How to Choose a Health Insurance Plan During Open Enrollment If Your Family Uses Therapy
Clinically Reviewed By: Levi Baker, LSCSW
Last Clinically Reviewed: October 29, 2026 | Reading Time: ~6 minutes
Service Areas: Kansas, Missouri, Colorado & Arizona (Telehealth Only)
If your family uses therapy, choose your plan by its total yearly cost of care rather than its premium alone. Copay plans (PPO/HMO) keep each session predictable. High-deductible plans paired with a Health Savings Account (HSA) often cost less each month, but you may pay the full in-network rate for sessions until the deductible is met.
Key Clinical Takeaways:
- What It Is: A way to compare employer and Marketplace plans by what therapy and ADHD testing will really cost.
- Evidence-Based Approach: PHQ-9 and GAD-7 scores track progress and document medical necessity; CBT, DBT, EMDR and TF-CBT are billed by session time.
- When to Seek Care: Marketplace open enrollment for 2027 coverage runs November 1, 2026 to January 15, 2027. Enroll by December 15 for coverage starting January 1. Employer plans set their own deadlines.
- Coverage & Access: Available in-network with Blue Cross Blue Shield, Cigna, UnitedHealthcare, Aetna, and select Medicaid plans across Kansas, Missouri, Colorado, and Arizona.
What Are the Signs Your Family's Health Plan Is a Poor Fit for Therapy?
Open enrollment opens November 1, the day Daylight Saving Time ends (most of Arizona doesn't observe it; NIST). Winter-pattern seasonal affective disorder often starts in late fall as daylight shortens (NIMH), so budget for winter care, not just this year's sessions.
Common Clinical Indicators to Watch For:
- High Per-Session Costs: You paid most of the allowed amount for regular sessions, or cost led you to skip appointments.
- Deductible Resets: Costs jump every January when the deductible resets, even though weekly sessions continue.
- Out-of-Network Gaps: Your current therapist isn't in network, or your plan offers no out-of-network benefit for behavioral health.
- Screening Benchmark (PHQ-9/GAD-7/ADHD): Repeated PHQ-9 and GAD-7 scores and ADHD testing results document severity and change over time, which insurers use to review medical necessity. Pick a plan that covers this ongoing care.
How Do Copay Plans Compare With HSA-Eligible High-Deductible Plans for Therapy?
Your plan's Summary of Benefits and Coverage (SBC) has actual figures.
| Feature / Clinical Dimension | PPO / HMO Copay Plan | HDHP + HSA (incl. Marketplace bronze) |
|---|---|---|
| Core Mechanism | Higher premium; a set copay or coinsurance per session | Lower premium; you pay until the deductible is met, then coinsurance |
| Cost per Session (90834/90837) | Often a flat copay, sometimes before the deductible | The full in-network allowed amount until the deductible is met |
| Duration & Triggers | Costs stay fairly even all year | Costs are highest early in the year, after the deductible resets |
| Out-of-Network Care | PPOs usually pay part of the cost; HMOs usually pay nothing | Depends on the plan, often with a separate deductible |
| Telehealth | Varies by plan | May be covered before the deductible (optional for plans) |
| Tax Advantage | None built in | HSA money can pay for qualified medical expenses, including psychotherapy (IRS Pub. 502) |
| Assessment/Screener Used | PHQ-9, GAD-7 and ADHD testing, subject to the plan's rules | Same; testing may count toward the deductible |
| Best Fit | Weekly sessions or several family members in care | Lower use, or a well-funded HSA |
2027 IRS figures: HSA limits are $4,500 (self-only) and $9,000 (family), plus $1,000 at 55 or older. Qualifying high-deductible plans have deductibles of at least $1,750/$3,500 and out-of-pocket caps of $8,700/$17,400 (Rev. Proc. 2026-24). Since 2026, Exchange bronze and catastrophic plans count as HSA-compatible (IRS).
How Does Therapy Get Billed to Your Insurance?
Every session with our clinicians happens by secure video, but your insurer processes it like any other behavioral health claim. Knowing the codes helps you price each plan before you enroll.
- Step 1: Intake & Baseline Screening (CPT 90791): Your first telehealth session is a diagnostic evaluation, billed as 90791 (Telehealth.HHS.gov). Your clinician reviews history and goals and records baseline scores on the PHQ-9 for depression (Kroenke et al., 2001) and the GAD-7 for anxiety (Spitzer et al., 2006). If ADHD testing is recommended, it's billed separately, commonly with 96130/96131 for evaluation and 96136/96137 for test administration (CMS billing guide). Many plans require prior authorization for testing, so ask before you schedule.
- Step 2: Active Skill-Building or Processing: Ongoing sessions are billed by length, not by type of therapy. Code 90834 covers 38–52 minutes and 90837 covers 53 minutes or more. In CBT, clients learn to spot and change unhelpful thought patterns and practice between sessions. In PCIT, the clinician coaches a parent in real time over video while the parent plays with their child. On a copay plan, both codes usually cost the same copay. On a high-deductible plan, you pay the allowed amount for each code until the deductible is met, so longer sessions can cost more early in the year. Federal law now lets HSA-eligible plans cover telehealth before the deductible, but plans aren't required to, so check the plan documents (IRS).
- Step 3: Measurable Progress Tracking: Repeating the PHQ-9 and GAD-7 at regular points shows whether symptoms are improving. The scores document progress that insurers may review when deciding whether continued care is medically necessary. After each claim, your insurer sends an Explanation of Benefits (EOB) showing what it paid and what you owe. If you pay on your own without insurance, federal law generally entitles you to a written Good Faith Estimate before care is scheduled (CMS).
What Should Be on Your Open Enrollment Checklist for Therapy Benefits?
- List everyone in therapy, how often they go, and any planned ADHD testing.
- Find your therapist in the directory, then call the insurer to confirm network status for that exact plan.
- In the SBC, check the mental health cost per session and whether it applies before or after the deductible.
- Ask whether 90837 sessions or psychological testing need prior authorization.
- Confirm what telehealth therapy costs, and whether an HSA-eligible plan covers it before the deductible.
- Estimate the yearly total:
- Copay plan: expected sessions × copay + premiums
- High-deductible plan: sessions × allowed amount until the deductible, then coinsurance up to the out-of-pocket maximum, + premiums − employer HSA contribution
- Know your rights: federal parity law still bars stricter mental health cost-sharing than medical cost-sharing; regulators have paused enforcement only of the newer 2024 rule provisions (DOL).
Accessing In-Network Care in Kansas, Missouri, Colorado, and Arizona
- Adult, teen and child therapy and ADHD testing are covered under most major plans; verify your benefits.
- We're in network with Blue Cross Blue Shield (BCBS), Cigna (Evernorth), UnitedHealthcare (UHC/Optum), Aetna, and select state Medicaid plans. Check the exact plan name, because networks differ by product and by state.
- All care is delivered by HIPAA-compliant telehealth to clients located anywhere in KS, MO, CO, or AZ.
- Kansas, Missouri and Arizona residents enroll through HealthCare.gov. Coloradans use Connect for Health Colorado, which follows the same 2027 dates.
Frequently Asked Questions
Does the type of therapy, like EMDR or TF-CBT, change what my insurance pays?
Usually not. Psychotherapy is billed by session length (90834 or 90837) along with a diagnosis, not by type of therapy. What you pay depends on your plan's copay, deductible and coinsurance. Ask whether longer 90837 sessions need prior authorization, and confirm your clinician is in network before you enroll.
How do PHQ-9 and GAD-7 scores and ADHD testing affect insurance coverage?
The PHQ-9 and GAD-7 are brief, validated questionnaires given at intake and repeated during care. The scores document symptom severity and progress, which insurers may review for medical necessity. ADHD testing is billed with separate psychological testing codes and often needs prior authorization, so check your plan's rules first.
Is a PPO or an HSA plan better for therapy with BCBS, Cigna, UHC, or Aetna in Kansas, Missouri, Colorado, or Arizona?
It depends on how often your family uses care. Weekly sessions often favor a predictable copay plan. Lower use may favor a high-deductible plan with an HSA. Compare yearly totals for your specific BCBS, Cigna, UnitedHealthcare or Aetna plan, and verify behavioral health benefits before the December 15 deadline.
Ready to Take the Next Step?
Whether you know exactly what kind of support you are looking for or have questions about where to start, our clinical team across Kansas, Missouri, Colorado, and Arizona is here to help:
- Match with a Clinician Now: Use our interactive Find Your Therapist tool to filter providers by your state (KS, MO, CO, or AZ), insurance plan (BCBS, Cigna, UnitedHealthcare, Aetna, or Medicaid), age group, and clinical specialty.
- Have Questions First? Not sure if you need an ADHD evaluation, child play therapy, or a specific treatment modality? Send us a secure message to ask a question or request a quick insurance benefits check.
Clinical References & Medical Disclaimer
- American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.; DSM-5-TR).
- Internal Revenue Service. (2026). Rev. Proc. 2026-24 (2027 HSA amounts). https://www.irs.gov/pub/irs-drop/rp-26-24.pdf
- HealthCare.gov. Mental health and substance abuse coverage. https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage/
- Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613.
- Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092–1097.
- Disclaimer: This article is for educational and informational purposes only and does not constitute medical advice or establish a therapist-client relationship. If you or someone you love is experiencing a mental health crisis, call or text 988 to reach the Suicide & Crisis Lifeline.