Therapy isn’t just about the copay - here’s what you’re really paying
You show up for your therapy session, swipe your card, and pay $30. Easy, right? But that $30 is just the tip of the iceberg. If you’re relying on insurance to cover therapy, you might be shocked to find out how much more you’re actually spending over the year - especially if you don’t know what’s hidden behind the copay.
Let’s say your insurance says your copay is $30 per session. Sounds affordable. But what if you haven’t met your deductible yet? What if your therapist charges $125 per session and your plan only covers 20% after you hit $1,500 out of pocket? Suddenly, that $30 turns into $125 for the first dozen sessions. And if you’re seeing your therapist weekly for six months? That’s $1,500 before you even start paying the copay.
Most people don’t realize this until they get their first bill. Nearly 40% of patients say they were blindsided by their actual therapy costs, according to Shasta Health’s 2023 survey. The problem isn’t the system - it’s the lack of clear, upfront information. This guide breaks down every single cost you need to track to know exactly how much therapy will cost you, beyond that simple copay.
Understanding your insurance plan type
Not all insurance plans work the same way. Three main structures determine how much you pay for therapy: copay plans, deductible plans, and coinsurance plans. Knowing which one you have is the first step to calculating your real cost.
Copay plans are the simplest. You pay a fixed amount per session - say $30 - no matter what the therapist charges. But here’s the catch: many copay plans only kick in after you’ve met your deductible. So if your deductible is $1,500 and you haven’t met it yet, you pay the full session rate until you do. That’s not a copay - that’s full price.
Deductible plans mean you pay 100% of the cost until you hit your annual deductible. For example, if your therapist charges $125 per session and your deductible is $1,500, you’ll pay $125 for 12 sessions ($1,500 ÷ $125 = 12). Only after that do your copays or coinsurance apply.
Coinsurance plans are the trickiest. After you meet your deductible, you pay a percentage of the cost - usually 20% to 40%. If your plan has 20% coinsurance and the allowed amount for a session is $125, you pay $25. But if the therapist charges $200 (and your insurance only allows $125), you still pay $25 - because coinsurance is based on the allowed amount, not the actual charge.
Check your insurance documents or call your provider. Ask: “Is my therapy benefit structured as a copay, deductible, or coinsurance plan?” Don’t assume. You could be paying way more than you think.
The hidden cost: in-network vs. out-of-network
Choosing a therapist isn’t just about fit - it’s about money. In-network therapists have agreed to accept your insurance’s negotiated rates. Out-of-network therapists haven’t. That difference can cost you hundreds - or thousands - per year.
If you see an in-network provider, your insurance will pay a portion of the session cost based on your plan’s rules. You pay your copay or coinsurance. Simple.
But if you go out-of-network, you pay the full fee upfront. Then you submit a claim to your insurance. They reimburse you based on their “allowed amount” - which is often much lower than what the therapist charges. For example, if your out-of-network therapist charges $200 per session, but your insurance only allows $125, you might get reimbursed 50% of $125 ($62.50). That means you pay $137.50 out of pocket - even if your copay is $30.
Alma’s 2023 analysis shows patients with out-of-network benefits pay 40-50% of the session cost after deductible, compared to 20-30% for in-network. That’s a massive gap. And it gets worse in high-cost areas. In New York, the average session is $176. In North Dakota, it’s $227. Same insurance. Different prices. Same coinsurance rate. Totally different bills.
Always verify whether your therapist is in-network before booking. Ask: “Do you accept my insurance as in-network?” Don’t rely on their website or a directory - call your insurer directly. The answer matters.
What your out-of-pocket maximum really means
Here’s the good news: your insurance plan has a cap. No matter how many sessions you need, you won’t pay more than your out-of-pocket maximum in a year.
In 2024, the federal limit for individual plans is $9,350. For families, it’s $18,700. That includes all your deductibles, copays, and coinsurance for covered services. Once you hit that number, your insurance pays 100% for the rest of the year.
But here’s the catch: not all services count toward the same maximum. Some plans have separate deductibles for medical and mental health care. That means your $1,500 mental health deductible could be in addition to your $1,500 medical deductible. So you could hit $3,000 in out-of-pocket costs just to get to your mental health out-of-pocket maximum.
And if you’re on Medicare? You pay 20% of the Medicare-approved amount after your Part B deductible. That’s about $28.65 per session on average, according to Thriveworks’ 2024 data. But if you have original Medicare without a supplemental plan (like Medigap Plan G), you’re stuck with that 20% forever - unless you hit your out-of-pocket limit. And Medicare doesn’t have an out-of-pocket maximum for Part B services. That’s why many people buy Medigap - but it adds another monthly premium.
Know your plan’s out-of-pocket maximum. And ask: “Does mental health have a separate deductible or maximum?” If yes, you’re paying twice as much to get to coverage.
How many sessions will you really need?
Most people think therapy is a short-term fix. It’s not. According to Grow Therapy’s 2023 analysis, 50% of patients need 15 to 20 sessions to see real improvement. For complex issues like PTSD, depression, or trauma, 20+ sessions are common.
Let’s do the math. Say you’re paying $40 per session after your deductible. If you go weekly for 20 weeks, that’s $800. If you go weekly for 52 weeks? That’s $2,080. If you’re paying full price before your deductible? At $125 per session, 12 sessions = $1,500. Then $40 for 40 more sessions = $1,600. Total: $3,100.
And that’s just the therapy. What about transportation? Time off work? Childcare? Shasta Health’s guide points out that many patients don’t factor these in - but they add up. A 30-minute commute twice a week? That’s 52 hours a year. If you’re paid $25/hour, that’s $1,300 in lost wages.
Don’t assume therapy will end in 6 weeks. Plan for 6 months. Or a year. Build your budget around the worst-case scenario - then see if you can reduce it.
What to do if you can’t afford it
Therapy shouldn’t be a luxury. If your insurance costs are too high, or you don’t have insurance, you still have options.
First, ask your therapist about sliding scale fees. Thriveworks’ 2024 data shows 42% of private practice therapists offer income-based discounts - often 30-50% off. You don’t need to be poor. Just ask. Many don’t advertise it.
Second, try Open Path Collective. It’s a nonprofit network that connects people with therapists who charge $40-$70 per session. No insurance needed. Just a one-time $59 membership fee.
Third, university training clinics. Graduate students in psychology programs offer therapy under supervision at 50-70% below market rates. You might wait longer, but the cost is a fraction.
And if you’re on Medicaid? You often pay nothing. No copay. No deductible. Just show up.
How to calculate your total cost - step by step
Here’s a simple formula to figure out your real therapy cost for the year:
- Find your deductible. How much do you need to pay before insurance helps? Write it down.
- Find your session rate. What does your therapist charge? What does your insurance allow? Use the lower number.
- Calculate sessions until deductible is met. Divide your deductible by the allowed session rate. Example: $1,500 ÷ $125 = 12 sessions. That’s how many you pay full price.
- Find your coinsurance or copay. After deductible, what do you pay? 20%? $30? Write it down.
- Estimate total sessions. Plan for 15-20 sessions minimum. If you’re dealing with chronic issues, plan for 30-40.
- Calculate post-deductible cost. Multiply remaining sessions by your copay or coinsurance rate. Example: 18 sessions × $30 = $540.
- Add deductible + post-deductible. $1,500 + $540 = $2,040.
- Check your out-of-pocket maximum. Is your total under the cap? If yes, you’re safe. If not, your insurance will cover the rest.
- Add premiums. Don’t forget your monthly insurance payment. Multiply by 12.
- Add extras. Transportation, childcare, missed work. Be honest.
Example: Deductible $1,500, session rate $125, 20 sessions, $40 copay after deductible.
- First 12 sessions: $1,500 (deductible met)
- Next 8 sessions: $40 × 8 = $320
- Total therapy cost: $1,820
- Plus $300/month insurance premium × 12 = $3,600
- Total annual cost: $5,420
That’s not $30 per session. That’s $5,420. And you still have to pay for medication, if you need it.
Tools to help you track it
You don’t have to do this alone. Use these tools to get accurate numbers:
- Your insurance portal - Log in. Look for “mental health benefits” or “behavioral health.” It often shows your deductible progress and copay amounts.
- Alma’s Cost Estimator - Free tool. Enter your insurance and therapist. It tells you your remaining deductible and estimated cost per session.
- Rula’s cost estimator - Reports average insured patients pay $15/session. But your number will vary. Use it as a reference, not a rule.
- GoodRx - Even if you’re not buying meds, their healthcare cost data gives you context on average out-of-pocket spending.
Don’t guess. Use these tools. Update them every quarter. Your budget will thank you.
Final tip: Time your therapy with your insurance year
Your insurance resets every January. That’s your secret weapon.
If you know you’ll need 20 sessions, start in December. You’ll pay full price for 12 sessions - but those count toward your deductible. Then in January, your deductible resets. You start fresh. You can do another 12 sessions at full price - and then your copay kicks in again.
It’s not cheating. It’s strategy. And it can cut your annual cost in half.
Same goes for other medical services. If you’re getting an MRI or physical therapy, schedule it early in the year. Every covered service counts toward your deductible. The more you use, the faster you hit your out-of-pocket maximum - and the less you pay later.
Is my therapy copay the only thing I pay?
No. Your copay is just one part. You might also pay your full deductible before the copay applies, coinsurance after the deductible, and monthly premiums. If your therapist is out-of-network, you may pay even more. Always check your plan’s structure.
How do I know if my therapist is in-network?
Call your insurance provider directly. Ask: “Is [therapist’s name] in-network for mental health services?” Don’t rely on directories or therapist websites - they’re often outdated. Only your insurer has the real-time data.
What if I can’t afford my therapy payments?
Ask your therapist about sliding scale fees - 42% of private practices offer them. You can also use Open Path Collective for $40-$70 sessions, or check university training clinics for low-cost care. Medicaid often covers therapy with no out-of-pocket cost.
Does Medicare cover therapy?
Yes. Medicare Part B covers 80% of the approved amount for therapy after you meet your annual deductible. You pay 20% - about $28.65 per session on average. Without a Medigap plan, you pay that 20% forever. There’s no out-of-pocket maximum for Part B services.
How many therapy sessions do I really need?
Most people see improvement after 12-16 sessions. But for complex conditions like PTSD or chronic depression, 15-20 sessions are common. Some need 30 or more. Plan for at least 20 sessions when budgeting.
Next steps: What to do today
- Log into your insurance portal and find your mental health benefits.
- Call your therapist and ask: “What’s your fee? What’s your insurance allowed amount?”
- Use Alma’s Cost Estimator to plug in your numbers.
- Calculate your worst-case annual cost: full price until deductible, then coinsurance, plus premiums.
- Ask your therapist about sliding scale options - even if you think you make too much.
Therapy is worth it. But you shouldn’t have to go broke to get it. Knowing the real cost - not just the copay - is the first step to getting the care you need without financial shock.
