Does Aetna Cover Therapy? What to Check Before You Book

Many Aetna plans include mental health benefits, which means therapy sessions with an in-network provider may cost you far less than paying out of pocket. But Aetna offers dozens of different plan types, and what your plan covers depends on your specific contract. Before you book with a new therapist, it is worth spending ten minutes confirming your own benefits.

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Does Aetna cover therapy?

Many Aetna plans cover outpatient therapy. The details vary, so checking your own plan is the only way to know what does Aetna cover therapy mean for you specifically. When a plan does include mental health benefits, federal law shapes how those benefits must work. The Mental Health Parity and Addiction Equity Act requires plans to apply the same financial rules to mental health care as to comparable medical care. You can read how that works at healthcare.gov.

What parity does not do is require every plan to include mental health benefits in the first place. So the first question is not how Aetna covers therapy. It is whether your specific Aetna plan covers therapy at all, and on what terms.

Your plan type matters: HMO, PPO, EPO or another. So does whether your plan is through an employer or purchased on your own, and the state you live in. Two people with Aetna cards can have very different benefits.

How much does therapy cost with Aetna insurance?

If your plan covers in-network therapy, you will typically pay a copay or a percentage of the session cost (coinsurance) after meeting your deductible. The exact amounts vary by plan, so the only reliable number is the one on your own summary of benefits.

What you pay also depends on whether you have met your deductible for the year. Before the deductible is met, you may owe the full contracted rate for each session. After it is met, you pay only your copay or coinsurance.

If you are switching from one plan to another mid-year, your deductible usually resets. That can affect what you pay for your first several sessions with a new provider.

For a broader look at what therapy costs with and without insurance, see our post on how much therapy costs.

Does Aetna cover online therapy or teletherapy?

Aetna's public site references telehealth as part of its member services, and many plans expanded teletherapy coverage in recent years. Whether your plan covers video or phone sessions depends on your plan, your state, and sometimes the specific provider you use.

Before you book a teletherapy appointment, call the number on your Aetna card and ask:

• Does my plan cover teletherapy for mental health?
• Does the provider need to be licensed in my state?
• Is there any difference in my copay for telehealth versus in-person visits?

Do not assume that because teletherapy is common, your plan automatically covers it the same way as an in-office visit.

Does Aetna cover psychiatry and medication management?

Many Aetna plans that cover therapy also cover psychiatric care, including evaluations and medication management visits. Psychiatrists and psychiatric nurse practitioners bill differently from therapists, and your cost per visit may differ.

If you are looking for a prescriber, the same verification steps apply. Call member services and ask specifically about psychiatry benefits. Therapy and psychiatry are sometimes listed separately in your plan documents.

For more on the difference between a therapist and a psychiatrist, and which one you might need, see our post on psychiatrist vs therapist.

Does Aetna cover out-of-network therapists?

This depends almost entirely on your plan type.

If you have a PPO, your plan may cover out-of-network providers at a lower reimbursement rate. You pay more per session, and you can choose providers outside the network. If you have an HMO or EPO, out-of-network care is typically not covered except in emergencies.

Switchers moving from a PPO to an HMO sometimes discover this difference only after they have already booked with a therapist they like. If your current therapist is not in Aetna's network, call member services before your first appointment and ask what your out-of-network benefits are, if any.

Out-of-network therapy can cost significantly more. Some therapists offer a superbill, which is a receipt you submit to your insurer for partial reimbursement. Ask your insurer whether they accept superbills and what percentage they reimburse before you count on that option.

Do I need a referral or prior authorization for therapy with Aetna?

Some Aetna plans require a referral from a primary care provider before you can see a mental health specialist. Others let you book directly. Prior authorization, which is approval from your insurer before treatment begins, is required by some plans for certain types of care.

Both requirements vary by plan. The safest approach is to ask two questions when you call member services:

• Do I need a referral to see a therapist or psychiatrist?
• Does my plan require prior authorization for outpatient mental health visits?

If prior authorization is required and you skip it, your insurer may deny the claim and leave you responsible for the full cost.

How do I check my Aetna mental health benefits before I book?

This is the step most people skip, and it is the one that prevents surprises.

Step 1. Find the member services number on the back of your Aetna insurance card.

Step 2. Call and tell them you are looking for outpatient mental health care. Ask:

• Does my plan cover outpatient therapy and psychiatry?
• What is my copay or coinsurance for in-network mental health visits?
• Have I met my deductible for this year?
• Do I need a referral or prior authorization?
• Does my plan cover teletherapy?
• What are my out-of-network benefits, if any?

Step 3. Write down the answers and the name of the representative you spoke with. If there is a dispute later, that record helps.

Step 4. When you find a provider you want to see, confirm with their office that they are currently in-network with your specific Aetna plan. Provider directories are not always up to date, and a provider listed as in-network may have left the network since the directory was last updated.

Step 5. Ask the provider's office whether they handle prior authorization, or whether you need to initiate it yourself.

Ten minutes on the phone before your first appointment can save you hundreds of dollars in unexpected bills.

You can also log in to your Aetna member account at aetna.com to review your plan documents and find in-network providers. But calling is still the most reliable way to get answers specific to your situation.

Common questions

How many therapy sessions does Aetna cover per year?

Aetna does not publish a universal session limit that applies to all plans. Some plans have no session cap; others may have limits tied to medical necessity reviews. Call the number on your card and ask whether your plan has any session limits for outpatient mental health care.

Can I use Aetna to see a therapist who is not on their provider list?

It depends on your plan type. PPO plans often allow out-of-network visits at a higher cost to you. HMO and EPO plans generally do not cover out-of-network care. Ask member services about your specific plan before booking with a provider outside the network.

Does Aetna cover couples therapy or family therapy?

Some Aetna plans cover couples or family therapy when there is a diagnosed mental health condition being treated. Others do not cover it at all. This is worth asking about specifically when you call, because it is often handled differently from individual therapy.

What if my new Aetna plan does not cover my current therapist?

You have a few options. You can ask your therapist whether they plan to join the Aetna network. You can ask whether they offer a sliding-scale fee for sessions you pay out of pocket. Or you can look for a new in-network provider. Our post on finding the right therapist walks through how to approach that search.

Does Aetna cover therapy the same way in every state?

No. State laws affect what insurers must cover. Employer-sponsored plans are sometimes governed by federal rules instead. Your benefits may differ from someone else with an Aetna card in a different state or a different employer plan.

Not sure where to start with your new Aetna plan, or looking for a provider who takes your insurance? Tell saycalm what's going on, for you or someone you love, and we'll explain your options and help you find a provider who fits. Start a conversation