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Will Insurance Continue to Cover Online Therapy?
These are revolutionary times for insurance coverage of mental health treatment. It’s more likely than ever that your insurance covers therapy and other mental health services.
It’s also more likely than ever that your insurance covers online therapy. In response to the coronavirus pandemic, insurance companies significantly expanded in-network options for online mental health care. They even waived co-pays for it at the height of the pandemic to make it easier for people to access.
This has changed the therapy world in a short amount of time. Therapists have quickly warmed up to it and more people are signing up for online therapy than ever before.
Will this continue? We can’t be certain, but we believe online therapy—and insurance coverage of online therapy—are here to stay. Read on to learn why.
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How Many Therapists Offer Online Therapy?
Many therapists were skeptical of online therapy before the coronavirus pandemic and didn’t offer it. Some went as far as to say it wasn’t therapy at all. There was just too much missing from the experience of being in the therapy room. As far as they were concerned, without that sacred space, therapy was no longer therapy.
Then the pandemic changed everything. Suddenly, therapists who never considered offering virtual sessions had to figure out how to offer them. When it became the only way their clients could continue to have sessions, they changed their practices almost overnight. Many went from offering no online therapy to offering only online therapy.
Online Therapy Is More Popular Than Ever
According to a Time Magazine article, an American Psychiatric Association poll found that 64 percent of therapists did not use virtual sessions at all before the pandemic. After the pandemic, that number shrank to only 2 percent. This means that two thirds of the therapists they spoke to didn’t offer online sessions before the pandemic, while nearly all of them do now.
(Other research studies have found similar results.)
Will Therapists Continue to Offer Online Therapy?
The Time article and other therapist interviews have shown that therapists didn’t take long to change their minds about online therapy. They learned for themselves what the research shows: online therapy is effective, and the differences between online and in-person therapy are subtle, not definitive.
For one thing, it makes therapy more accessible. Online therapy makes it easier for clients with health issues, busy schedules, or young children at home to regularly attend therapy. Many therapists were delighted to see that with online therapy, cancellation rates went way down.
Some therapists were surprised to find that online therapy actually improved how connected they felt with their clients. The playing field was leveled when both therapist and client were on neutral ground, in and seeing into each other’s homes.
This broke down the traditional power structure of the therapy room. Many clients felt safer and more relaxed in virtual sessions, so they opened up more.
Online Therapy Isn't Always Great
For all these benefits, online therapy isn’t perfect. It depends on a good internet connection to be good. Poor video quality or buffering issues can quickly and dramatically lower the quality of sessions. And even with the best connection, many nonverbal cues become difficult, if not impossible, for therapists to read. A certain quality of being in the room with someone is lost.
Yet the vast majority of therapists who have tried online therapy have concluded that the trade-offs balance out. They’ve seen that online therapy is just as effective as in-person therapy while making life easier for them and their clients.
And they plan to keep offering it. In fact, many say that the only thing that would keep them from continuing to provide online therapy is if clients—and insurance companies—stop paying for it.
Will Insurance Plans Continue to Cover Online Therapy After COVID?
We can’t read tea leaves and tell you what insurance companies will do in the future. But we can read between the lines of what insurance companies are saying and tell you
Even before the coronavirus pandemic, many insurance plans were already covering online therapy. This was due in part to their voluntary efforts to keep up with industry trends and in part due to state laws that require them to cover telemedicine.
Since the pandemic, new laws and policies have expanded coverage of telehealth services. In 2020, Medicare removed many long-standing restrictions on its coverage of telemedicine. They no longer limit telehealth coverage to people in rural areas, and they started covering telehealth services provided in a person’s home.
State Medicaid plans and private insurance plans soon followed suit. In fact, many plans went above and beyond to waive co-pays for telehealth visits during the height of the pandemic so that more people could access care safely from their own homes.
What Do We Think Will Happen?
Based on public statements by insurance company representatives, new laws, and historical trends, we expect both private and public insurance plans to continue covering online therapy. We don’t expect to see Medicare (or any other plans) returning to the awkward restrictions they had before the pandemic (like requiring patients to go to a clinic to get telehealth services).
However, we don’t expect insurance companies to continue waiving co-pays like they did during the height of the pandemic. (Many have stopped already.) Whether insurance companies will continue to observe payment parity for telehealth visits (i.e. covering them at the same rate as in-person visits) is harder to predict. However, we think public pressure and changing attitudes will ultimately lead to payment parity, whether now or in the future.
How Has Mental Health Coverage Been Changing?
History can tell us a lot about what to expect in the future. And recent history shows a trend toward significantly improved insurance coverage of mental health treatment.
In the past, many insurance plans put restrictive caps on mental health treatment that they didn't put on medical treatment. Some didn't cover mental health treatment at all. But in the span of just a single decade, this unequal coverage of mental health has become exceedingly rare.
This is largely due to two important laws. The 2008 Mental Health Parity and Addiction Equity Act (Parity Act) required insurance plans to cover mental health treatment in parity with medical treatment. This means that if an insurance plan covers mental health treatment at all, it can’t place restrictions on that coverage that it doesn’t place on medical treatment. It can’t limit your mental health visits more than it limits your medical visits or charge more for them.
The 2010 Affordable Care Act (ACA) expanded and enhanced the Parity Act by making it apply to a wider range of plans. It also required large group plans to cover mental health as an essential benefit, making it harder for plans to opt out of covering mental health treatment altogether. (Note, though, that the ACA doesn’t apply to all plans. Grandfathered older plans and plans at smaller companies don’t have to meet all the ACA requirements.)
So, Why Should We Expect Teletherapy Coverage to Continue?
Despite many threats and attempts to repeal it, the Affordable Care Act was never repealed. While the ACA hasn’t delivered on all of its promises regarding affordable insurance coverage, it has changed the game in other ways. For one thing, it has expanded access to mental health care tremendously.
So have new laws that state and federal governments have passed requiring insurance coverage of telehealth. The pandemic has had an even bigger effect.
Not only did the expanded availability of telehealth help people access mental health care during the pandemic, it also helped people get mental health care who couldn’t access it before the pandemic. By eliminating the commute to the therapy office and removing the need to find child care, online therapy opened the door to many new therapy seekers.
It seems unlikely to us that we’d go back to what we had before this revolution in access to mental health care. We expect to see the same kind of lasting change in coverage of online therapy as we’ve seen in general insurance coverage of mental health care in recent years.
How Might Expanded Telehealth Coverage Change the Therapy Field?
Widespread adoption of online therapy is a huge change, but it may only be the beginning. Online therapy challenges many norms in the therapy world that may eventually fall by the wayside.
This policy not only limits options for clients, it limits how therapists can practice. This unfairly forces therapists who diligently maintain their licenses to watch as life coaches accept clients from all across the country. In response, therapists are pushing to change these laws and establish interstate license compacts—legal agreements to let therapists practice across state lines.
One is the Psychology Interjurisdictional Compact (PSYPACT). As of mid-2021, 26 states are participating in PSYPACT, meaning psychologists in these states can practice across state lines and offer online sessions to clients in any member states. Other states have pending PSYPACT legislation.
Other types of therapists are pushing for interstate compacts, too. Licensed mental health counselors and licensed professional counselors are working on an interstate compact for LMHCs and LPCs. The National Association of Social Workers (NASW) and Association of Social Work Boards (ASWB) are working on an interstate licensing compact for social workers.
If PSYPACT and other interstate licensing compacts successfully expand interstate therapy practice, it could mean more than just giving clients more therapists to choose from. It could also encourage the growth of specialist therapy practices that could help more people with specific and complex needs get better and more effective care.
The coronavirus pandemic accelerated the growth of telehealth. Insurance plans now widely cover telehealth services including online therapy.
Therapists have also warmed to online therapy. They are much less skeptical of it than they were before the pandemic, and they want to continue offering it. Just like it does for their clients, online therapy helps them better balance their family and work lives.
Due to the increased use of online care, more states are likely to pass laws requiring insurance companies to cover telehealth. Given the historical precedent of laws like the Affordable Care Act and the Parity Act, which permanently expanded insurance coverage of therapy, it seems likely that the changes we’re seeing in coverage of online therapy are only the beginning of a long-term trend.
It’s likelier than ever that your insurance plan covers online therapy. Our decision-making guide on using insurance to get online therapy can help you decide whether it’s the right choice for you. It’s not always the right choice for everyone, but it’s a fantastic option we embrace because we know it will help more people get the care they need.
Stephanie Hairston is a freelance mental health writer who spent several years in the field of adult mental health before transitioning to professional writing and editing. As a clinical social worker, she provided group and individual therapy, crisis intervention services, and psychological assessments.