Most people think their therapy copay is the whole story. You see $30 on your insurance card, assume that’s what you’ll pay per session, and budget accordingly. But that’s only the tip of the iceberg. If you’re paying for therapy long-term - and most people need 12 to 20 sessions to see real change - the real cost adds up fast. And if you haven’t met your deductible yet? You could be paying hundreds per session before your copay even kicks in.
What You’re Really Paying: More Than Just the Copay
Your copay isn’t the full price of therapy. It’s just the portion your insurance lets you pay after you’ve met other financial obligations. To know what you’ll actually spend, you need to understand three key pieces: your deductible, your coinsurance, and whether your therapist is in-network or out-of-network.Let’s say your therapist charges $125 per session. Your insurance says your copay is $30. Sounds good, right? But if your annual deductible is $1,500, you’ll pay the full $125 for each session until you’ve spent $1,500 out of pocket. That’s 12 sessions before your copay even applies. By then, you’ve already paid $1,500 - not $30.
And if your plan uses coinsurance instead of a flat copay? That’s even trickier. Let’s say you have a 20% coinsurance after your $3,000 deductible. That means once you hit $3,000, you still pay 20% of every session’s allowed amount. If your therapist’s allowed rate is $125, you pay $25 per session after the deductible. But if you need 20 sessions total? You’re looking at $3,000 (deductible) + $500 (20 sessions × $25) = $3,500 total. That’s not $30 per session. That’s nearly $175 per session on average.
In-Network vs. Out-of-Network: A Big Difference in Your Wallet
Choosing a therapist who’s in-network can save you hundreds - or even thousands - over the year. In-network providers have agreed to accept your insurance’s negotiated rate. That means if your insurance says the allowed amount for a session is $125, the therapist can’t charge you more than that.Out-of-network therapists? They can charge whatever they want. Your insurance might only cover a portion of that cost - often based on what they consider “usual and customary” in your area. If your out-of-network therapist charges $200 per session, but your insurance only allows $125, you pay the full $200 upfront. Then your insurance reimburses you 50% of the allowed amount ($62.50). So you’re out $137.50 per session. That’s more than double what you’d pay in-network.
And here’s the kicker: out-of-network payments usually don’t count toward your in-network deductible or out-of-pocket maximum. So you’re paying more, and getting less coverage in return.
What About Medicare and Medicaid?
If you’re on Medicare, the math changes again. Medicare covers 80% of the approved amount for therapy. That means you pay 20% - plus any Part B deductible. For a $143 session, that’s about $28.60 per session after the deductible. But if you have a Medigap Plan G, it covers that 20% coinsurance. So your out-of-pocket drops to just the Part B deductible - usually around $226 for 2025.Medicaid plans vary by state, but most have little to no copay for therapy. In many cases, you’ll pay nothing out of pocket. That’s a huge difference compared to private insurance plans.
How Many Sessions Will You Really Need?
Most people think therapy is a short-term fix. But data shows that’s not usually the case. According to Grow Therapy’s 2023 analysis, 50% of patients need 15 to 20 sessions to see meaningful improvement in symptoms like anxiety or depression. For trauma, PTSD, or chronic conditions, it’s often 25+ sessions.So if you’re paying $40 per session after your deductible, and you need 20 sessions? That’s $800. If you’re paying $125 per session before your deductible? That’s $2,500 before insurance even helps. Add in monthly premiums - which average $200-$400 per month for individual plans - and you’re looking at over $3,000 just for therapy in a year, even with insurance.
Out-of-Pocket Maximums: The Safety Net
Every insurance plan has an out-of-pocket maximum - the most you’ll pay in a year for covered services. In 2025, that cap is $9,350 for individuals and $18,700 for families. Once you hit that number, your insurance pays 100% of covered therapy costs for the rest of the year.But here’s what most people miss: only in-network services count toward this cap. Out-of-network payments don’t always roll in. And some plans have separate deductibles for mental health and medical care. So if you’ve spent $5,000 on your knee surgery, that doesn’t help you meet your mental health deductible.
That’s why tracking your spending matters. Check your insurance portal every few months. Look for: total paid toward deductible, total paid toward out-of-pocket max, and how many therapy sessions you’ve had.
What If You Don’t Have Insurance?
About 1 in 5 Americans don’t have mental health coverage. But therapy doesn’t have to be $150+ per session. Sliding scale fees are more common than you think. Thriveworks’ 2024 data shows 42% of private therapists offer income-based rates - often cutting costs by 30-50%. A $125 session might drop to $60 or $70.Platforms like Open Path Collective connect uninsured people with therapists who charge $40-$70 per session. University training clinics, staffed by supervised grad students, often charge 50-70% less than private practices. Some community centers even offer free group therapy.
These aren’t last resorts - they’re realistic options. And they’re worth exploring even if you have insurance but a high deductible. If you’re paying $125 per session until you hit your $1,500 deductible, you might as well switch to a sliding scale provider for the first 10-12 sessions. You’ll save money and still get the care you need.
How to Build Your Real Therapy Budget
Here’s how to calculate your actual cost, step by step:- Find your plan type: Is it copay, deductible, or coinsurance? Check your insurance summary or call your provider.
- Confirm your therapist’s network status: In-network or out-of-network? Ask the therapist directly - don’t rely on your insurance website.
- Ask for the allowed amount: What’s the maximum your insurance will pay per session? That’s the number that matters for coinsurance.
- Estimate your session count: Plan for 12-20 sessions, unless your provider says otherwise.
- Calculate Phase 1 (pre-deductible): Full session cost × sessions until deductible is met.
- Calculate Phase 2 (post-deductible): Copay or coinsurance × remaining sessions.
- Add your monthly premium: Multiply by 12. That’s a fixed cost, even if you don’t use therapy.
- Check your out-of-pocket max: Will you hit it? If yes, your cost stops after that point.
Example: You have a $1,500 deductible, $40 copay, and a $125 session rate. You plan for 20 sessions.
- Phase 1: $125 × 12 sessions = $1,500 (deductible met)
- Phase 2: $40 × 8 sessions = $320
- Total therapy cost: $1,820
- Plus $2,400 in annual premiums = $4,220 total
That’s not $600. That’s over $4,000.
Tools to Help You Track It
You don’t have to do this alone. Use these tools:- Your insurance portal - search for “mental health benefits” or “cost estimator.”
- Alma’s free Cost Estimator Tool - enter your insurance and therapist to see your exact out-of-pocket.
- Rula’s calculator - shows average costs by plan type and location.
- GoodRx Mental Health - compares therapy prices and finds discounts.
And don’t forget: transportation, time off work, and childcare can add $50-$100 per week. Include those in your budget too.
Final Tip: Timing Matters
If you’re close to hitting your deductible, consider starting therapy in the last quarter of the year. That way, you pay full price now - but it counts toward next year’s deductible. You’ll reset your financial reset point, and your copay will kick in sooner.Or, if you’re near the end of your out-of-pocket max, push your last few sessions into the next year. You might pay more per session, but you’ll avoid paying more than you have to.
Therapy isn’t just about your mental health. It’s a financial decision too. And if you don’t understand the real cost, you’ll get stuck - either in therapy you can’t afford, or in silence because you’re afraid of the bill.
Is my therapy copay the only thing I pay?
No. Your copay is just the portion you pay after meeting your deductible. Before that, you pay the full session rate. You may also owe coinsurance - a percentage of the allowed amount - even after your deductible is met. Plus, your monthly insurance premium adds to your total cost.
What’s the difference between in-network and out-of-network therapy?
In-network therapists agree to your insurance’s negotiated rate. You pay a set copay or coinsurance. Out-of-network therapists can charge more, and your insurance may only reimburse you a portion - often based on a lower “allowed amount.” You pay the difference, and those payments may not count toward your out-of-pocket maximum.
Do I have to pay my deductible before therapy is covered?
Yes - for most plans. You pay the full cost of each therapy session until you’ve spent your deductible amount. Only after that does your copay or coinsurance apply. Some plans have separate mental health deductibles, so your medical expenses (like doctor visits) might not count toward your therapy deductible.
How many therapy sessions do most people need?
Most people see improvement after 12-16 sessions. But for complex issues like trauma, anxiety, or depression, 15-20 sessions are common. Some need 25+ sessions. Don’t assume therapy is short-term - plan your budget for at least 15 sessions.
Can I get therapy for less if I don’t have insurance?
Yes. About 42% of private therapists offer sliding scale fees based on income. Platforms like Open Path Collective offer sessions for $40-$70. University training clinics, staffed by supervised students, often charge 50-70% less than private practices. These are legitimate, affordable options.
What’s the out-of-pocket maximum for therapy?
In 2025, the federal out-of-pocket maximum is $9,350 for individuals and $18,700 for families. Once you hit that limit, your insurance pays 100% of covered therapy costs for the rest of the year. But only in-network expenses count toward this cap. Out-of-network payments often don’t contribute.
Alex Curran
Most people don't realize their deductible eats up half their therapy budget before the copay even kicks in
I went through this last year with anxiety therapy and ended up paying $2k before my $40 copay started
Turns out my insurance had a separate mental health deductible that wasn't listed anywhere obvious
Just called them and they said it was buried in the fine print of the PDF
Don't trust the website, call the number on your card