Therapy isn’t just about the $30 you pay at the door
Most people think their therapy copay is the full price. You show up, swipe your card, pay $30, and walk out. Easy. But that $30? It’s just one piece of a much bigger financial puzzle. If you’re in therapy long-term - and most people are - you could end up paying thousands more than you expect. And no one tells you until it’s too late.
What your insurance card doesn’t show you
Your insurance card says ‘$30 copay for therapy.’ That’s it. But what if you haven’t met your deductible yet? Then that $30 doesn’t apply. You pay the full session fee - maybe $125 or more - every time until you hit your deductible. That’s not a small difference. If your deductible is $1,500 and each session costs $125, you’ll pay $1,500 out of pocket before your copay even kicks in. That’s 12 sessions. Just to get to the point where your copay starts working.
And if your plan uses coinsurance instead of a fixed copay? Now you’re paying 20% to 40% of the full cost after your deductible. So if your therapist charges $140 and your coinsurance is 30%, you’re paying $42 per session - not $30. And if you need 20 sessions? That’s $840 just in coinsurance, not counting what you already paid to meet your deductible.
In-network vs. out-of-network: A massive cost gap
Not all therapists are created equal when it comes to cost. If your therapist is in-network, your insurance has a deal with them. They agree to charge a set rate - say $125 per session - and your plan covers part of it. You pay your copay or coinsurance, and that’s it.
But if your therapist is out-of-network? You’re on your own. You pay the full fee upfront - maybe $180 or $220 - and then you submit a claim to your insurance. They might reimburse you 50% of what they consider the “allowed amount,” which could be $100. So you pay $180, get back $50, and still owe $130. That’s more than double what you’d pay in-network.
And here’s the kicker: out-of-network providers don’t have to tell you their rates upfront. You might not realize how expensive it is until you get the bill. In some states, therapy sessions for out-of-network providers average $227. That’s not a typo.
How many sessions do you really need?
Most people assume therapy is a few sessions. But real change takes time. According to data from Grow Therapy, 50% of patients need 15 to 20 sessions to see real improvement. For conditions like anxiety, depression, or PTSD, 20 sessions is the norm, not the exception.
So if you’re paying $40 per session after your deductible, and you need 20 sessions? That’s $800. Add the $1,500 you paid to meet your deductible? You’re at $2,300. And that’s before you factor in your monthly premium - which you’re paying whether you use therapy or not.
Now multiply that by a year. Weekly sessions? That’s 52 sessions. Even with a $40 copay, that’s $2,080 in copays alone - not counting your deductible. If you’re on coinsurance, it could be $4,000 or more.
The out-of-pocket maximum: Your financial safety net
Every insurance plan has a cap. In 2024, the maximum you can pay out of pocket for in-network services is $9,350 for an individual plan. That includes your deductible, copays, and coinsurance - everything. Once you hit that number, your insurance pays 100% for the rest of the year.
But here’s the trap: that cap doesn’t include your monthly premium. And it doesn’t cover services that don’t count toward your mental health deductible. Some plans have separate deductibles for medical and mental health care. So even if you’ve paid $9,000 toward your medical deductible, your mental health deductible might still be at $1,500. You’re not protected until you hit both.
And if you’re on Medicare? You pay 20% of the approved amount after your Part B deductible. That’s $28.65 per session on average - but only if your therapist accepts Medicare assignment. If they don’t, you could pay more.
What you’re not counting - and it adds up fast
Therapy isn’t just the session fee. There’s gas or public transport to get there. Time off work. Childcare. Maybe even parking. One patient in Adelaide told me she spent $25 a week on parking alone. That’s $1,300 a year - extra.
And if you’re taking medication? That’s another cost. Antidepressants, anti-anxiety meds - even with insurance, you might pay $10 to $50 a month per prescription. That’s $120 to $600 a year. Add that to your therapy costs, and you’re looking at $3,000 to $5,000 just for mental health care.
What to do if you can’t afford it
You don’t have to pay full price. About 42% of private practice therapists offer sliding scale fees based on income. That means you could pay $50, $70, or even $30 per session instead of $125. You just have to ask.
Open Path Collective connects uninsured people with therapists who charge $40 to $70 per session. University training clinics - where graduate students provide therapy under supervision - often charge 50% to 70% less than private providers. Some even offer free sessions.
And don’t overlook group therapy. It’s often half the price of individual sessions and just as effective for many conditions.
How to calculate your total cost - step by step
- Find your plan type. Is it copay, deductible, or coinsurance? Call your insurer or check your online portal.
- Check your deductible. How much have you paid so far this year? How much is left?
- Know your session cost. Ask your therapist what they charge in-network. If you’re out-of-network, ask what they charge and what your insurance allows.
- Estimate your session count. Will you do 12 sessions? 20? 52? Be realistic.
- Calculate Phase 1: Pre-deductible. Multiply the full session cost by how many sessions you’ll have before hitting your deductible.
- Calculate Phase 2: Post-deductible. Multiply your copay or coinsurance rate by the remaining sessions.
- Add your annual premium. Multiply your monthly premium by 12.
- Include extras. Transport, childcare, medication.
- Check your out-of-pocket maximum. Will you hit it? If so, your costs drop to zero after that point.
Example: Deductible $1,500, session cost $125, 20 sessions, $40 copay after deductible.
- Phase 1: 12 sessions × $125 = $1,500 (deductible met)
- Phase 2: 8 sessions × $40 = $320
- Premium: $300/month × 12 = $3,600
- Transport: $25/week × 52 = $1,300
- Total: $1,500 + $320 + $3,600 + $1,300 = $6,720
That’s not $30 per session. That’s $6,720.
What to do next
Don’t wait until you’re deep into therapy to realize you can’t afford it. Call your insurance company. Ask for a breakdown of your mental health benefits. Use tools like Alma’s Cost Estimator or Rula’s calculator. Ask your therapist if they offer sliding scale fees. Look into Open Path or university clinics.
Therapy is worth it. But it shouldn’t bankrupt you. Knowing the real cost - not just the copay - is the first step to getting the care you need without the financial shock.
Is my therapy copay the only thing I pay?
No. Your copay only applies after you’ve met your deductible. If you haven’t met it yet, you pay the full session cost. You also pay your monthly insurance premium regardless of how many sessions you use. And if your plan uses coinsurance, you pay a percentage of the session cost after your deductible - not a fixed amount.
How do I know if my therapist is in-network?
Call your insurance company and ask for a list of in-network mental health providers. You can also check your insurer’s website or app. If your therapist says they’re in-network, ask them to confirm with your insurance directly. Don’t rely on their word alone.
Can I use my HSA or FSA for therapy?
Yes. Therapy is a qualified medical expense under both Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs). You can use pre-tax dollars from these accounts to pay for copays, coinsurance, or even full session fees if you’re out-of-network. This can reduce your out-of-pocket cost by 20% to 30%, depending on your tax bracket.
What if I don’t have insurance?
You still have options. Look for therapists who offer sliding scale fees based on income. Check Open Path Collective for sessions between $40 and $70. University training clinics often charge 50% to 70% less than private providers. Some community health centers offer free or low-cost mental health services. Don’t assume therapy is unaffordable without insurance.
Do all therapy sessions count toward my deductible?
Not always. Some insurance plans have separate deductibles for medical and mental health services. Even if you’ve paid $9,000 toward your medical deductible, your mental health deductible might still be $1,500. Always ask your insurer if your mental health visits count toward the same deductible as your doctor visits or prescriptions.
Can I reduce my therapy costs by timing my sessions?
Yes. If you’re close to hitting your deductible, you might want to start more sessions before the end of the year. That way, you meet your deductible faster, and your copay kicks in sooner. If you start therapy early in the year, you’ll pay more out of pocket early on - but your costs will drop later. Plan your sessions around your insurance year reset date.
Is group therapy cheaper than individual therapy?
Yes. Group therapy sessions typically cost half as much as individual sessions - often $25 to $60 per session. Many insurance plans cover group therapy at the same rate as individual therapy. For conditions like anxiety, depression, or grief, group therapy can be just as effective and far more affordable.
What’s the average cost of therapy without insurance?
Without insurance, the average therapy session costs $143.26, according to Thriveworks’ 2024 data. But prices vary widely: $176 in New York, $227 in North Dakota, and around $130 in most Australian cities. In Adelaide, you can expect $120 to $160 per session without insurance. Sliding scale fees can cut that in half.
Final thought: Know the full price before you start
Therapy changes lives. But it shouldn’t come with a financial surprise. The copay is just the tip of the iceberg. If you don’t understand your deductible, coinsurance, out-of-pocket max, and session frequency, you’re flying blind. Take 15 minutes today to call your insurer. Ask the questions. Do the math. You’ll thank yourself later.
