Navigating your insurance plan can feel overwhelming, especially when it comes to deductibles. This guide will help you understand how high-deductible plans work and what they might mean for your therapy costs.
Key Points
A deductible is the set amount you pay out-of-pocket before your insurance starts covering part of your therapy costs.
With a high-deductible plan, you'll pay more sessions entirely out-of-pocket before insurance coverage kicks in, compared to a low-deductible plan.
Once your deductible is met, you'll typically owe a copay or coinsurance per session — not necessarily $0 — until you reach your out-of-pocket maximum.
Your out-of-pocket maximum is the annual cap on your total cost-sharing. Once you reach it, insurance covers 100% of the remaining plan year.
Not all plans have deductibles — some use flat copays instead. Check your Summary of Benefits and Coverage (SBC) or call your insurer to confirm how your plan works.
What is a deductible?
A deductible is a set amount of out-of-pocket spending. With a deductible plan, the out-of-pocket price per session is determined by your insurance company. Once you've reached your deductible amount, your insurance company will start contributing to your therapy costs. Your plan determines the set amount or percentage they cover.
What if my plan uses copays instead of a deductible?
Not all plans work the same way. Some plans — particularly EPO, HMO, and certain employer-sponsored plans — use a flat copay per session rather than a deductible. With a copay plan, you pay the same fixed amount every visit, regardless of how much you've spent that year, and insurance covers the rest right away.
If your plan has a $0 deductible or uses copays, this article may not fully apply to your situation. The best way to confirm how your plan works is to check your Summary of Benefits and Coverage or call the member services number on the back of your insurance card.
How do high-deductible plans work for therapy?
With a high-deductible plan, you'll need to pay more out-of-pocket before your insurance company contributes. The difference in deductibles between plans can mean you spend more months paying the full session cost out of pocket before insurance coverage starts. For example:
Plan Type | Deductible | Session Cost | Sessions Required | Time Required |
Low Deductible | $1000 | $100 | 10 | ~2.5 months |
High Deductible | $3000 | $100 | 30 | ~7.5 months |
But remember, this example only covers therapy costs. If you plan to receive other care that counts toward your deductible, the sessions and duration before your insurance coverage begins could change a lot.
What happens after you meet your deductible?
Meeting your deductible doesn't mean your sessions become free — it means insurance starts covering part of the cost. What you pay after that depends on your plan:
Coinsurance: You pay a percentage of the allowed amount per session (for example, 20%), and your insurance covers the rest. Your share will vary slightly depending on the session rate.
Copay: You pay a fixed amount per session (for example, $30), regardless of the total session cost.
Both: Some plans have you pay a copay until you meet your deductible, then switch to coinsurance — or vice versa.
Your plan documents (often called a Summary of Benefits and Coverage) will specify which applies to you.
Out-of-pocket maximum
Once your total out-of-pocket spending — including your deductible, copays, and coinsurance — reaches your plan's out-of-pocket maximum, your insurance covers 100% of covered services for the rest of the plan year. For clients in high-deductible plans, this is the point at which therapy becomes fully covered.
🌟 Note: Your out-of-pocket maximum typically resets at the start of each new plan year, along with your deductible.
Key things to consider
🗓️ Therapy timeline
Many clients find that 3–6 months of therapy aligns with their goals. With a high deductible, you may complete treatment before reaching insurance coverage.
🏥 Other medical care
If you plan to receive additional care that will count towards your deductible, the sessions and time required may change dramatically. The example above is for illustrative purposes and only considers Grow Therapy costs.
Next steps
Review your plan's Summary of Benefits and Coverage (SBC) — a standardized document your insurer is required to provide — to see your deductible, out-of-pocket maximum, and what's covered. You can usually find it in your insurer's member portal or by calling the member services number on the back of your insurance card.