Latest / The Mental Health Evolution / Ep 25: Out‑of‑Pocket and Out of Reach

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Ep 25: Out‑of‑Pocket and Out of Reach · The Mental Health Evolution

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  (Transcribed by TurboScribe. Go Unlimited to remove this message.) This podcast is part of the Frederick Podcast Network.
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  Learn more at listenfrederick.com.
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  Welcome to Mental Health Evolution, a podcast about what's changing in mental
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  health and why it matters.
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  I'm your host, Rachel Harrison, inviting you into honest conversations with
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  people from all perspectives in the field, clinicians, tech founders,
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  investors, insurance companies, and all the folks in between.
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  Let's explore what's working, what's not, and what's next.
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  Welcome back, everyone, to the Mental Health Evolution podcast, where we
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  explore changes happening in the mental health industry and discuss topics from
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  multiple perspectives.
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  More and more, I am finding the need to be able to
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  set the stage and talk through some various dynamics in the industry
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  as a solo episode.
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  And that's what we're going to do today.
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  I want to share some insights and some information on a topic
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  I've been thinking about and exploring, which is how rising out-of
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  -pocket health care costs are impacting people's ability to stay in therapy
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  as well as access mental health support.
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  In this episode, I'll walk through some of the forces behind these
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  changes, including deductibles, co-pays, and market-based shifts, and explore
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  what those trends may mean for clients, clinicians, and the broader mental
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  health system.
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  So let's start with a few articles here to set the stage.
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  We wanted to find current information.
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  And so you will see at least one here that is a
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  2026 article.
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  And that's important because many of these shifts that are being seen
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  and reported by providers and clients alike are more recent, really starting
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  early this year in 2026 and some at the end of 2025,
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  as insurance plans and deductibles have reset for the year.
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  But let's go over some of these articles in brief to get
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  you an idea of what has been happening.
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  The first one I want to highlight here is called the high
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  costs of mental health care, a barrier, a burden, and a call
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  to action.
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  This one from the Access Institute that helps to create access for
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  people that have a barrier.
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  And they report on how cost remains a major barrier to accessing
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  therapy as demand continues to grow while provider supply and affordability lag
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  behind.
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  So we're going to dig into some of those pieces.
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  The next article that I want to look at is called insurance
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  design can create co-pay barriers to mental health care.
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  This one is a research review from RWJF and many insurance plans
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  they have found do charge higher co-pays for mental health visits
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  compared with primary care.
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  That is not necessarily new, but it does reduce utilization, especially for
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  older adults in Medicare Advantage plans.
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  But I think across the board, I know that most of you
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  probably realize that if you are accessing mental health care, usually you're
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  paying at least the specialty provider rate and sometimes an even higher
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  rate when you are accessing mental health care.
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  And this is one of the barriers that we will talk about
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  more and more.
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  Next article, just to go over this briefly, the APA services.
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  This is the 2026 summary, which I found very helpful.
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  I do highly recommend taking a look at it.
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  Saying new policies affecting access to mental health care.
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  And this article is discussing how policy decisions are limiting affordable
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  access, including things like cost sharing, funding cuts and barriers that have
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  been disproportionately affecting people who need care.
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  This article also offers some suggestions of what can be done.
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  And I'm going to highlight that a little bit later in the
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  episode as well.
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  And the last, the PMC report.
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  This is from 2024, so a little further back.
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  But the article is called High Out-of-Pocket Cost Burden for
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  Mental Health Care.
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  And again, research showing that a subset of patients spends a large
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  percentage of income on out-of-pocket mental health care costs and
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  highlighting those affordability challenges.
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  So with that setting the stage, I'd like to talk about some
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  broader themes and some anecdotal scenarios that are going on, because I
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  want to highlight conversations that I have been hearing about personally and
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  professionally and what people are reaching out to tell the podcast.
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  I'm also seeing from other providers what they are expressing either personally
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  or on a public forum such as social media.
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  And the bottom line is that everyone is reporting a change.
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  I would say it like this.
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  Things are different in 2026.
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  We are seeing a shift.
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  I talked to a colleague recently and have changed any identifying data
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  so as not easily identify this person.
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  She's a group practice owner and she has a practice that accepts
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  commercial insurance.
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  She is saying a couple of things.
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  First, she is saying it's harder to get referrals as a local
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  practitioner.
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  I have heard this echoed throughout different forums online.
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  I've also heard this from multiple solo providers.
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  People are struggling to get referrals.
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  Local practitioners who used to feel like they couldn't see enough people,
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  there was too much demand, are now really looking for clients.
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  So that's just an interesting trend that is shifting.
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  And two, some clients are terminating services due to higher costs and
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  they have insurance.
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  So these are not people saying the cost of out of pocket
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  mental health care or practitioners who don't take insurance is too much.
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  These are people saying I have insurance and I can't afford mental
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  health care.
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  And that represents a big shift too in our industry.
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  And I want to dig through that a little bit more and
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  kind of unpack that.
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  Because as I process and as we process on the pod these
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  two things, I sat with some of the things I've been hearing
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  as trends.
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  And I want to highlight each one here, how it impacts clients,
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  clinicians and businesses in this space.
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  First, we're going to talk about changes being seen in commercial and
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  employer provided insurance plans.
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  Number one, the cost of insurance plans has skyrocketed.
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  This has been all over social media.
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  I'm sure you've seen it.
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  But there are things happening here where even people with employer plans
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  are having to pay more just to have insurance.
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  So the price of entry is has gone up exponentially.
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  I know people that are paying double and triple the amount to
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  have their monthly pay rate just to have insurance.
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  Medical insurance also covers mental health care.
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  Typically, these people are seeing higher rates required just to have
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  insurance.
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  And as you can imagine, that creates a significant financial burden.
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  That means there's less cash available in that person's budget for other
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  things such as maybe deductibles or co-pays.
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  So even for providers that are in network, this piece is the
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  first layer of complexity.
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  The next layer is that deductibles across the board seem to be
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  increasing.
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  Again, this is not every single plan and it doesn't reflect everything,
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  but it is a pattern seen by many.
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  Providers are reporting this all across the country.
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  These deductibles often create a financial burden that is not sustainable.
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  For a client to pay eight or ten thousand dollars of their
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  mental health care costs out of pocket before being able to access
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  a benefit.
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  And as you can imagine, that's another layer to this barrier of
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  getting care even for clients that have insurance.
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  And third, co-pays are increasing.
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  Again, not every plan, but we are seeing this more and more.
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  A large number of commercial plans are seeing an increase in co
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  -pay costs for outpatient mental health care.
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  I believe inpatient as well, although I haven't heard as much about
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  that.
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  And this means that a client who is already paying more for
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  their insurance plan may also have a higher deductible and now has
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  a higher co-pay once the deductible is met.
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  So the multiplication effect is pretty significant.
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  The cost of receiving care may double, triple, quadruple for people that
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  have been utilizing mental health care.
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  They're saying, can I still afford this?
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  So I think it's worth us taking a look at that pattern
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  and how it is impacting the industry as a whole.
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  The other factor is Medicaid cuts.
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  This is well known and we have talked about this some on
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  the pod.
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  But as one of the articles referenced, the Medicaid cuts mean that
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  11.8 million individuals, 11.8 million, if you can just think
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  about that for a moment, will no longer have access to Medicaid
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  benefits.
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  According to the AP article that I referenced above, these are individuals
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  often who have an acute need for mental health care.
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  So cuts here mean that there are more people who cannot afford
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  care.
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  When I look at this data and clients or patients who are
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  no longer able to afford mental health services, I just wonder to
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  myself, where do they go?
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  What happens next?
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  At the same time, providers are often saying that they can no
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  longer afford to accept Medicaid, Medicare and even some commercial insurances
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  due to the low reimbursement rates and the rising costs to remain
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  in practice.
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  So by my assessment, this means that our gap continues to widen.
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  We have providers who cannot afford to provide care through insurance that
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  we have.
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  And we have clients and patients who cannot afford out-of-network
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  care and sometimes cannot even afford care with their commercial insurance and
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  with Medicaid cuts may not even be covered anymore.
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  My question is this.
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  I'm curious, who stands to gain with these trends?
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  And I'm just going to leave that there.
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  While these data points don't present a great picture for the mental
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  health industry, I think there are a few points to consider.
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  And some of these also come from the APA recommendations.
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  First, I want to say if you currently have a reasonable co
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  -pay for mental health services, please use it.
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  Enjoy it.
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  Count yourself as fortunate.
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  This is a good thing and we're glad for it.
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  Secondly, I encourage any client or provider to look into local resources
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  that might be able to fill a gap.
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  This could be a mental health association.
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  This could be a grant that supports with co-pays.
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  There are some resources out there, though they can be hard to
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  find.
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  And if we can do things to help bridge the gap for
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  a client to be able to afford care, I think we should.
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  Whether that means in our communities there is a resource or whether
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  that means that we ourselves are able to be that resource.
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  And thirdly, I really like the APA's recommendation in their article of
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  documenting what is happening.
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  Let's really look at this.
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  Let's write down when we have a client that terminates because they
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  can't afford their co-pay.
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  Let's document that.
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  Let's make a note of that.
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  And let's share this information with colleagues who are also providers and
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  patients.
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  Gathering collective data helps us all to see trends and patterns and
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  come up with collective solutions to the barriers we are seeing.
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  It also helps us if we are going to talk to policymakers
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  about changes that we would like to see.
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  So talk to your friends and colleagues.
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  Unity for local providers, I think, is going to be a necessity
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  with all of the market changes that we are facing.
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  And lastly, I want to inspire some creative and out of the
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  box thinking.
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  This is for clients seeking care as well as providers.
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  I don't have all the answers, but the question to ask is
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  what can be done to make this work?
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  Maybe it's a client can come for fewer sessions but not stop
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  entirely.
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  Maybe there are some creative financial solutions that can help.
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  Maybe providers can create programs, look for grants, other ways to fund
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  services.
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  I am not sure, but I know we need to think about
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  this differently.
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  I know that as an industry, we have providers and business owners
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  that care deeply.
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  And I am hopeful that we can find a way to help
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  support client and patient needs while confronting these changes.
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  If you are someone that has found a way to get creative
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  here, to find resources, to do unique things, I would love to
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  hear from you.
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  I'd love to have you on the pod.
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  I would love to hear about how we are looking at creative
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  solutions and for clients too.
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  If you have found a way, if you have figured out how
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  do we budget this?
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  How do we look at our yearly medical budget and make a
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  way?
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  Like what kind of creative ideas are there out there for that?
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  I think that's great too.
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  The bottom line is that mental wellness and mental health care continue
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  to be important to all of us.
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  They're important for our communities.
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  And I hope that as things are changing and things are getting
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  more expensive and financial stresses are really becoming something that people
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  have to think about day to day.
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  Some people have always thought about that day to day.
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  Let's be real.
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  I hope that we can find a way to continue to make
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  mental health care accessible.
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  With that, thank you for listening to today's solo episode.
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  We will continue to build upon this trend with other guests and
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  data so we can look at what is happening and make the
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  best decisions for client care, clinician well-being and business health in
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  our industry.
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  If this topic resonates with you, whether you're a clinician, a practice
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  owner or someone trying to navigate mental health care, we would love
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  to hear your thoughts.
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  We'll be back in the next episode to explore more issues relevant
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  to the mental health care community.
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  Thank you for listening and bye for now.
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  Thanks for listening to the Mental Health Evolution podcast.
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  Join the conversation.
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  Find us on socials, send us your thoughts and tell us what
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  you're seeing in your corner of the mental health world.
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  Until next time, stay curious and keep evolving.
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  .com.