Cost is one of the main reasons people put off therapy. The good news is that most health coverage in the United States must include mental health care. There are also free and low-cost options for people with little or no insurance.

This page explains how private insurance, Medicare, Medicaid, work programs, veterans' care and community clinics can help pay. It also gives you questions to ask before your first visit, so the bill is not a surprise.

Key points

Most health plans must cover mental health care. Large employer plans and individual plans cannot make it harder to use than medical care.^1,2
Medicare Part B covers therapy. After the 2026 deductible of $283, you usually pay 20% of the Medicare-approved amount.^3,4
Medicaid pays for more mental health care than any other payer in the country.⁵ In Virginia, apply through Cover Virginia.⁶
No insurance? Community health centers must serve everyone and charge by income. Virginia's 40 Community Services Boards offer same-day help.^7,8
If you pay on your own, you have the right to a written cost estimate before care.⁹

Start with a few questions

Before you book, call your insurance plan (the number is on the back of your card) or the therapist's office. Ask:

Is this therapist in my plan's network? Seeing an in-network provider almost always costs less.
Do I need a referral or approval first? Some plans require a note from your doctor or prior approval.
What will I pay per visit? Ask about the copay (a set fee), coinsurance (a percent of the cost) and whether you must meet a deductible (the amount you pay each year before the plan starts paying).
Is there a limit on visits? Write down the answer and the name of the person you spoke with.
Are video or phone visits covered? Many plans pay for them the same way as office visits.

Our page on how to find a therapist explains how to search plan directories and what to look for in a good fit.

Private insurance and the parity law

Most job-based plans and plans you buy on your own cover mental health care. Plans sold on HealthCare.gov must cover counseling and psychotherapy as an "essential health benefit." They cannot turn you down or charge you more because of a past mental health condition.²

What parity means. A federal law from 2008, the Mental Health Parity and Addiction Equity Act, says mental health benefits cannot be more limited than medical benefits.¹ In plain words, the rules for seeing a therapist should be about the same as the rules for seeing a heart doctor. This covers:^2,10

Copays, coinsurance and deductibles
Limits on the number of visits or days
Rules like prior approval before treatment

Who the law covers. It applies to employer plans with more than 50 workers and to individual plans. Small employer plans get similar protection through the health benefit rules.¹ The parity law does not apply to Medicare. It does apply in part to Medicaid managed care plans and CHIP (the children's health program).¹

A note on newer rules, as of October 2026. In 2024, federal agencies added stronger parity rules. In May 2025, they said they would pause enforcing the new parts while a court case continues. The 2008 law and the older rules still apply.¹¹

If your plan says no. Ask the plan, in writing, why a therapy claim was denied and how its rules compare with those for medical care. You can appeal a denial. Keep copies of letters, bills and notes from phone calls.

Out-of-network therapists. Some therapists do not take insurance. If your plan has out-of-network benefits, you can pay the therapist and send the plan a detailed receipt to get part of the cost back. Ask your plan how much it pays before you start.

Medicare Part B

Medicare covers outpatient mental health care under Part B. This includes:³

Individual and group therapy
Family counseling, when the main goal is to help you
Psychiatric evaluation and medicine management
One depression screening each year in a primary care office, at no cost if the provider accepts Medicare's approved amount (called "accepting assignment")
Safety planning if you are at risk of suicide or overdose, and a follow-up call after an emergency room visit for a mental health crisis
Partial hospital and intensive outpatient programs (several hours of treatment a day without staying overnight)

Who you can see. Medicare covers therapy from psychiatrists and other doctors, clinical psychologists, clinical social workers, nurse practitioners, clinical nurse specialists and physician assistants.³ Since January 1, 2024, Medicare also pays licensed marriage and family therapists and mental health counselors (often called LPCs).¹² This means many more therapists can now see people on Medicare.

What you pay in 2026.^3,4

Cost	Amount in 2026
Part B monthly premium	$202.90 for most people (more with higher income)
Part B yearly deductible	$283
Your share of each therapy visit after the deductible	20% of the Medicare-approved amount
Yearly depression screening	$0 if the provider accepts assignment

For example, if Medicare approves $100 for a visit, you would pay about $20 once you have met your deductible. Visits at a hospital outpatient clinic may add a separate hospital charge.³

Telehealth. Medicare covers therapy by video from your home. Medicare says this home coverage runs through December 31, 2027.¹³ See our page on online therapy and apps.

Help with the 20%.

Medigap (Medicare Supplement) policies help pay your share of costs in Original Medicare, such as coinsurance.¹⁴
Medicare Advantage (Part C): if you have one of these plans, your copays and list of therapists may be different. Call your plan to check.
Medicare Savings Programs, run by your state Medicaid office, can pay Part B premiums. One of them, called QMB, also pays Part B deductibles and coinsurance.¹⁵ You should still apply even if you are not sure you qualify.¹⁵

Ask any therapist, "Do you accept Medicare?" before your first visit. For more detail, read what Medicare covers for mental health and finding geriatric mental health care.

Medicaid

Medicaid is health coverage for people with low income, and for many older adults and people with disabilities who need long-term care. It is the largest payer for mental health services in the United States.⁵ Coverage of therapy, crisis care and day programs varies by state.

In Virginia, Medicaid is called Cardinal Care. Adults 19 to 64 without Medicare can qualify if their income is under 138% of the federal poverty level. In 2026, that is about $22,025 a year for one person.⁶ New work and community engagement rules start in January 2027 for adults in the Medicaid expansion group. Adults with a disability and people over 64 are not subject to them.⁶ To apply or ask questions, call Cover Virginia at 1-855-242-8282 (TTY 1-888-221-1590).⁶

If you have Medicare and limited income, Medicaid or a Medicare Savings Program may help pay what Medicare does not.¹⁵ For long-term care questions, see Medicaid and long-term care.

Employee Assistance Programs (EAPs)

Many employers offer an Employee Assistance Program. An EAP gives free, confidential assessments, short-term counseling and referrals for problems like stress, grief, family conflict and substance use.¹⁶ The number of free sessions depends on the employer.

An EAP can be a good first step for a working caregiver. Ask your human resources office or check your benefits booklet. Some EAPs also help family members. Read more on working while caregiving.

Free and low-cost options

If you pay on your own

If you have no insurance, or you choose not to use it, the therapist must give you a Good Faith Estimate in writing. It lists the expected cost of your care. You can ask for one before you schedule. If your final bill is $400 or more above the estimate, you can dispute it. Keep the estimate with your records.⁹

You may also be able to use money in a health savings account (HSA) or flexible spending account (FSA). The IRS counts therapy and psychiatric care as medical expenses.¹⁸ These costs may also count toward the medical expense tax deduction if you itemize. See tax help for caregivers.

When cost should not wait

Do not let money stop you from getting help in a crisis.

Call or text 988 (the Suicide and Crisis Lifeline) any time, day or night. It is free. Veterans can call 988 and press 1, or text 838255.¹⁷
Call 911 or go to the nearest emergency room if someone is in danger right now.
In Virginia, your local CSB also offers crisis services.⁸

Making a safety plan ahead of time can help. If you are worried about a family member, read when a family member is in a mental health crisis. For more crisis numbers, see our help page.

Questions people often ask

Does Medicare cover counselors, or only psychologists?

Both. Since 2024, Medicare pays licensed mental health counselors and marriage and family therapists, in addition to psychologists, clinical social workers and doctors.¹² The therapist must be enrolled in Medicare, so always ask first.

Will my employer find out if I use the EAP?

EAP services are described as confidential.¹⁶ Ask the EAP counselor at the start how your information is protected and when, if ever, it could be shared.

My plan has very few therapists. What can I do?

Ask the plan to help you find an in-network therapist who has openings. If none is available, ask whether it will cover an out-of-network therapist at in-network cost. Video visits can also widen your choices.

Is a cheaper therapist a worse therapist?

Not necessarily. Fees depend on the setting, location and type of license. What matters most is training in a proven method and a good working relationship. See starting therapy.

Sources

Centers for Medicare & Medicaid Services. The Mental Health Parity and Addiction Equity Act (MHPAEA). CMS, 2026. CMS
HealthCare.gov. Mental health and substance abuse health coverage options. Centers for Medicare & Medicaid Services, 2026. HealthCare.gov
Medicare.gov. Mental health care (outpatient). Centers for Medicare & Medicaid Services, 2026. Medicare.gov
Medicare.gov. Medicare costs. Centers for Medicare & Medicaid Services, 2026. Medicare.gov
Medicaid.gov. Behavioral health services. Centers for Medicare & Medicaid Services, 2026. Medicaid.gov
Cover Virginia. Adults 19–64 years old. Virginia Department of Medical Assistance Services, 2026. Cover Virginia
Health Resources and Services Administration. What is a health center? HRSA, 2026. HRSA
Virginia Department of Behavioral Health and Developmental Services. STEP-VA. DBHDS, 2026. DBHDS
Centers for Medicare & Medicaid Services. Right to receive a Good Faith Estimate of expected charges (sample notice). CMS, 2022. CMS
U.S. Department of Labor, Employee Benefits Security Administration. Mental health and substance use disorder parity. DOL, 2026. DOL
U.S. Departments of Labor, Health and Human Services, and the Treasury. Statement regarding enforcement of the final rule on requirements related to MHPAEA. DOL, 2025. DOL
Centers for Medicare & Medicaid Services. Marriage and family therapists and mental health counselors. CMS, 2026. CMS
Medicare.gov. Telehealth. Centers for Medicare & Medicaid Services, 2026. Medicare.gov
Medicare.gov. Medigap (Medicare Supplement Insurance). Centers for Medicare & Medicaid Services, 2026. Medicare.gov
Medicare.gov. Medicare Savings Programs. Centers for Medicare & Medicaid Services, 2026. Medicare.gov
U.S. Office of Personnel Management. What is an Employee Assistance Program (EAP)? OPM, 2026. OPM
U.S. Department of Veterans Affairs. Mental health care. VA, 2026. VA.gov
Internal Revenue Service. Publication 502: Medical and dental expenses. IRS, 2026. IRS

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.