How Much Is a Therapy Copay With Insurance?

What does mental health parity law mean for my copay?

The Mental Health Parity and Addiction Equity Act (MHPAEA) 1Ref 1U.S. Department of Labor, Employee Benefits Security Administration (2024).Mental Health Parity and Addiction Equity Act (MHPAEA).Federal parity requirement that insurers cannot charge more for mental health benefits — including copays, coinsurance, and visit limits — than for comparable medical and surgical benefits — enacted in 2008 and strengthened by the Consolidated Appropriations Act of 2021 — requires that insurance plans covering mental health benefits cannot impose stricter financial requirements on those benefits than they do on comparable medical and surgical benefits. In plain language: if your plan charges a $35 copay for an in-network internal medicine specialist, it generally cannot charge more than that for an in-network licensed therapist.

This parity applies to copays, coinsurance rates, deductibles applied to mental health, and limits on the number of covered visits. Research has documented persistent gaps: patients remain significantly more likely to seek out-of-network care for mental health than for physical health, reflecting inadequate provider networks despite the law. 2Ref 2Centers for Medicare and Medicaid Services (2024).The Mental Health Parity and Addiction Equity Act (MHPAEA).Data showing patients are significantly more likely to seek out-of-network mental health care than physical health care, despite parity requirements — reflecting persistent network adequacy gaps If you believe your plan is violating parity, you can file a complaint with your state's insurance commissioner or the U.S. Department of Labor.

Why do so many people pay more than they expect for therapy?

Two common reasons:

Network gaps. Many licensed therapists, especially in private practice, do not accept insurance. They set their own rates — often between $100 and $200 or more per session — and either do not contract with insurers or have stopped accepting new insurance clients. In that case, you pay out of pocket and may or may not receive partial reimbursement through your plan's out-of-network benefit.

Deductible timing. Some plans apply the deductible to therapy visits before the copay applies. If that is how your plan works, you pay the full session cost for several visits at the start of the year until your deductible is met. Ask your insurer explicitly: 'Does my therapy copay apply before or after my deductible?'

What does a typical therapy session bill look like?

A standard therapy session is billed under a CPT code for a 45- or 60-minute psychotherapy session. The allowed amount — what your insurer has agreed to pay the in-network provider — is split between your share (your copay or coinsurance) and what the insurer pays.

An initial intake session may be billed at a higher code because it involves more time and assessment, so it may cost slightly more even under the same copay structure. Group therapy sessions, when available and in-network, are typically billed at a lower rate than individual sessions.

Ask your therapist's office which billing code they will use and what your expected cost-sharing will be.

What if my therapist is out-of-network?

Check whether your plan has out-of-network mental health benefits. Some plans — especially PPOs — reimburse a percentage of a therapist's fee, based on the plan's 'usual and customary' rate. You typically pay the full fee upfront, then submit a superbill from the therapist to your insurer and receive a reimbursement check. That reimbursement is partial and subject to your out-of-network deductible.

Ask your insurer: 'What are my out-of-network outpatient mental health benefits, and what is my out-of-network deductible and reimbursement rate?'

What lower-cost options exist if my copay or rate is too high?

• Federally Qualified Health Centers (FQHCs): HRSA-funded health centers served over 32.4 million patients in 2024 3Ref 3Health Resources and Services Administration (HRSA) (2024).Find a Health Center — HRSA Health Center Program.HRSA-funded health centers served over 32.4 million patients in 2024; FQHCs are required to provide sliding fee discounts for low-income patients and are required by federal law to offer sliding fee discounts — patients at or below 100 percent of the federal poverty level pay minimal or nominal fees. Use findahealthcenter.hrsa.gov to locate one.
• University training clinics (psychology or social work graduate programs) offer therapy with closely supervised pre-licensed therapists at reduced rates.
• Sliding-scale therapists in private practice sometimes reserve reduced-rate slots — it is worth asking directly.
• Telehealth therapy is broadly available and in many cases carries the same copay as in-person therapy, which expands the pool of in-network options.
• Employee Assistance Programs (EAPs) through your employer may offer a set number of free sessions per year — check with HR.