Navigating Insurance For Therapy: Your 2026 Guide

Therapy

Nov 25

If you're reading this over Thanksgiving weekend because you've been meaning to review your insurance benefits before the deadline, you're not alone. Many employer open enrollment periods close in early December, making this your last window to understand your coverage and make informed decisions about your mental health benefits for 2026.

Let's be honest: finding a therapist is hard enough without trying to decode your insurance benefits. And with premiums going up across the board, it's even more frustrating when you can't get a straight answer about what your plan actually covers.

We get it. Insurance is confusing, and mental health coverage seems intentionally complicated. That's why we put this guide together—to help you understand what you're working with and find a path forward that actually works for your life and budget.

As we head into 2026, a lot of our clients are dealing with higher premiums and shrinking benefits. It's discouraging, and we're not going to sugarcoat that. But here's what we also know: taking care of your mental health is still one of the most important investments you can make—for yourself, your relationships, and your family.

"Is it too late to do anything about my 2026 coverage?"

It depends on your situation:

If you have employer-sponsored insurance: Many open enrollment periods close in early December, so if your deadline hasn't passed, this might be your last chance to make changes. Check with HR immediately to confirm your deadline.

If you're on a marketplace/ACA plan: You have until January 15, 2026, to enroll or make changes (though enrolling by December 15 gets you January 1 coverage).

If your enrollment already closed: You can't change your plan selection, but that doesn't mean you're out of options. This guide will show you how to maximize whatever coverage you have, explore alternative payment options, and advocate for better benefits.

What you CAN do right now:

Understand exactly what coverage you have and how to maximize it
Explore HSA/FSA funds you may already have available
Learn about sliding scale and out-of-network options
Advocate with your HR department if you have a self-funded plan with restrictive coverage
Plan your therapy strategically around deductibles and out-of-pocket maximums
Make the most of each session with your therapist

This guide will help you navigate the insurance maze and explore all your options for making therapy work within your budget, no matter what time of year you're reading this.

Understanding Your Insurance Benefits

What Does “In-Network”

When your therapist is in-network, it means the provider has signed a contract with your insurance carrier to provide services for an agreed-upon rate. Your policy will cover their services (if deemed medically necessary) according to your plan benefits, and you'll only be responsible for your copay or deductible/coinsurance.

InPowered Therapy is currently in-network with most BCBS PPO, Blue Choice PPO plans, and Aetna.

What Is A Copay?

A copay is the fixed amount you pay per session. For example, if a session costs $150 and you have a $20 copay, you pay $20 and insurance covers the remaining $130. With rising premiums, some employers are switching to higher copays, but these plans still offer predictable costs per session.

What Is A Deductible and Coinsurance?

High-deductible plans often come with lower monthly premiums, which is why more employers are offering them as costs rise. Here's how they work:

Deductible: The amount you pay out-of-pocket before insurance starts covering services
Coinsurance: The percentage you pay after meeting your deductible

Example: With a $1,000 deductible and 20% coinsurance, you'd pay the full contracted rate until you've spent $1,000 on healthcare. After that, you'd pay 20% of each session's cost.

Planning tip: If you're on a high-deductible plan, consider scheduling therapy sessions strategically. Many people front-load sessions early in the year when they're meeting their deductible, knowing that costs decrease once the deductible is met.

What Is An Out-Of-Pocket Max?

This is the maximum amount you'll pay for healthcare in a plan year. Once you reach this amount, you'll owe $0 for covered services until the next plan year (typically January 1st).

Note: Out-of-pocket maximums are often separate for in-network vs. out-of-network services.

2026 Planning Tip: If you've had significant medical expenses and are close to your out-of-pocket max late in the year, this might be an ideal time to increase therapy frequency or address deeper issues while services are fully covered.

What Is An Insurance Carve-Out?

Increasingly common, carve-outs mean your mental health benefits are provided through a separate insurance company than your primary plan.

Most common example: BCBS primary plans often carve out mental health coverage to Optum (also known as United Health Insurance). InPowered Therapy is NOT in-network with Optum.

This is one reason why it's crucial to verify your specific mental health coverage, not just your primary insurance.

What Are HSA and FSA Accounts?

Both Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA) are pre-tax savings accounts for qualified medical expenses, including therapy.

HSA: Available with high-deductible plans, higher contribution limits, funds roll over year to year
FSA: Lower contribution limits, funds typically must be used by end of year or are forfeited

2026 Money-Saving Strategy: Contributing to an HSA or FSA reduces your taxable income while setting aside funds specifically for healthcare. For 2026, HSA contribution limits are $4,300 for individuals and $8,550 for families. Even setting aside $50-100 per paycheck can make therapy more affordable throughout the year.

When Your Therapist is Out-of-Network

What Does "Out-Of-Network" Mean?

Being out-of-network means your therapist hasn't signed a contract with your insurance company. This happens when insurance companies offer inadequate compensation rates, are difficult to work with, or aren't accepting new providers.

You may still have coverage. Many plans include out-of-network benefits with a separate deductible and coinsurance percentage. Some plans actually have solid out-of-network coverage, making it worth exploring even with rising costs.

We're happy to help you check your out-of-network benefits if you'd like more information.

Using Superbills For Reimbursement

If you have out-of-network benefits, here's how it works:

You pay your therapist at the time of service
Your therapist provides a superbill (detailed receipt with diagnostic codes)
You submit the superbill to your insurance for reimbursement
Insurance reimburses you based on your out-of-network benefits

While this requires paying upfront, many clients find the flexibility of choosing their ideal therapist worth the administrative step.

We've Made This Easier: Partnership with Mentaya

We've partnered with Mentaya to streamline out-of-network reimbursement. You can check your out-of-network benefits using our benefit checker, and Mentaya can handle the processing and submission of your out-of-network claims for you. This takes the administrative burden off your plate so you can focus on your therapy, not paperwork.

What If My Out-Of-Network Benefits Don’t Help?

We offer sliding scale fees—reduced rates that don't go through insurance. Our sliding scale options start around $80-$100 per session depending on your clinician's license level, training, and experience.

We believe everyone deserves access to quality mental health care. Don't let insurance barriers prevent you from reaching out. Let's have a conversation about what might work for your situation.

Understanding Self-Funded Plans (And Why You Should Care)

This is one of the most important sections for many of our clients, yet most people don't even know what type of plan they have.

What Is A Self-Funded Plan?

With a self-funded plan, your employer actually pays your healthcare claims—the insurance company just processes them. With a fully-funded plan, the insurance company pays your claims.

Why Does This Matter So Much?

Fully-funded plans must follow state insurance regulations, including Illinois laws that protect your access to telehealth without platform restrictions.

Self-funded plans are exempt from state insurance laws. This means your employer gets to decide:

Whether to cover telehealth at all
Which platforms are approved for telehealth
Whether telehealth is reimbursed at the same rate as in-person care

As of 2026, we're seeing more self-funded plans restricting or denying telehealth coverage, or limiting it to platforms like MDLive that we are NOT in-network with.

How To Find Out Which Type of Plan You Have

Call your insurance company and ask: "Is my plan fully-funded or self-funded?"

You can also check your plan documents—look for language about "ERISA" (Employee Retirement Income Security Act), which typically indicates a self-funded plan.

If You Have A Self-Funded Plan: Advocate With Your HR Department

Here's what many people don't realize: your employer chose these restrictions. And employee feedback can influence their decisions, especially during annual plan reviews.

What you can do:

Contact your HR benefits team and express concerns about mental health coverage
Share specific impacts: "The telehealth restrictions prevent me from accessing my established therapist" “telehealth allows me to see my provider on my lunch hour and maintain better work/life balance”
Request they reconsider platform restrictions or telehealth limitations
Connect with colleagues who share concerns—collective feedback carries more weight
Emphasize the business case: better mental health access reduces absenteeism and improves productivity

Talking points for HR:

"Illinois law protects telehealth access for fully-funded plans. Why doesn't our self-funded plan offer the same protection?"
"Restricting telehealth to specific platforms limits access to quality care and disrupts established therapeutic relationships"
"As healthcare costs rise, telehealth is a cost-effective way to maintain mental health benefits"
"Mental health parity laws require equal coverage—are telehealth restrictions creating disparities?"

The Impact On Your Care

If you're in a self-funded plan WITH telehealth restrictions:

You may need to see your therapist in-person only
You may need to switch to a platform-based provider (disrupting your established relationship)
You may face denied claims for telehealth services
You may need to use out-of-network benefits or private pay options

We want to help you navigate this. If you're facing telehealth coverage issues due to a self-funded plan, let's discuss your options. We can also provide documentation to support your HR advocacy efforts.

InPowered Therapy is NOT in-network with designated platforms such as MDLive.

Making Therapy Work in 2026: Strategic Planning

As healthcare costs rise, here are some ways to prioritize your mental health:

Review Your Plan During Open Enrollment

Note: If you're reading this around Thanksgiving and your employer open enrollment closes in early December, act now—this is your window. If your enrollment already closed, bookmark these tips for next year. Most companies hold open enrollment in October-November, with deadlines ranging from late November to early December.

Compare mental health benefits across plan options
Calculate total costs: premiums + anticipated therapy costs
Sometimes a higher-premium plan with better mental health coverage costs less overall

Maximize Your Benefits Early

If you have a deductible, consider how other healthcare needs might help you meet it
Schedule therapy proactively rather than waiting for crisis
Start now: Even if it's late in the year, establishing care now means you're ready when your deductible resets January 1st

Use Pre-Tax Accounts Strategically

Maximize HSA/FSA contributions during open enrollment
Remember: therapy is a qualified medical expense
If you already have an HSA/FSA: Use those funds for therapy sessions—you've already set that money aside
Planning for 2026: If you missed this year's enrollment, calculate what you spent on therapy in 2025 and set that as your 2026 contribution goal

Consider Session Frequency Flexibly

Weekly sessions when you're working through acute issues
Bi-weekly or monthly maintenance sessions during stable periods
Intensive periods when you've met your deductible

Communicate With Your Therapist

We understand financial constraints and can work with you on frequency
We can help you make the most of each session
We can provide resources between sessions to extend your care

Your Mental Health Is Worth Prioritizing

Rising healthcare costs are real, and we won't minimize the financial stress many people face. At the same time, we've seen countless clients find that investing in therapy—whether through insurance, out-of-pocket, or sliding scale—remains one of the most valuable investments they make.

Mental health challenges don't pause because premiums increase. In fact, financial stress often makes mental health support even more crucial. We're committed to working with you to find a sustainable path forward.

Questions to Ask Your Insurance Before Starting Therapy

Basic Coverage:

Is InPowered Therapy (NPI # 1801330048) in-network with my plan?
How does my plan cover "outpatient behavioral health" services (CPT Codes 90834 and 90837)?
Does my plan require pre-authorization for outpatient mental health services?

Cost Details (specify IN or OUT of network):

Do I have a deductible or a copay? If you have a deductible ask:
- How much is it?
- How much have I already met this year?
- What is my coinsurance percentage after meeting my deductible?
What is my out-of-pocket maximum?

Plan Type:

Is my plan fully-funded (claims paid by the insurer) or self-funded (claims paid by my employer)?

Telehealth Coverage (especially important for self-funded plans):

Does my plan cover telehealth for mental health services?
Is telehealth reimbursed at the same rate as in-person services?
Are there restrictions on which telehealth platforms my therapist can use?