How to Pay for Therapy: Your Options (Including Free Therapy)

Private pay. Being a “private pay client” means you’re paying out of your own pocket for therapy. You’re not using insurance and charitable or grant funds aren’t covering part of your bill for you. There are ways you can save when you’re paying out of pocket, but let’s go over some basics first.

Different ways to pay. Most therapists accept cash, checks, and credit or debit cards. Cards are easier and more convenient to use than ever, thanks to apps and tools that allow people to accept credit card payments through smartphones. However, you should always check with a therapist first to make sure they accept the payment method you want to use. 

How credit cards can help. A credit card can make therapy more accessible. If you make enough per month to cover what therapy costs, but you don’t necessarily have all of those funds available at the time of your weekly therapy appointment, you can use your credit card at the time of your appointment and pay it off by the end of the month. 

Keep in mind we do not advise going into credit card debt for therapy (or for any other reason). You can lose a lot of money on credit card fees and can even end up in an impossible financial situation if you get behind on payments.

Some employers allow you to set an amount that will automatically be drawn from each paycheck and put into your HSA. Sometimes, HSAs are promoted alongside high-deductible plans. These plans may have lower monthly premiums, saving you money in another way. 

Money you spend on premiums is money you’ll never get back, but money stays in your HSA until you spend it. In some cases, you can put into an HSA what would have gone toward premiums and have enough to cover your DeductibleDeductibleThe amount you have to pay out of your own pocket before insurance pays anything toward your covered expenses. For example, if your deductible is $3,000, you will have to pay $3,000 out of pocket before your insurance kicks in. (Deductibles often do not apply to basic services that require only a standard co-pay. In many cases, you'll always pay the same co-pay whether you've met your deductible or not. Deductibles usually only apply when coinsurance is required for a certain type of service rather than a co-pay.) within a planned amount of time.

Most HSAs give you a card that works like a debit card. When you use the card, it pulls from funds that are already in your account. (Note that HSA cards don’t work like credit cards; you can’t “charge” an amount you expect to have in your account later.) It can be hard to use an HSA at places that don’t accept credit or debit cards. (Though many HSAs also send you a checkbook.)

In many cases, you can use an HSA to pay for therapy, but you should check with your benefits provider and therapist first. There are rules for using HSAs that may limit how you can use yours.

Setting up a payment plan. If you don’t have a credit card, or don’t want to use one, you may be able to set up a payment plan with a therapist that works in a similar way. Ask if you can pay once a month, or every two sessions, or whatever works for your budget. Not all therapists will agree to this, but some will, and it never hurts to ask.

Working with large healthcare organizations. Due to the unfortunately common problem of hugely expensive medical bills, many large healthcare organizations have entire departments dedicated to setting up payment plans for patients who can’t pay their entire bill all at once. 

For example, even if therapy costs $300 a month, they may let you pay $100 or $150 per month. In many cases, unlike with a credit card, hospitals don’t charge you interest on the amount you owe. (Make sure to check whether an organization charges interest before you assume, though.)

Working with private practice therapists. Keep in mind that many therapists in private practice—in other words, therapists who are self-employed—can’t afford to take on the same level of risk as a large healthcare organization. If a private practice therapist is willing to set up a payment plan with you, they will probably expect you to stay pretty current with what you owe.

Instead of payment plans, many therapists are willing to offer discounted rates, which ultimately saves you more money. One of the most common ways therapists do this is by offering sliding scale rates.

Sliding scale rates. Many therapists are willing to accept less than their standard asking rate. If you see on a therapist’s bio or profile that they offer sliding scale rates, this means they’ll assign you a rate that’s based on your income. That amount can be significantly less than the rate they advertise.

During your initial call with a therapist, you should confirm that they still offer sliding-scale rates. Sometimes, therapists have limited “slots” for sliding-scale clients, and sometimes they stop offering a sliding scale but forget to update their bio. Make sure you’re clear about what you can afford to pay and be willing to shop around if the therapist can’t meet it.

Affordable agencies. You’ll often spend less if you see a therapist who works in an agency instead of a private practice. This is even more true if the agency where you go see a therapist is:

• A publicly-funded mental health center or
• A non-profit community counseling agency.

These types of organizations often have the lowest sliding-scale rates you can find. They can also sometimes offer special discounts because of grant funds or charitable donations they receive.

Seeing a less experienced therapist. You can often save money by seeing a therapist who hasn’t been in the field long and who is still trying to build their practice. Therapists just starting a private practice tend to charge lower rates. At community counseling agencies, you can often see trainee or associate therapists for a lower rate. If you want to learn more about the pros and cons of seeing a less experienced therapist, you can read our full article about it.

However, that’s not always true, and it can be tricky to get the most out of your insurance benefits. 

For one thing, many therapists don’t accept insurance, so you have to decide if it’s worth it to pay more to see a therapist who doesn’t accept insurance or if you can find someone who’s the right match in your insurance network.

If you can find the right therapist in your insurance network, that’s probably (but not always) your best option. If you avoid common insurance pitfalls, you can enjoy top-tier therapy for a minimal price.

This is one of the simplest ways to get affordable therapy. Pick a therapist who’s in your insurance network, set up an appointment, and bring your insurance card with you. 

For tips on how to find in-network providers, you can read our article on using insurance to get online therapy. Many methods in that article work for offline as well as online providers.

Before you start shopping for an in-network therapist, though, you want to make sure you know how your benefits work.

When this is true, you may be able to save money by not using insurance. (Remember when we said that high-deductible plans usually end up costing you more? Yeah.)

Using out-of-network benefits can sometimes save you money if you want to see a therapist who’s not in your insurance network. But they can be tricky to use and have hidden costs.

Fortunately, we’ve written an in-depth article on how to spot and avoid the pitfalls when you want to use out-of-network benefits:

• Thinking of Seeing an Out-of-Network Therapist? Read This Before You Do

An important fact we discuss in that article is that with out-of-network benefits, you are the person responsible for filing your claims. 

Some therapists will submit a claim on your behalf. But whether you send the claim or your therapist does, you are the one responsible to appeal the decision if the insurance company denies your claim.

If insurance doesn’t deny your claim, but offers partial payment, you’ll be expected to pay the difference between what the therapist charges and what the insurance company paid. (This is called “balance billing.”) Whether it’s worth it depends on how much insurance actually covers.

Our nation’s public insurance plans are a great way to pay for therapy. You can look for providers who are in-network with Medicare and Medicaid the same way you would with any other plan—go to your insurance provider’s website or filter for providers that accept Medicare and Medicaid on Psychology Today. 

There are definitely therapists out there who accept these plans. But it can alleviate some frustration to go into your search knowing that fewer therapists tend to accept them than other plans because the amount they cover is often lower than what commercial insurance plans cover. 

On the other hand, Medicare and Medicaid often cover things that commercial or employer-based insurance plans don’t cover at all.

If all else fails, you can usually find local non-profit or publicly-funded providers that accept Medicare and Medicaid. Mental health clinics and agencies run by larger hospital and healthcare organizations are also a good place to look.

Special eligibility. There are a few different ways you can get low-cost or free therapy. One way is if you’re a member of a certain demographic or cultural group. For example:

One way to find out if you qualify for a low-cost program is to call a state or local mental health hotline, especially a hotline run by your city or county’s public mental health program. The people who answer can usually help you figure out if you qualify for public mental health services and/or determine what other local non-profits might be an option for you.

Local availability. Sometimes, you can get free or low-cost therapy even if you’re not a member of a demographic group with special eligibility. Sometimes, it’s just a matter of having good local resources.

For example, you may live in a community where local leaders have partnered with a non-profit to create a special mental health program open to all members of your community.

During a special event, certain services may be discounted or become more widely available. Many organizations offered free or low-cost therapy during the initial wave of the coronavirus pandemic, for example.

As with special eligibility, the best way to find out about affordable options that are local to your community is to call a state or local mental health crisis and information line.

There are more ways to pay for therapy than you might think.

Learning what options you have and how a therapist can work with you will help you set up your therapy budget. Therapy can be expensive, but there are ways to make it more affordable.

Our mission at OpenCounseling is to increase awareness of all the methods there are to lower the cost of therapy. We hope this article has sparked some ideas and has put you on the road to finding the therapy you need at a cost you can afford.

Note: The original version of this article was written by Jason Simpkins. This version has been updated, edited, and expanded by Stephanie Hairston.