plan that will get you reimbursed for therapy costs:

  1. Opt for a plan that includes "out-of-network" benefits, often referred to as OON benefits.
  2. A great place to start is by exploring the PPOs offered by your employer (most PPOs provide OON benefits).
  3. Avoid HMO and EPO plans, as these will charge you the full out-of-pocket rate for the entire visit, with no insurance coverage, leaving you responsible for the full payment.

How do plans that have OON benefits work?

  • These plans permit you to see both in-network doctors and therapists (those who accept your insurance) and out-of-network therapists who may not accept insurance.
  • Typically, there are two separate deductibles you need to meet - one for in-network services and another for "out-of-network" services.
  • Once you meet your deductible, you can generally receive around 50% to 80% coverage for therapists who do not accept your insurance, often referred to as "out-of-network providers."

Here’s an example to help this come to life:

  • Imagine your therapist charges $200 per session, and you choose a PPO plan for the upcoming year with a $1000 out-of-network deductible and 30% out-of-network coinsurance. English please?
  • What this means is that you pay your therapist's full fee of $200 per session until you reach your deductible, which would typically take about five sessions. After meeting your deductible, for each subsequent session, you'll pay your therapist $200, but your insurance will reimburse you an estimated $140 per session.
  • If you're attending therapy once a week for an entire year, you could potentially save thousands of dollars on therapy because you've opted for a plan with out-of-network benefits.

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