Is Depression Treatment Covered by Insurance? Your Complete Guide

Depression is one of the most common mental health conditions in the United States, affecting millions of adults each year. In 2021, an estimated 8.3% of all U.S. adults, around 21 million people, had at least one major depressive episode.

People with depression can benefit from treatment as it helps relieve symptoms and improve their quality of life. If you're seeking help for depression, you may be wondering whether your health insurance will cover the cost of treatment. The answer, in many cases, is yes; federal laws require most health insurance plans that include mental health coverage to cover depression treatment on the same level as they cover physical health conditions.

Understanding how your insurance covers depression treatment can help you access the care you need and plan for any out-of-pocket costs.

Key Takeaways

• Depression treatment is an essential health benefit: Under the Affordable Care Act (2010), most Marketplace plans and many employer-sponsored plans include mental-health services (including depression treatment) as required or subject to parity rules. Insurance plans cannot deny coverage or charge more because of a depression diagnosis.

• Parity laws ensure equal coverage: The Mental Health Parity and Addiction Equity Act (2008) requires that your copays, deductibles, and treatment limits for depression be no more restrictive than those for physical health conditions like diabetes or heart disease.

• Multiple treatment options are covered: Most plans cover therapy (including cognitive-behavioral therapy), antidepressant medications, psychiatric evaluations, and sometimes advanced treatments like TMS for treatment-resistant depression.

How Federal Law Protects Your Depression Coverage

The Affordable Care Act (ACA)

The Affordable Care Act (ACA) made mental health coverage a fundamental part of health insurance. According to the Department of Health and Human Services, mental and behavioral health services are considered essential health benefits that most individual and small employer health insurance plans must cover. This means depression screening, therapy, medication, and other treatments are required benefits in Marketplace plans.

Before the ACA, many individual insurance plans excluded mental health coverage entirely or imposed severe limitations. Now, Marketplace plans cannot refuse to cover you, charge higher premiums, or limit benefits because of a depression diagnosis or another mental health condition.

The Mental Health Parity and Addiction Equity Act (MHPAEA)

The Mental Health Parity Act ensures that when insurance plans offer mental health benefits, they must provide coverage that's comparable to medical and surgical benefits. This means your insurance cannot impose more restrictive financial requirements (like higher copays) or treatment limitations (like fewer covered visits) on depression treatment than on physical health treatment.

For example, suppose your plan covers unlimited visits to a cardiologist with a $40 copay. In that case, it cannot limit your therapy visits to 20 per year or charge a $60 copay for mental health appointments.

What Depression Treatments Does Insurance Cover?

Therapy and Counseling

Most insurance plans cover various forms of psychotherapy for depression:

• Individual therapy: One-on-one sessions with a licensed therapist, psychologist, or counselor

• Cognitive-behavioral therapy (CBT): An evidence-based approach that's considered highly effective for treating depression

• Group therapy: Sessions with multiple participants, often at lower cost than individual therapy

• Telehealth therapy: Virtual sessions via video call, which have become widely covered and accepted

• Family or couples therapy: When depression affects family dynamics (coverage varies by plan)

Antidepressant Medications

Prescription drug coverage for depression is included in most health insurance plans. According to the National Institute of Mental Health, antidepressants typically take 4-8 weeks to show full effects and work best when combined with therapy.

• SSRIs: Selective serotonin reuptake inhibitors like sertraline (Zoloft), fluoxetine (Prozac), and escitalopram (Lexapro); often available as low-cost generics

• SNRIs: Serotonin-norepinephrine reuptake inhibitors like venlafaxine (Effexor) and duloxetine (Cymbalta)

• Other antidepressants: Including bupropion (Wellbutrin), mirtazapine, and tricyclic antidepressants

Generic medications are typically covered at lower copays (often $10-$30 per month), while brand-name medications may have higher costs or require prior authorization. Actual copays vary by plan and state.

Psychiatric Services

• Psychiatric evaluations: Comprehensive assessments to diagnose depression and develop treatment plans

• Medication management: Follow-up appointments to monitor and adjust antidepressant medications

• Depression screening: Medicare and many plans cover annual depression screenings at no cost

Advanced Treatments for Treatment-Resistant Depression

For depression that doesn't respond to standard treatments, some insurance plans cover:

• Transcranial magnetic stimulation (TMS): An FDA-approved, non-invasive treatment (often requires prior authorization)

• Electroconvulsive therapy (ECT): A highly effective treatment for severe depression

• Esketamine (Spravato): An FDA-approved nasal spray for treatment-resistant depression, administered in a healthcare setting

These advanced treatments are often covered when medically necessary for treatment-resistant cases, but they commonly require prior authorization and documentation that less intensive treatments were tried first.

Understanding Your Out-of-Pocket Costs

While depression treatment is covered by most insurance plans, you'll likely have some expenses. Your costs depend on your specific plan and may include:

• Monthly premiums: What you pay for insurance coverage itself

• Deductible: Amount you pay before insurance covers services (typically $500-$2,000 for individual plans)

• Copays: Fixed amounts per visit (typically $20-$50 for therapy, $10-$50 for medications)

• Coinsurance: Percentage of costs after deductible (often 10-30%)

• Out-of-pocket maximum: Annual limit on your expenses; after reaching this, insurance covers 100%

For out-of-network providers, you may incur higher costs for services. You may also be required to pay charges up front and file for reimbursement later. Whenever possible, opt for in-network providers to reduce out-of-pocket costs. 

Coverage by Insurance Type

Employer-Sponsored Plans

Most employer plans from companies with more than 50 employees must comply with mental health parity laws and provide comprehensive depression coverage. Many employers also offer Employee Assistance Programs (EAPs) that provide free short-term counseling sessions.

Note: Self-insured employer plans (ERISA plans) have different administrative rules and appeal processes. Seek benefits or legal help if your appeal is complex.

Marketplace Plans

All ACA Marketplace plans cover mental health services as essential health benefits. When shopping for plans, you can compare mental health coverage details. Plans cannot exclude depression coverage or charge more because of pre-existing conditions.

Medicare

Medicare Part B covers outpatient mental health services, including therapy and psychiatric visits. Medicare covers one annual depression screening at no cost when provided by a primary care doctor who accepts assignment. After meeting your deductible, you typically pay 20% of the Medicare-approved amount for treatment.

Medicaid

Medicaid covers mental health services, including depression treatment. In most states, beneficiaries have minimal out-of-pocket costs. Coverage details vary by state, so it’s essential to check with your state Medicaid program. Medicaid expansion under the ACA extended coverage to millions of low-income adults who previously had no access to mental health care.

How to Verify Your Depression Treatment Coverage

1. Review your plan documents: Check your Summary of Benefits and Coverage (SBC) for mental health benefits

2. Call member services: Ask about specific benefits for depression treatment, including copays, deductibles, and any visit limits

3. Confirm provider status: Verify that your chosen therapist or psychiatrist is in-network to minimize costs

4. Check medication coverage: Look up antidepressants on your plan's formulary to understand copay tiers

5. Ask about prior authorization: Find out if any treatments require pre-approval from your insurance

Medical Disclaimer

This article explains general rules; your plan documents (Summary of Benefits and Coverage) are the legal record of coverage. Insurance coverage and benefits vary by plan and are subject to change. Always contact your insurance provider directly to verify your specific benefits. 

For legal rights, consult your state insurance commissioner or an attorney experienced in ERISA/insurance law. If you are experiencing a mental health crisis, contact the 988 Suicide and Crisis Lifeline by calling or texting 988.

Sources

1. National Institute of Mental Health. (n.d.). Major depression.         https://www.nimh.nih.gov/health/statistics/major-depression 

2. U.S. National Center for Biotechnology Information. (2024). Depression: Learn More – How is depression treated?. InformedHealth.org [Internet]  https://www.ncbi.nlm.nih.gov/books/NBK279282/

3. U.S. Department of Health and Human Services. (n.d.). Does the ACA cover individuals with mental health problems? https://www.hhs.gov/answers/health-insurance-reform/does-the-aca-cover-individuals-with-mental-health-problems/index.html 

4. HealthCare.gov. (n.d.). Mental health & substance abuse coverage. https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage/ 

5. U.S. Centers for Medicare & Medicaid Services. (n.d.). The Mental Health Parity and Addiction Equity Act (MHPAEA). https://www.cms.gov/marketplace/private-health-insurance/mental-health-parity-addiction-equity 

6. HealthCare.gov. (n.d.). Mental health & substance abuse coverage. https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage/

7. Centers for Medicare & Medicaid Services. (n.d.). Mental health care — outpatient coverage under Original Medicare (Part B). https://www.medicare.gov/coverage/mental-health-care-outpatient

8. National Institute of Mental Health. (n.d.). Mental health medications. https://www.nimh.nih.gov/health/topics/mental-health-medications

9. National Alliance on Mental Illness. (n.d.). Mental health by the numbers. https://www.nami.org/about-mental-illness/mental-health-by-the-numbers

10. National Alliance on Mental Illness. (n.d.). Medicaid expansion.  https://www.nami.org/advocacy/policy-priorities/improving-health/medicaid-expansion