CareSource for Therapy

CareSource is a health insurance company that provides coverage for members across a handful of states. They offer Medicare, Medicare, and marketplace plans, and have published a large number of mental health resources on their website, which shows their dedication to the mental health and well-being of their members.

Does CareSource cover therapy?

Yes, CareSource insurance plans offer coverage for therapy sessions and other mental health services. They understand the common struggles faced by individuals and families, and want to support them to get the care they need.

They provide mental health benefits only for therapists that are in-network with CareSource, which means that you’ll need to find a therapist that is approved to provide reimbursable services through a CareSource insurance board. If you want to work with a therapist that’s not in the CareSource network, you’ll be responsible for paying the full session fee out-of-pocket.

How do I check if my CareSource plan covers therapy?

To check if your CareSource insurance plan provides coverage for therapy sessions is to read through your Summary of Benefits document, which lists out the copay or coinsurance required for each service type. Look under “If you need mental health, behavioral health, or substance abuse services,” where you’ll find therapy under “Outpatient services.”

If you receive your CareSource insurance plan from your employer or a family member’s employer, ask your HR team for a copy of this document. You can find this document in your CareSource online account or by requesting it from CareSource by calling the number on the back of your insurance card.

How much does therapy cost with my CareSource plan?

CareSource offers members many different plans to choose from, and how much therapy will cost you out-of-pocket depends on the details of your specific plan. However, you can expect to pay a copay of between $25-35 each session. For some plans, on top of that copay, you’ll be responsible for a 20% coinsurance. There are also some plans that provide full coverage for therapy sessions after you’ve met your deductible, which means you won’t be responsible for any of the session fee.

It’s important to check your plan’s details before you start therapy so you aren’t surprised by any expenses. This way, you can focus your attention on your mental health knowing what impact sessions will have on your budget.

What types of mental health conditions does CareSource cover?

CareSource plans provide coverage for treatment of a wide range of mental health conditions and life situations. You will need to receive a specific diagnosis from your therapist, however, to access CareSource’s benefits. Most health insurance companies require a diagnosis so they can track your progress and ensure their benefits are being appropriately used.

Here are a few common mental health conditions that are covered by CareSource:

This is not an exhaustive list, and CareSource provides coverage for many more mental health conditions.

What types of therapy does CareSource cover?

CareSource requires that all covered therapy services be provided by a credentialed mental health professional, like a psychologist, psychiatrist, social worker, marriage and family therapist, licensed professional counselor, or nurse practitioner. Your therapist must also use evidence-based therapy approaches or modalities that have clinical research backing their efficacy.

Some commonly found, evidence-based therapy approaches include:

Your therapist might also use a blended or integrated approach, which means that they combine multiple approaches so they can provide tailored, individualized sessions based on your personality, mental health state, and goals for therapy.

What types of therapy does CareSource NOT cover?

CareSource does not cover therapy services provided by therapists that do not have professional qualifications and the right credentials to practice in your state. This means that services provided by life coaches or career coaches who have no other professional credentials are not covered by CareSource.

CareSource also does not cover non-evidence based therapy approaches like reiki healing or other energy work when it comes to mental health treatment. Therapies like aromatherapy, naturopathic therapy, and massage therapy also do not qualify for coverage.

Does CareSource cover online therapy?

CareSource partners with Teladoc, an online platform that provides members with 24/7 access to primary care, urgent care, and therapy sessions. When you see a therapist through this app, you won’t need to pay anything — that includes no copay or coinsurance.

If you see your in-network therapist outside of Teladoc, however, you’ll pay the same amount you would if you met with them in-person. This enables you to take your therapy from a convenient location, without the hassle of travel.

Does CareSource cover couples therapy?

No, CareSource does not cover couples therapy, similar to many other health insurance companies. This is mainly because it’s difficult to track a diagnosis outside of individual therapy sessions.

CareSource does, however, cover sessions with marriage and family therapists through individual sessions. Even if they don’t cover couples sessions, you can still make progress in your relationships by working one-on-one with a therapist that specializes in relationships.

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

CareSource offers many different types of plans, including both HMOs and PPOs. If your CareSource plan is an HMO, then you will need to see your primary doctor before starting therapy. This is because you’ll need a referral, as therapists are considered specialists. If you don’t receive a referral before you start therapy, CareSource might not provide you with any coverage.

If your CareSource plan is a PPO, however, you do not need a referral from your primary doctor before starting therapy. Once you find the right therapist for you, you can start attending sessions knowing exactly what you’ll pay.