Magnacare for Therapy

Magnacare, a division of the larger Brighton Health Plan Solutions, is what’s called an administrative services organization (ASO). They offer third party administration, meaning that they process claims and reimbursements for other health insurance companies. If you have a Magnacare plan, it means that your healthcare insurance plan is underwritten by another company but is managed by Magnacare.

Does Magnacare cover therapy?

Yes, many Magnacare plans provide mental health benefits, including coverage for therapy sessions. Mental health benefits mean that you won’t need to pay as much out-of-pocket when you work with a therapist.

Magnacare also offers case management services for its members to help them connect with the mental health services that are appropriate for them. However, the exact details of coverage for therapy depends on your specific plan. Be sure to learn about your member benefits before you start therapy to avoid surprising costs.

How do I check if my Magnacare plan covers therapy?

To check if your Magnacare plan covers mental health services, locate your Summary of Benefits document. This may be available through your Magnacare online portal, or, if you receive your Magnacare membership through your employer, your HR team.

In your Summary of Benefits, look for the section that refers to mental health benefits. You may see sections for outpatient or inpatient care — therapy falls under the outpatient category. You’ll also generally see services broken into in-network providers and out-of-network providers. You’ll pay less out-of-pocket when you see a therapist that’s in-network with Magnacare or the underwriting healthcare insurance company.

If you cannot find this document, you can call the customer service hotline number on the back of your insurance card and ask them about your mental health benefits.

How much does therapy cost with my Magnacare plan?

The cost for therapy depends on which plan you have with Magnacare. Because Magnacare is the administrator of healthcare insurance plans and not the actual health insurance carrier, their plans are diverse in terms of coverage. Some plans will have greater coverage for therapy services, while others have limited benefits particularly for out-of-network providers.

That being said, on average you can expect to pay a copay of between $25-65 per session with an in-network therapist or a coinsurance of between 30-50% for sessions with out-of-network therapists. This still saves you money when compared with paying the entire session fee out-of-pocket, which can amount to between $180-250 per session.

What types of mental health conditions does Magnacare cover?

Magnacare provides coverage for therapy services related to many mental health conditions and life situations. You will need a valid mental health diagnosis by a credentialed mental health professional to access this coverage. This diagnosis enables Magnacare to track your billing and reimbursements.

Examples of mental health conditions include:

What types of therapy does Magnacare cover?

Magnacare covers therapy modalities that are backed by evidence. After you receive a mental health diagnosis from your therapist, they will then need to offer you the appropriate type of therapy for treatment. Your therapist must have appropriate mental health credentials and have a license in your state, and they must practice evidence-based therapy. This means that the type of therapy they use in sessions with you are proven to benefit individuals in a clinical setting. Some examples of evidence-based therapy modalities include:

There are many more types of therapies, and many therapists offer “eclectic” or “integrative” therapy that blends more than one approach based on your specific needs. As long as your therapist utilizes at least one evidence-based therapy approach, Magnacare will continue to provide you coverage for your sessions.

What types of therapy does Magnacare NOT cover?

Magnacare does not provide coverage for life coaching, career counseling, or holistic treatment modalities like aromatherapy. It also does not cover energy work such as reiki healing.

Many individuals find that these therapy types are still helpful in their mental health journeys, and many therapists incorporate elements of these therapy types into their sessions. However, if these types of therapy are the only approach used in a session, Magnacare will not provide coverage and you may be on the line to pay the full session fee.

Does Magnacare cover online therapy?

Yes, Magnacare covers online therapy. Magnacare positions itself as a modern solution to the healthcare crisis, which is why they enable and empower their members to access online services. This means that you can see your therapist online from the comfort of your own home. You’ll pay the same copay or coinsurance as you would if you were meeting with your therapist in-person.

Does Magnacare cover couples therapy?

Some — but not all — Magnacare plans offer coverage for couples therapy. This is generally because health insurance companies cannot monitor progress under a diagnosis when more than one person is involved.

Many couples still benefit from seeing a couples therapist and are willing to pay for these sessions, even if just in the short term, and there are other ways to afford couples therapy.

Do I need to see my primary doctor before starting therapy?

Magnacare plans can be HMO or PPO plans, so it depends on your specific plan whether or not you’ll need to see your primary doctor before starting therapy. If your plan is an HMO plan, then you will need to schedule an appointment with your primary doctor to get a referral. Once you have this referral, you can meet with a therapist and receive coverage for those sessions. If your plan is a PPO plan, then you do not need a referral, as you can start seeing a therapist right away.