Managing the High Cost of Mental Health Care
Cases of anxiety, depression and other conditions are rising, and so is the price of treatment. These strategies can help you get care you can afford.
Editor’s Note: This article is the fourth in a five-part special report exploring the connection between your money and your health. Other stories in the series look at 15 ways to lower your healthcare costs, how your finances affect your physical and mental health, the challenges of long-term care and what’s new in Medicare this year.
In 2023, Kent Scheibel finally found a psychologist who seemed like the perfect fit. The therapist specialized in treating people with bipolar disorder, which Scheibel, then 51, had been diagnosed with at age 20. After decades of trying to manage extreme emotional highs and lows, the treatment helped him find steadier footing at last.
The problem was the price. Scheibel was paying $175 a week out of pocket for therapy because the psychologist, like many mental health professionals, didn’t accept health insurance. By 2025, the expense had become impossible to sustain.
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“I was feeling pressure financially,” says Scheibel, who was then self-employed as a life coach. “The first thing that goes is something like therapy. I guess you could call it a luxury even though it’s actually a necessity.”
Scheibel eventually took a full-time staff job selling insurance to qualify for employer-sponsored health coverage, a less expensive option than the $792 a month he’d been paying in premiums for a marketplace plan. He’s found a psychiatrist in his insurance network who has prescribed helpful medication. But he has yet to find an in-network therapist who meets his needs.
“My ability to function in life has to do with the care I get,” says Scheibel, now 53 and living in Marina del Rey, Calif. “I’m looking forward to having a therapist again, but it’s just not feasible financially right now.”
Scheibel’s experience underscores a difficult reality for millions of Americans: Getting mental health care can be a challenge. Paying for it may be even harder.
Nearly one in four adults in the U.S. experienced anxiety, depression or another mental, behavioral or emotional health condition in 2024, according to the latest data from the National Survey on Drug Use and Health run by the Department of Health and Human Services. The rate climbs to one in three for young adults ages 18 to 25, a group that often depends on a parent’s support — and health insurance — for care.
Yet despite how common mental health issues are, getting care is problematic for many people seeking treatment for themselves or someone they love. About half of those facing a mental health challenge in 2024 didn’t receive any treatment, according to the national survey.
Cost was one of the top barriers, cited by nearly two-thirds of adults 18 and older. About four in 10 didn’t have insurance coverage that would cover mental health treatment.
Those who do receive care often struggle to pay for it. Out-of-pocket costs for insured people who receive treatment for depression or anxiety, for instance, are almost twice as high as those for enrollees not being treated for a mental health condition, according to data from KFF, a nonpartisan health policy research organization.
Among adults with medical debt, 20% said they’d borrowed to pay bills for mental health treatment, a separate KFF survey found.
“These are choices no one should have to make,” says Jennifer Snow, national director of government relations and policy at the National Alliance on Mental Illness (NAMI). “You shouldn’t be forced to choose between your financial stability and the essential, life-improving care that you or your loved ones need.”
If your family is grappling with high out-of-pocket costs for mental health treatment, experts say there are steps you can take to help make those bills more manageable and avoid that trade-off.
Here’s what they recommend.
Why affordable care is elusive
It wasn’t supposed to be this tough. For decades, lawmakers at both the federal and state level have tried to require insurers to cover mental health and addiction treatment the same way as they cover physical health care — a concept known as parity.
The 2008 Mental Health Parity and Addiction Equity Act (MHPAEA), for example, required group health plans that cover mental health or substance use disorders to make treatment limits and financial requirements, such as deductibles, co-payments and coinsurance for those benefits, equal to those for medical care.
Two years later, the Affordable Care Act went further by requiring most individual and small-group health plans to include mental health and substance use treatment as essential health benefits. All 50 states and Washington, D.C., also have their own parity laws.
Together, the requirements have helped millions of Americans gain insurance coverage for therapy, psychiatric care and addiction treatment. But coverage on paper doesn’t always translate into care people can actually get.
Evidence, in fact, is plentiful that mental health treatment is still not on par with benefits for medical and surgical care. “No question, there is a big gap,” says Mark Covall, interim president and CEO of the National Association for Behavioral Healthcare.
One of the biggest challenges for people with coverage is finding mental health providers in their plan’s network. Insurers have struggled to build networks of mental health providers large enough to offer the same level of access that patients typically have for medical care, says Stoddard Davenport, who has researched disparities in care as a health care management consultant at Milliman, an actuarial and consulting firm.
Part of the problem is a nationwide shortage of mental health professionals, he says. But many therapists, psychologists and psychiatrists also choose not to belong to insurance networks because administrative requirements can be burdensome, and reimbursement rates are much lower compared with what other medical providers receive.
As a result, people with insurance often go outside their plan’s network to get care. A 2024 study by the Research Triangle Institute found that patients sought out-of-network care 8.9 times more often for psychiatrist visits and 10.6 times more often for psychologist visits than patients who went for medical and surgical office visits.
“Going out of network is almost always going to mean a significant increase in costs,” Snow says.
Even when people do find in-network care, out-of-pocket costs still can add up quickly. That’s because, despite parity laws, many insurers have continued to use stricter prior-authorization reviews for coverage, exclude key mental health and substance abuse treatments from benefits, and deny claims after treatment at a higher rate than they do for physical health care, according to a 2024 report to Congress on MHPAEA enforcement.
A 2024 federal rule addressed some of the disparity by requiring insurers to document how their mental health coverage plans work in practice and to measure outcomes, says Kaye Pestaina, a vice president at KFF, where she directs its program on patient and consumer protections. But the rule has faced legal challenges, and the Trump administration has not been enforcing some of its regulations, she says.
Know your rights around mental health care costs
If you have health insurance, the first step to getting mental health treatment at a price you can afford is understanding what your plan covers.
The MHPAEA doesn’t require employer group health plans to cover mental health and addiction treatment. But if they do, those benefits must be comparable to medical coverage. That means the plans typically can’t impose higher co-pays, stricter limits on appointments or separate out-of-pocket maximums for mental health services.
The parity law also applies to Medicaid plans and individual plans sold through the Health Insurance Marketplace, which are required to cover mental health and addiction treatment. It doesn’t apply to Medicare, although the program does cover a range of mental health services, including an annual screening for depression and individual and group therapy, as long as the provider is certified and accepts the insurance.
Signs that your health plan may be violating parity requirements include higher costs or fewer allowable visits for mental health services than other types of care, and requiring permission to get mental health care but not for other kinds of medical treatment and services, according to NAMI. Another red flag: None of the plan’s in-network mental health providers are taking new patients.
Before seeking treatment, ask your insurer about deductibles, co-pays and out-of-network reimbursement, as well as whether prior authorization is required. “You want to get as much information as possible up front about what you have to pay,” Pestaina says.
Also double-check with your insurer that any therapist, psychiatrist or other mental health professional you plan to see is actually in its network. Directories are often outdated and may include mental health providers who don’t accept new patients or have left the network, Pestaina says. If you contact several listed providers and can’t find one with availability, ask your insurer to identify an in-network provider who can see you. If one isn’t available, ask whether the plan will allow you to see an out-of-network provider at the in-network rate.
If your insurer denies coverage after you submit a claim for mental health treatment, you generally have up to 180 days from the date you’re notified to appeal the decision. If that’s turned down as well, you can request an independent external review. The denial notice should include information about assistance programs that can help you file an appeal, Pestaina says.
Look for lower-cost options
Can’t find a therapist, psychologist or psychiatrist in your health plan’s network who is accepting new patients? You might have other treatment options that don’t involve going out of network and being forced to pay more.
Telehealth is one of them. Your health plan might cover the cost of mental health care delivered remotely through online video conferencing. “That gets rid of geographical constraints to some extent,” Davenport says.
Your small town might not have a therapist, but a big city in your state could have several providers participating in your health plan’s telehealth network. Medicare also covers some telehealth services for mental health and addiction treatment.
Depending on your needs, your primary care provider might also be able to provide treatment or prescribe medication. “More mental health is seen in primary care than in the other setting,” says Benjamin Miller, a psychologist and adjunct professor at Stanford University School of Medicine.
There’s a growing trend known as the collaborative care model that integrates behavioral health managers and mental health clinicians into primary care practices. “It’s the easiest way to be able to have kind of a one-stop-shop, more-comprehensive approach to care,” Miller says.
Availability of this type of care varies by state. If your current primary care provider doesn’t offer integrated care, Miller recommends checking with other providers in your health plan’s network to see whether they do.
Negotiate a lower price
Therapists, psychologists and psychiatrists might be willing to adjust their rates. The key is knowing what to ask.
“Even if you have health insurance, one of the best things you can ask anybody is, Is there a difference in price if I pay cash or if I use my insurance?” Miller says. Also ask providers whether they use a sliding scale — that is, if they lower their rates based on a patient’s income or if the patient is experiencing financial hardship, he says.
Another option to keep down costs, if your health permits: Ask your provider whether you can meet less frequently, says Nancy Ruddy, a psychologist and behavioral health care consultant in Portland, Maine — say, every other week instead of weekly.
Explore other kinds of support
If the cost of traditional individual therapy is out of reach, there are other ways to get help that may be more affordable. Here are some of the approaches you might try.
Group therapy. Getting counseling in a group setting can cost half as much as one-on-one therapy, Miller says. Or there may be free peer-support groups in your community led by people with conditions similar to yours (to find out, check with community centers or the local branch of the Mental Health Association). NAMI also offers free groups for a variety of mental health conditions (find one here).
Employee assistance programs. Nearly all large and midsize U.S. companies, along with many small businesses, offer this free benefit, which provides short-term, confidential counseling for employees. The program typically covers three to six sessions, and counselors can help with referrals to other mental health care providers as well. “It’s a good place for people to start,” especially if you don’t need long-term treatment for a chronic condition, Ruddy says.
Certified Community Behavioral Health Clinics. These clinics are required to serve anyone with a mental health or substance use need, regardless of their ability to pay. The National Council for Mental Wellbeing has a list of CCBHCs by state. Telehealth services are available, and you don’t have to live in the state where they’re based to access them.
Student therapists. If you live near a university, you or your loved one might be able to see a student who is training to be a psychologist, social worker or family therapist. These clinicians-in-training typically charge much lower rates and are supervised by experienced mental health care providers, Ruddy says.
Online services. If you simply need some tips to get through a tough time, Ruddy suggests you look for therapist posts online that offer techniques to deal with conditions such as stress and anxiety. Look for videos that offer evidence-based strategies, she says. For example, mental health education platform Psych Hub has a YouTube channel featuring mental health experts.
Stay persistent
“All of these things may feel like you’re jumping through a hoop of fire backwards, blindfolded,” Miller says. He suggests trying to reframe how you think about the challenge: “It’s just trying to find a way you can get more timely access to the things that you have a right to get access to.”
Adds NAMI’s Snow, “Unfortunately, it’s set up that people have to stand up and fight for what they need.”
The payoff is usually worth it, says Kent Scheibel, who is all too familiar with how staying proactive about your care can make a meaningful difference in your overall well-being. “I’ve learned firsthand that without good mental and physical health, it’s difficult to achieve and enjoy anything in life,” he says. “Remember, you do have options.”
Note: This item first appeared in Kiplinger Personal Finance Magazine, a monthly, trustworthy source of advice and guidance. Subscribe to help you make more money and keep more of the money you make here.
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