What You Need to Know About Health Insurance and Deductibles for Therapy Services in the New Year
Navigating health insurance can feel like trying to read an ancient map with missing pieces—confusing, frustrating, and overwhelming. When it comes to mental health services like therapy, understanding how your insurance works, particularly regarding deductibles, is essential for ensuring you can continue receiving the care you need.
At Wild Hope Therapy, we want to empower you with the knowledge to make informed decisions about your mental health coverage. In this guide, we’ll explain how health insurance is used to pay for therapy, what deductibles are, how they reset at the beginning of the year, and what steps you can take to prepare for any changes. We know this process can be complicated, but with the right information and support, it’s manageable—and worth it.
Using Health Insurance for Mental Health Services
Health insurance can make mental health services like therapy more affordable by covering a portion of the costs. When you use insurance, the process usually involves these key terms:
Premiums: The monthly amount you pay to maintain your health insurance.
Copay: A set amount you pay for each session, such as $25 or $40, depending on your plan.
Deductible: The amount you must pay out of pocket for covered services before your insurance starts covering more of the cost.
Coinsurance: A percentage of the cost you’re responsible for after your deductible has been met.
For example, if you see a therapist who charges $150 per session, and your plan has a $25 copay for mental health services, you would pay $25, and your insurance would pay the remaining $125 (or the fee the insurance company has contracted with your provider, often less than their full fee.) The confusing part is that this does not kick in until after you meet your deductible (if applicable). That means that if your deductible hasn’t been met, you may be responsible for the full session cost until you’ve reached your deductible amount.
What Is a Deductible?
A deductible is the amount you must pay out of pocket for covered health services before your insurance begins to pay its share. Deductibles can vary widely depending on your insurance plan—some are as low as $500, while others can be $2,000 or more.
Here’s an example of how a typical deductible might work:
Your insurance plan has a $1,000 deductible.
You attend therapy sessions at Wild Hope Therapy, for which your insurance provider agrees to pay a contracted rate (usually different than your clinician’s listed rate.)
Until you meet your deductible, you will pay the full contracted rate per session out of pocket.
Once you’ve paid $1,000 for covered health services (including therapy), your insurance kicks in. After that, you might only need to pay a copay (e.g., $25 per session) or a coinsurance percentage (e.g., 20% of the session cost).
For many insurance plans, deductibles reset at the beginning of the year, meaning you start from zero on January 1st.
Why Deductibles Reset in the New Year
Deductibles typically run on a calendar year basis, starting on January 1st and ending on December 31st. If you’ve met your deductible during the previous year, you may have become accustomed to paying lower costs for therapy sessions (e.g., just your copay). But once the new year begins, you’ll need to meet your deductible again before those lower costs resume.
This shift can catch people off guard, especially if they’re not aware of how deductibles work. Suddenly paying more for sessions that were previously covered can be frustrating, but understanding this process in advance can help you plan and budget for the transition.
Steps to Ensure You’re Prepared for Changes
If you’re unsure how your insurance will affect your therapy costs after January 1st, here’s what you can do to prepare:
1. Check Your Plan Details
Log into your insurance portal or call your insurance provider to review your plan’s deductible, copay, and coinsurance amounts. Make note of whether your deductible resets on January 1st and how much you’ve already paid toward it this year. If it resets at a different time of year, set a reminder in your calendar to redo this process then!
2. Estimate Costs for the New Year
If you have not met your deductible by December 31st, calculate how much you’ll likely need to pay for therapy sessions at the start of the new year. For example, if your deductible is $1,000, and your therapy sessions cost $150, you’ll pay for about seven sessions out of pocket before your deductible is met.
3. Clarify Your Copay or Coinsurance
Once your deductible is met, find out what your financial responsibility will be for each session. This could be a set copay (e.g., $25) or a percentage of the session cost (e.g., 20%).
4. Contact Your Therapy Practice’s Billing Specialist
At Wild Hope Therapy, we understand how challenging it can be to navigate insurance. That’s why we have a dedicated billing specialist, Mindy Hubert, who can help answer your questions. While we can’t provide exact quotes, Mindy is here to provide guidance and support to help you better understand your coverage. You can reach her at billing@wildhopetherapy.com.
5. Plan Ahead Financially
If your deductible resets and you’ll need to pay more for therapy at the start of the year, consider adjusting your budget to account for the temporary increase. This can help you avoid interruptions in care.
Tools for Managing Insurance Frustration
Let’s face it: dealing with insurance can be a headache. But there are ways to reduce the stress and confusion:
1. Keep Detailed Records
Maintain a file (digital or physical) with important insurance documents, such as your explanation of benefits (EOBs), invoices from therapy sessions, and notes from conversations with your insurance provider. Having everything in one place makes it easier to track your progress toward your deductible and resolve any billing questions.
2. Use Your Insurance Portal
Most insurance providers have online portals where you can access plan details, view claims, and track your deductible status. Familiarize yourself with this tool to stay informed about your coverage.
3. Advocate for Yourself
If something doesn’t make sense, don’t hesitate to call your insurance provider for clarification. While it can be frustrating to wait on hold, getting clear answers is worth the effort. You are entitled to understand your plan and how it works.
4. Lean on Your Therapy Practice for Support
At Wild Hope Therapy, we’re here to help you navigate this process. While we can’t resolve issues directly with your insurance provider, we can provide billing statements, help you understand your financial responsibility, and guide you in asking the right questions.
5. Be Patient with Yourself
It’s okay to feel overwhelmed or frustrated by the complexity of health insurance. Remember that you’re doing the best you can, and each step you take to understand your plan is a step toward ensuring consistent access to care.
Therapy Is Worth It—Even When Insurance Is Complicated
We know that navigating insurance isn’t always easy, and it can be especially frustrating when deductibles reset or costs change unexpectedly. But your mental health is worth the effort. Therapy is an investment in yourself—a way to prioritize your well-being, find support, and work toward your goals.
At Wild Hope Therapy, we’re committed to helping you access the care you need. Whether you’re navigating insurance questions, adjusting to new deductible requirements, or simply trying to understand your plan better, know that we’re here for you. Our billing specialist, Mindy Hubert, is always available at billing@wildhopetherapy.com to help guide you through the process.
Preparation, support and the right resources
Yes, insurance can be confusing, and deductibles resetting at the start of the year might feel like one more hurdle. But with preparation, support, and the right resources, you can navigate these challenges and continue your journey toward healing.
Remember: You are not alone in this process. Whether it’s understanding your coverage, budgeting for therapy, or working through mental health challenges, you have a team behind you. And with each step, you’re taking control of your mental health and prioritizing what matters most—your well-being.