Choosing an Insurance Plan That Supports Your Care

The Affordable Care Act—or Any Open Enrollment

Most important—is it a PPO plan?

If you want the freedom to choose any therapist or specialist, look for a PPO plan. These plans typically allow you to:

  • See providers both in and out of network

  • Use your benefits with fewer restrictions

  • Get partial reimbursement when working with Out-of-Network providers (like myself)

HMO plans, by contrast, restrict you to a specific provider network. If your preferred therapist isn’t in that network, your benefits won’t apply. While HMO premiums are often lower, they don’t offer the same flexibility.

What mental health benefits does the plan offer?

Don’t be swayed by a low monthly premium without looking closely at the mental health coverage. If therapy is part of your care plan—or may be—you may save more in the long run by choosing a plan with stronger mental health benefits.

What’s the reimbursement rate for Out-of-Network providers?

Reimbursement rates vary widely by plan. Unfortunately, this information isn’t always obvious on CoveredCA.org or other exchange sites. If this is is important to you (and it often is), I recommend:

  • Contacting the insurance provider directly

  • Reaching out to a local ACA navigator or insurance agent for help

Is there a separate deductible for Out-of-Network care?

It’s rare—but possible. Some plans have separate deductibles for in-network vs.
out-of-network services. Be sure to confirm this in advance to avoid unpleasant surprises later on.

Do you qualify for income based subsidies?

Many people do! This is one of the most important features of ACA plans and can significantly reduce your monthly premium. At the same time, legislators often want to revise the ACA benefits. If you're unsure, use the CoveredCA.org calculator or speak with an enrollment counselor.

Remember: PPO insurance offers the most flexibility

Many therapists—including myself—have chosen not to join insurance panels in order to maintain our specialties and autonomy. If you want to work with a provider who’s Out-of-Network, such as a Somatic Experiencing Practitioner, you’ll need a PPO plan to receive any reimbursement.

Can I see a therapist without using my insurance?

Absolutely. Many of my clients have HMO insurance, which doesn’t cover therapy with Out-of-Network providers. Still, they choose to work with me because of the depth and specificity of my approach. Specialties like Somatic Experiencing are hard to find within traditional insurance networks.

Some clients with PPO insurance even choose not to submit claims, out of a desire to keep their therapy fully confidential.

If you’re thinking about working together

If you're thinking about moving forward and want to connect, let's set up a call. We can explore whether my work is a good fit for where you are today. I offer a brief consultation to talk through your needs, answer any lingering questions, and consider next steps—when you're ready.

"MAY YOU BE WELL.
MAY YOU BE HAPPY.
MAY YOU BE FREE OF SUFFERING."
~TIBETAN HEART MEDITATION