3 Steps to Understanding and Maximizing Your Mental Health Insurance Coverage (Updated for 2025)

Start by securing a copy of your insurance policy from your employer’s HR department or directly from your insurer’s website. Review the Summary of Benefits (SOB) to quickly understand what mental health (also called behavioral health or psychiatric) services are covered, such as counseling, therapy, psychiatric visits, and prescription medications.

Federal regulations (MHPAEA and the Affordable Care Act) mandate equal coverage for mental health and medical services, stating that copays and deductibles for mental health visits cannot be higher than for other medical visits.

In 2024, new MHPAEA regulations further require insurers to:

• Conduct and document analyses showing their mental health coverage standards are equivalent to their other medical coverage standards.
• Ensure their policies and network standards don’t unfairly limit access to mental health services compared to other medical services.
• Clearly disclose these analyses and coverage details upon request.

Watch Out for Red Flags

Be cautious about certain terms in your policy that might complicate mental health coverage:

• Medical Necessity: Ambiguity around whether a service qualifies for coverage.
• Pre-Authorization: Required approval before services are covered.
• Step Therapy: Mandates trying lower-cost treatments before more expensive options.
• Non-Quantitative Treatment Limitations (NQTLs): Includes requirements like prior authorizations and network restrictions that must not disproportionately affect mental health coverage.

Consider selecting providers in your insurance network to help avoid extra costs. Confirm provider participation by:

• Calling the provider’s office directly.
• Checking your insurance’s online directory.

While the number of private practice therapists who accept insurance is limited, there are other kinds of providers who almost always accept insurance. Mental health care clinics run by large health systems nearly always take major insurance, for example. Large mental health care companies with offices nationwide usually work with most major health insurance plans, making it more likely that their services will be in-network for your insurance. LifeStance accepts many major insurances across more than 550 locations and approximately 7,400 providers. Once you find a mental health care clinic near you, our helpful office staff will use your insurance information to determine what benefits you have and what your copay may be. This way you can focus on your treatment and not on the scope of your insurance coverage.

Your policy typically outlines copays (fixed amounts) or coinsurance (percentage-based) you owe for services:

• • Copay: If your medical visits have a $25 copay, for example, mental health visits should also cost $25.
  • Coinsurance: You might pay a percentage (e.g., 20%) of service costs after meeting your deductible.

Be sure to understand your deductible—the amount you must pay out-of-pocket before insurance coverage starts. Always verify costs with your insurer or a LifeStance representative before scheduling appointments, to avoid unexpected bills.

Online Therapy & Psychiatry

Online therapy and counseling sessions are now widely covered by health insurance at the same rate as in-person visits. LifeStance offers both onsite and online therapy and psychiatry services.