How to Calculate Total Cost of Therapy Beyond the Copay

Therapy isn't just about the copay - here's what else you're really paying

You show up for your therapy session, swipe your card, and pay $30. Easy. But that $30? It’s just the tip of the iceberg. If you think that’s your total cost for therapy, you’re setting yourself up for a financial surprise. Many people don’t realize their insurance plan might be costing them thousands more over the year - even if they have coverage.

Let’s say you’re seeing a therapist weekly. At $30 per session, that’s $1,560 a year. Sounds manageable, right? But what if your deductible hasn’t been met yet? What if your plan uses coinsurance instead of a flat copay? What if you need 20 sessions instead of 12? Suddenly, that $30 becomes $125 - then $75 - then $150. And you didn’t see it coming.

Here’s the truth: therapy cost isn’t just what you pay at the door. It’s your monthly premium, your deductible, your coinsurance, your out-of-pocket maximum, and whether your provider is in-network or out-of-network. All of it adds up. And if you don’t understand how these pieces fit together, you could end up paying way more than you expected.

Understanding your insurance plan type - copay, deductible, or coinsurance?

Not all insurance plans work the same way. There are three main structures for how you pay for therapy, and each changes your total cost dramatically.

• Copay plans: You pay a fixed amount per session - like $30 or $50 - regardless of the actual cost of the session. This is the simplest. But only if your deductible is already met.
• Deductible plans: You pay the full price of each session until you hit your deductible. For example, if your deductible is $1,500 and your therapist charges $125 per session, you’ll pay $125 for the first 12 sessions before insurance kicks in.
• Coinsurance plans: After you meet your deductible, you pay a percentage of the cost - usually 20% to 40%. So if your session costs $125 and your coinsurance is 20%, you pay $25. But here’s the catch: the insurance company only recognizes a certain amount as “allowed.” If your therapist charges $150 but the allowed amount is $125, you still only pay 20% of $125.

Most people assume their copay is their only cost. But if you haven’t met your deductible, that $30 copay doesn’t apply yet. You’re paying full price - and that can be $100 to $200 per session depending on where you live. In New York, the average session is $176. In North Dakota, it’s $227. Location matters.

How your deductible can double your therapy costs - before you even see a copay

Let’s say your annual deductible is $1,500. You’ve seen your therapist 10 times already this year. Each session was $125. You’ve paid $1,250. You’re close. But you still need 5 more sessions to meet your goal. That’s another $625 - and you haven’t paid a single copay yet.

This is where people get blindsided. They think, “I have insurance, so therapy should be cheap.” But until your deductible is met, you’re paying full price. And if your therapist charges more than what your insurance considers “usual and customary,” you’re on the hook for the difference.

For example, if your therapist charges $150 per session but your insurance only allows $125, you pay $150 - not $125. That $25 difference doesn’t count toward your deductible. You’re paying extra, and it doesn’t help you get closer to insurance coverage. This is called “balance billing,” and it’s common with out-of-network providers.

That’s why it’s critical to ask your therapist: “What’s your fee? And what’s your insurance allowed amount?” If they don’t know, they might not be in-network. And if they’re not in-network, your costs could balloon.

Coinsurance isn’t just a percentage - it’s a hidden cost multiplier

Once you meet your deductible, coinsurance kicks in. Sounds fair, right? But here’s the problem: coinsurance applies to every session, even if you need 30, 40, or 50 sessions over the year.

Let’s say your deductible is $3,000, your coinsurance is 20%, and your therapist charges $125 per session. You need 24 sessions to feel better.

• First 24 sessions at $125 = $3,000 total. You pay $3,000 to meet your deductible.
• After deductible: 24 sessions × $125 = $3,000. You pay 20% = $600.
• Total out-of-pocket: $3,600.

That’s $3,600 for therapy - and you’re still paying your monthly premium on top of that. Now imagine you need 40 sessions. Your coinsurance kicks in after $3,000, so you pay 20% of $5,000 (the remaining cost). That’s $1,000. Total: $4,000.

And here’s the kicker: your out-of-pocket maximum is $9,350 for an individual plan in 2024. That means if you have other medical needs - a broken bone, a hospital visit, a prescription - those costs also count toward your max. But if your mental health coverage has a separate deductible? Then your therapy costs don’t help you reach your medical out-of-pocket cap. You’re paying twice.

In-network vs. out-of-network: The $100 difference you can’t ignore

Therapists who are “in-network” have agreed to accept your insurance’s allowed amount as payment in full. That’s a big deal. Out-of-network therapists don’t. That means they can charge whatever they want - and you pay the difference.

For example:

• In-network therapist: $125 per session. Insurance allows $125. You pay $40 copay after deductible.
• Out-of-network therapist: $180 per session. Insurance allows $125. You pay $180. Then you submit a claim. Insurance reimburses you 50% of $125 = $62.50. So you’re still out $117.50 per session.

That’s $77.50 more per session than if you’d chosen an in-network provider. For 20 sessions? That’s $1,550 extra.

And if you’re on Medicare? Out-of-network therapy isn’t covered at all unless you have a Medigap Plan G. Otherwise, you pay 100%. That’s why 42% of therapists offer sliding scale fees - because insurance alone doesn’t make therapy affordable.

What you’re not counting: premiums, transportation, and medication

Therapy isn’t just the session fee. You’re also paying your monthly insurance premium - even if you never use therapy. That’s $200-$500 a month for many plans. That’s $2,400-$6,000 a year just to have the option.

Then there’s transportation. If you’re driving 45 minutes each way, that’s 90 minutes of time and gas money. For weekly therapy, that’s 78 hours a year - and $100-$200 in fuel. Not a small thing.

And if you’re on medication? Many people take antidepressants, mood stabilizers, or anti-anxiety meds alongside therapy. A 30-day supply of generic sertraline can cost $10 with insurance. Without? $150. That’s $120 extra a month. Add that to therapy, and you’re looking at $500-$700 a month.

Most people don’t track these together. But they all add up to your real cost of treatment.

How to actually calculate your total therapy cost - step by step

Here’s how to figure out what you’ll really pay - no guesswork.

1. Find your plan type. Call your insurer or log into your portal. Ask: “Is my mental health coverage based on copay, deductible, or coinsurance?”
2. Ask your therapist. “What’s your fee? What’s your in-network allowed amount? Are you in-network with my plan?”
3. Check your deductible status. How much have you paid this year? How much is left? If you’ve paid $1,000 of a $1,500 deductible, you’re 2/3 of the way there.
4. Estimate your sessions. Most people need 12-20 sessions for meaningful progress. If you’re dealing with trauma or depression, plan for 20+.
5. Calculate in phases:

• Phase 1 (pre-deductible): Full session cost × sessions until deductible is met.
• Phase 2 (post-deductible): Copay or coinsurance × remaining sessions.
• Phase 3 (out-of-pocket max): Your total can’t exceed $9,350 (individual) in 2024 - but only if all services count toward the same cap.

Example: Deductible $1,500, session cost $125, 20 sessions, $40 copay after deductible.

• Phase 1: $1,500 (12 sessions × $125)
• Phase 2: $40 × 8 sessions = $320
• Total: $1,820

That’s a 41% savings compared to paying full price. But only if you know how to calculate it.

What to do if you can’t afford therapy - even with insurance

Not everyone can pay $1,800 a year for therapy. Here are real options:

• Sliding scale fees: 42% of private therapists offer income-based rates. Ask. You might pay $50 instead of $125.
• Open Path Collective: A nonprofit network offering sessions for $40-$70 to uninsured or underinsured people.
• University clinics: Graduate students provide therapy under supervision. Often 50-70% cheaper.
• Community health centers: Federally funded clinics offer mental health services on a sliding scale.
• Teletherapy apps: Platforms like Rula report average copays of $15-$25 for insured users - sometimes lower than in-person.

And if you’re on Medicaid? Many plans have $0 copays. If you’re on Medicare? You pay 20% of the allowed amount - usually around $28 per session. That’s affordable. But you still need to track your deductible and out-of-pocket max.

Final tip: Don’t wait until you’re overwhelmed to check your costs

Almost 40% of people say they didn’t know their therapy copay until after they’d already paid for several sessions. That’s avoidable.

Call your insurance provider. Ask for your mental health benefits summary. Write down:

• Monthly premium
• Deductible amount and status
• Copay or coinsurance rate
• Out-of-pocket maximum
• In-network vs. out-of-network rules

Then call 2-3 therapists and ask the same questions. Compare. Budget. Plan.

Therapy is worth it. But only if you can afford it. And you can’t afford it if you don’t know how much it costs.