Does Insurance Cover Grief, Trauma, and PTSD Counseling?

It’s been a little over a year since the first case of COVID-19 was reported in the United States. The pandemic has since claimed more than 500,000 lives in the U.S., taking a huge toll on loved ones left behind. Stay-at-home orders, illness, and death have all negatively impacted our mental health.

The Centers for Disease Control and Prevention (CDC) found 40% of people are having a hard time with their mental health during the pandemic. This included depression, anxiety, and PTSD (post-traumatic stress disorder).

If you’re experiencing grief, trauma, or PTSD, you’re not alone. It’s important to reach out for support and seek professional counseling if it persists. But are counseling services covered by Medicare and private insurance? We’ll go over how to find help and how to pay for grief counseling with insurance when possible. 

What are the signs and symptoms of grief? 

The CDC reminds us that grief is a normal reaction to a traumatic event, such as the death of a loved one, loss of a job, or other big changes to our daily routines. Common signs of grief include:

• Shock or disbelief

• Anxiety

• Confusion

• Distress

• Anger

• Sadness

• Changes in sleep or appetite

• Feeling “stuck” in the past    

“Because we have all lost something or someone during the COVID-19 pandemic, counseling for grief, bereavement, anxiety, and trauma is at an all-time high,” Sherry Cormier, a licensed psychologist and bereavement trauma specialist, tells GoodRx.

If you’re experiencing grief or struggling with trauma, the first step toward healing is finding help. As you’re deciding on a counselor, Cormier suggests finding a healthcare provider with specialized experience in grief or trauma. “It is important to seek services from a practitioner who has both training and experience,” she says.

Does private health insurance cover grief, trauma, or PTSD counseling?  

Under the Affordable Care Act, mental health services such as grief, trauma, or PTSD counseling are an essential health benefit that most private health insurance plans must cover. 

Private health insurance includes both individual and group plans. Group plans are usually offered through employers. 

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If you’re looking for an individual plan, there are four types of health insurance plans you can purchase through the federal marketplace healthcare.gov or your state’s marketplace, if it runs its own: 

• Bronze

• Silver

• Gold

• Platinum 

You’ll pay the highest premium for a platinum plan, but the lowest out-of-pocket costs when you get care (insurance pays 90% and you pay 10%). With a bronze plan, you’ll pay the least in premiums but it pays for less care than the other available plans.

For people who don’t have health insurance, it’s a good time to sign up for coverage on the marketplace. Starting April 1, new subsidies will lower monthly premiums as a result of the COVID-19 American Rescue Plan. Enrollment is open through May 15. And if you’ve lost a job and want to hang on to your employer coverage, the government is paying for COBRA premiums through September.

Tips for using private insurance to pay for grief counseling

Here are some things to keep in mind when it comes to paying for your care:

• Try to find a therapist who is in your insurer’s network. This will help you save money. You can search for grief counselors using your insurance company’s healthcare provider directory. If your counselor doesn’t accept your insurance, you will usually pay upfront for the healthcare provider’s full rate. Your insurance also won’t cover as much of your cost. It’s also possible your insurer won’t pay for out-of-network healthcare at all. Check with your plan.

• Consider asking for a superbill. You can request a superbill — similar to an invoice — from your healthcare provider. Superbills often cover multiple dates of service and apply toward your deductible. You can submit your superbill to your insurance company for reimbursement, if applicable.

• Tap into your flexible spending account. If you have a flexible spending account (FSA) or health savings account (HSA), out-of-pocket mental healthcare expenses are eligible for reimbursement. 

Is grief counseling covered by Medicare?

Medicare Part B helps pay for outpatient mental health services, including grief counseling and PTSD treatment. It also covers preventive services such as depression screenings, wellness visits, and individual and group psychotherapy. 

If your loved one is receiving hospice care and you’re both on Medicare, you’ll be eligible for grief counseling (support group or individual therapy) and spiritual counseling following their death.

The Medicare costs you pay for grief counseling may include:

• 20% of the Medicare-approved amount for visits to your healthcare provider to diagnose or treat your condition. Your Part B deductible applies.

• If you get your services in a hospital outpatient clinic, you may have to pay an additional copayment.

Most Medicare plans pay for outpatient counseling services, but you’ll need to check your Evidence of Coverage, which lists your plan benefits and costs.

Will health insurance cover telehealth counseling? 

Because of COVID-19, the demand for telehealth has soared. Telehealth services allow you to schedule a virtual visit with a healthcare provider using your computer or smartphone. 

Medicaid, Medicare, and private insurers have expanded coverage for virtual health visits during the pandemic. Medicare, for example, pays about the same for telehealth as in-person office visits, including counseling. Coinsurance and deductibles apply, but Medicare says some providers are reducing or waiving telehealth fees during the pandemic. 

You can also check out services like Talkspace and BetterHelp, subscription-based apps that provide online therapy with licensed counselors. Counseling through these apps is available via text messaging, phone, or video. With most plans, you’ll use texting to work with your counselor. Video sessions are typically an extra charge on top of your monthly fees.

For a monthly subscription, Talkspace services range from $265 to $396, depending on the package. You can also schedule individual video therapy sessions for $65 each. Talkspace partners with several health plans, so check with your plan to see if you’re eligible. BetterHelp’s plans cost $240 to $360 a month. Their services are not covered by insurance plans right now. 

What kind of professionals treat grief, trauma, and PTSD?

There are many kinds of mental health professionals who can provide grief, trauma, and PTSD counseling. Each type of licensed healthcare provider offers different skill sets, which vary by state:

• Psychologists have a doctoral degree (Ph.D. or Psy.D.) and provide therapy or counseling. 

• Psychotherapists have a master’s degree and may be a licensed marriage and family therapist (LMFT) or a licensed professional counselor (LPC).

• Licensed clinical social workers (LCSW) hold a master’s degree in social work and often provide counseling.

• Psychiatrists are licensed medical doctors trained in mental health who typically diagnose conditions and prescribe medications if needed. 

• Psychiatric or mental health nurse practitioners specialize in psychiatry and can also diagnose conditions and prescribe medication in some states.

What can I expect when I go to grief counseling, and are there any specialized groups?

Counseling offers a safe space for you to work through your difficult thoughts and feelings with a trusted mental health professional. 

In one-on-one grief counseling, your counselor will listen and offer support and coping strategies so you can move forward in a positive way. If you have medical issues as a result of your grief, such as sleeplessness or depression, you may be referred to another provider for treatment of those issues.

If you’re more comfortable in a group therapy setting, you can find grief support groups online or by contacting local hospitals and churches. In a group setting, you’ll share your experience with others who are also grieving. 

Group members take turns talking as a counselor moderates the discussion. Group therapy sessions are usually held once or twice a week. Insurance coverage is similar for both group and individual therapy, but check your plan for details. 

There are also specific support networks to help you find a counselor who best fits your needs. Here are some examples:

• To find a counselor from your community or who understands the mental health impact of racism, Mental Health America’s Racial Trauma directory can help you find a therapist and other support resources. 

• The American Nursing Foundation launched the Well-Being Initiative, which includes a Happy app to connect nurses with compassionate listeners and other support groups.

• Inclusive Therapists provides a directory to search for counselors in your area based on cost, languages spoken, cultural knowledge, religion, disability access, and more.

• To find LGBTQ+ therapists, Gaylesta offers a way to search for individual counselors with in-person and telehealth appointments as well as therapy groups.

Are resources available if I’m uninsured and struggling to find help?

If you need grief or trauma counseling and you’re uninsured there are resources available for free or low cost. Among them:

• Some counselors offer discounts on their fees for those in need. If you find a counselor or therapy group you’d like to try but don’t have insurance, ask about lower cost sliding scale options. 

• The Department of Veterans Affairs has developed a free mental health and self-care app called COVID Coach. It’s available for anyone to use.

• The National Alliance on Mental Illness (NAMI) has more than 600 chapters across the country, many of which offer free support and education programs.

• Community health centers can provide or direct you to local low-cost mental health care on a sliding fee scale. Find a health center near you. 

• If you have a low income, you can apply for state health insurance called Medicaid. Medicaid offers assistance with healthcare, mental health programs, education, food benefits, and more. Visit the program’s site to find links to assistance in your state.

• If you’re employed, check with your human resources department to see if they offer an employee assistance program (EAP). An EAP provides free and confidential emotional well-being services such as grief counseling. 

Several mental health hotlines can also provide support and help you find other resources in your community:

• If you have thoughts of suicide or need immediate support, call the National Suicide Prevention Lifeline at 1-800-273-8255.

• If you’re facing mental health or substance use issues, call the Substance Abuse and Mental Health Services Administration (SAMHSA) at 1-800-662-HELP (4357).

• Veterans can access the Veterans Crisis Line by calling 1-800-273-8255 and press 1 for immediate support and suggestions for local resources.

• Domestic violence survivors can call the National Domestic Violence Hotline at 1-800-799-SAFE (7233).

• Eldercare Locator helps older adults find community resources. You can visit the organization’s website or call 1-800-677-1116.

There’s no reason to postpone treatment for grief, trauma, or PTSD. It’s OK to ask for help, especially during this time of crisis.

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Written by:

Laura Hipshire

Laura Hipshire has been writing professionally for more than 15 years. She’s a graduate of the University of Michigan with a B.A. in Communications & Journalism and earned an MBA in marketing from Baker College.

Edited by:

Kristen Gerencher, MSOT

Kristen Gerencher is an award-winning writer who has reported on healthcare, medicine, and insurance for a variety of national publications. Before contributing to GoodRx, she was a healthcare and personal finance reporter for MarketWatch.

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