Is Therapy Covered By Insurance In Canada

Taking the first step to seek therapy when faced with a mental health issue is a big step, whether it is virtual therapy or a physical-based one. Therapy can be pretty expensive when you want to settle the cost out-of-pocket, but do you know you can get it for free?

Is therapy covered by insurance in Canada? This is one of the most asked questions among individuals with mental health issues who want to get good therapy care for free or a subsided price. In this article, we will look at Therapy and insurance and whether therapy is covered by public and/or private insurance.

Is Therapy Covered By Insurance In Canada

Generally, Canada has a publicly funded healthcare system known as Medicare, which covers essential medical services, including mental health services, like therapy offered by doctors, psychiatrists, and physicians in public service or government-owned hospitals.

Licensed and registered psychotherapists, psychologists, or social workers working in private health settings are not covered by provincial healthcare plans such as ​​ Medical Services Plan (MSP) in British Columbia, Ontario Health Insurance Plan (OHIP), or the Alberta Health Care Insurance Plan (AHCIP). In this situation, you can get a private health insurance plan through your employers, or you can purchase one that may offer varying degrees of coverage for therapy and mental health services.

In some provinces, additional government-funded programs or initiatives may offer mental health support and therapy services to certain groups or demographics, such as undeserved and historically marginalized groups and homeless individuals. A significant example is the Canadian Mental Health Association (CMHA).

Is Therapy Covered By OHIP (Ontario Health Insurance Plan)?

The Ontario Health Insurance Plan (OHIP) covers therapy a medical doctor offers, such as a psychiatrist or family doctor in a hospital or clinic. To access therapy from a psychiatrist, you must get a referral from a family doctor. OHIP does not cover therapy provided by psychologists or psychotherapists in private practice.

OHIP generally covers medically necessary services provided by physicians and some specialists in hospitals and clinics. While OHIP may cover some mental health services provided by psychiatrists, it usually does not cover therapy sessions with psychologists, social workers, or other mental health professionals in private practice.

The Ontario government also funds a project called the Family Health Teams (FHT). These comprehensive healthcare clinics have a family doctor and other professionals, like dietitians, social workers, physiotherapists, and other mental health professionals, under one roof, and OHIP covers all services here.

There are subsidized or government-funded clinics that offer low-cost or free mental healthcare. To access such clinics, you often need a referral from a medical doctor to ensure your costs will be covered. Check the Toronto’s Centre for Addiction and Mental Health (CAMH) for the list of resources available for those living in and around the Greater Toronto Area (GTA).

Also, the Ontario government made provisions for additional funding for virtual mental health services in response to the COVID-19 pandemic in April 2020. They are as follows:

• The Kids Help Phone website or phone line (1-800-668-6868) is for teens and young adults under 18.
• ConnexOntario for individuals above 18 suffering from mental health, problem gambling services, and addiction. (Via phone at 1-866-531-2600)
• BounceBack Ontario is a guided self-help program for individuals 15 years and older and includes phone coaching support and workshops.
• Good2Talk is a 24/7 free and confidential mental health support service for postsecondary students in Nova Scotia and Ontario.

Is Therapy Covered By AHCIP (Alberta Health Care Insurance Plan)?

The Alberta Health Care Insurance Plan (AHCIP) covers medically necessary services provided by physicians and some specialists in hospitals and clinics.

In Alberta, there are government-funded community health centers like the Alberta division of the Canadian Mental Health Association (CMHA) that connect people to mental health services. CMHA offers several emergency helplines that you access in the province. Also, Alberta has a free virtual peer-to-peer mental health community called Togetherall, which is available 24/7, and a free national program BounceBack, for individuals 15 and older.

Is Therapy Covered By MSP (Medical Services Plan) In British Columbia?

The Medical Services Plan (MSP) in British Columbia, Canada, covers medically necessary services provided by physicians and some specialists in hospitals and clinics. MSP does not cover therapy offered by medical doctors in private practice.

The Province of British Columbia website has an interactive map tool and listings that help to connect you to government-funded or non-profit agencies in BC for mental health support, addiction, or abuse. However, you need referrals to access this service.

Examples of The Federally Supported Mental Health Services

The Canadian government provides federally supported mental health services and initiatives to support mental health and well-being nationwide. These services and programs are typically in addition to the provincial and territorial mental health services offered by individual provinces and territories.

Here are some examples of federally supported mental health services and initiatives:

First Nations and Inuit Health:

Indigenous Services Canada provides mental health programs and services specifically tailored to the needs of First Nations and Inuit communities. This includes culturally appropriate counseling, crisis intervention, and support for mental health challenges.

Canadian Armed Forces Mental Health Services:

The Canadian Armed Forces offer mental health services to active-duty members and veterans. These services address the mental health challenges those currently serving or have served in the military face.

Assistance for Refugees:

The Government of Canada provides mental health support for refugees who have experienced trauma and stress related to their migration journey and settlement in Canada.

Federal Government Programs:

The federal government also has some programs slated for mental health support, such as Togetherall, Wellness Together Canada, and Hope for Wellness Help Line.

Therapy And Private Insurance Plans

Therapy and private insurance plans can vary significantly depending on the specific insurance provider and plan. Below are some points to consider regarding therapy coverage and private insurance plans:

Types of Therapy Covered:

Private insurance plans may cover different types of therapy, such as group therapy, individual therapy, family therapy, and couples therapy. The coverage may extend to various mental health professionals, including psychologists, licensed counselors, social workers, and psychiatrists.

Coverage Limits:

Insurance plans may limit the number of therapy sessions covered per year or condition. For example, a plan may cover a certain number of sessions or have an overall monetary cap for mental health services.

Pre-authorization and Referrals:

Some insurance plans may require pre-authorization or referrals from a primary care physician before starting therapy. This step ensures the treatment is medically necessary and aligns with the insurance plan’s guidelines.

In-Network vs. Out-of-Network Providers:

Insurance plans often have a network of preferred providers with whom they have negotiated rates. If you choose an in-network therapist, you may have lower out-of-pocket costs. However, out-of-network therapists may still be covered, but the reimbursement rates and patient responsibility may differ.

Deductibles and Copayments:

Insurance plans may have deductibles you must pay out of pocket before coverage kicks in. Additionally, copayments are the fixed amounts you pay for each therapy session, and the insurance plan covers the rest.

Exclusions and Limitations:

Some insurance plans may have specific exclusions or limitations on certain mental health conditions or treatments. Reviewing the policy details to understand what is covered and what is not is crucial.

Employer-Sponsored Plans:

Many people access private insurance plans through their employers. The coverage and options may vary depending on the employer’s chosen plan and benefits package.

Individual Plans:

Some may purchase private insurance plans directly from insurance companies. The coverage and premiums will depend on the specific plan chosen.

Understanding Private Practice Therapy Fees And Workplace Benefits Coverage

Understanding private practice therapy fees and workplace benefits coverage is essential when seeking therapy services. Here are some key points to consider:

Private Practice Therapy Fees:

Variability of Fees:

Private practice therapy fees varies depending on several factors, including the therapist’s experience and qualifications, location, type of therapy offered, and the demand for their services.

Hourly Rates:

Therapists typically charge fees on an hourly basis. The hourly rate is the amount you will be billed for each therapy session, usually lasting around 45 to 60 minutes.

Sliding Scale Fees:

Some therapists offer sliding scale fees based on the client’s income or financial situation. This means that the fee for therapy sessions may be adjusted to be more affordable for individuals with lower income levels.

Package Deals or Discounts:

Some therapists may offer package deals or discounts for clients who commit to multiple sessions upfront.

Cancellation Policy:

Private therapists often have a cancellation policy that outlines the notice required for canceling or rescheduling appointments and any associated fees for missed sessions.

Workplace Benefits Coverage:

Many employers offer extended health benefits as part of their employee compensation package. These benefits may include coverage for mental health services, including therapy. Note that workplace benefits coverage may limit the number of therapy sessions covered per year or condition.

Some workplace benefits plans may have a network of preferred providers, including therapists, with negotiated rates. Using in-network providers may result in lower out-of-pocket costs. Also, they may require pre-authorization or referrals from a primary care physician before accessing mental health services like therapy.

Some employers also offer HSAs or FSAs, which allow employees to keep aside pre-tax money for eligible health-related expenses, including therapy.

For mental health services, workplace benefits coverage may extend to dependents, such as spouses and children.

How Many Therapy Sessions Do You Need?

The number of therapy sessions a person needs varies depending on several factors, including the individual’s specific concerns, goals for therapy, the type of therapy being used, the severity of the issue, and the person’s response to treatment. There is no one-size-fits-all answer to this question, as therapy is a highly individualized process.

In some cases, individuals may find significant progress or resolution of their concerns after just a few sessions. Short-term therapies, such as cognitive-behavioral therapy (CBT) for specific issues like phobias or anxiety, might require only a limited number of sessions.

cognitive-behavioral

On the other hand, longer-term therapy may be necessary for more complex or longstanding issues to achieve meaningful and lasting change. Some individuals may benefit from ongoing or intermittent therapy over an extended period to address various challenges or to maintain their mental well-being.

Therapy is not always linear, and progress may involve ups and downs. Therapists and clients must regularly assess the therapy’s effectiveness and whether the treatment goals are being met.

People Also Ask:

How Much Does Therapy Cost In Canada?

The cost of therapy in Canada varies depending on factors, including the type of therapy, the qualifications, and experience of the therapist, the location, and the specific needs of the individual seeking therapy. Here are some general guidelines for therapy costs in Canada:

Therapy sessions are typically charged on an hourly basis. The hourly rate for therapy can range from approximately $80 to $250 or more per session.

Is It Free To See A Therapist In Ontario?

In Ontario, accessing therapy from private practice therapists is typically not free. Therapy services provided by psychologists, psychotherapists, or other mental health professionals in private health practice are not covered by the public-funded healthcare system, the Ontario Health Insurance Plan (OHIP). In such cases, you must pay for these services out of pocket. The cost of therapy depends on the therapist’s qualifications, experience, type of therapy offered, and location.

However, the cost of therapy will be covered by OHIP if you underwent therapy from a family doctor or psychiatrist in public practice.

What Is The Most Common Mental Illness In Canada?

Anxiety disorders were reported to be the most common mental illness in Canada. Types of anxiety disorders include social anxiety disorder, generalized anxiety disorder (GAD), and panic disorder.

Depression is another prevalent mental health condition in Canada, and it is often ranked among the most common mental illnesses. Additionally, many other mental health disorders affect Canadians, such as substance use disorders, post-traumatic stress disorder (PTSD), and attention-deficit/hyperactivity disorder (ADHD).

Conclusion

Many governmental and provincial programs cover therapy in Canada as long as there are carried out by a family doctor or psychiatrist in government hospitals or subsidized clinics. The government does not cover therapy by professional doctors and social workers in private settings, but you can get a private health insurance plan to cover the cost. Also, some employer health care plan covers therapy for employees that you can benefit from.