Keeping you Informed: Understanding the 2026 ACA Changes and Navigating the Changing Therapeutic Landscape
The Affordable Care Act (ACA) has long required most health plans to include mental health services as essential benefits — a major step forward in recognizing therapy as a core part of health care rather than an optional add-on.
At the same time, the way people experience insurance has changed dramatically over the last several years.
Even though mental health coverage is still required under the ACA, many plans have shifted toward high-deductible models that place more financial responsibility on consumers. For many families, this now means:
• Higher annual deductibles before insurance begins to pay
• Higher copays or coinsurance once the deductible is met
• Higher monthly premiums in some plans, even with high deductibles
In practical terms, this means that while therapy is technically “covered,” many people still face significant out-of-pocket costs at the start of care. You may have benefits on paper — but you are often paying a large portion yourself until your deductible is satisfied.
For mental health care specifically, this can feel especially frustrating because:
• You often seek therapy when stress, anxiety, or family challenges are already high.
• Waiting until a deductible is met can delay care when it’s most needed.
• The financial structure of modern insurance can unintentionally create barriers to timely treatment.
This is why understanding your deductible, copays, and coinsurance is just as important as knowing whether therapy is “covered.”
In short:
The ACA protects access to mental health services, but today’s insurance designs — with higher deductibles and cost-sharing — mean that access and affordability are not the same thing. Being informed about your plan helps you make smarter, less stressful decisions about your care.
The Deductible Reality Most People Aren’t Told
Separate from federal policy changes, there has also been a rise in online companies such as Headway and Rula (formerly Rulo) that market themselves as easier ways to find therapists who “take insurance.” What is not explicitly stated is that these platforms are not neutral referral services. They are financially connected to insurance companies and investors whose business model depends on directing care through their systems.
Even more important — and rarely explained — is this key reality:
“In-network” is usually only cheaper AFTER your deductible is met.
Until your deductible is met, even in-network clients are typically required to pay the insurance company’s contracted rate out of pocket. That rate is determined by the insurer — not by the therapist — and is legally binding.
What this means in practice:
Before your deductible is met:
You are paying out of pocket whether your therapist is in-network or out-of-network — just at different rates.
Because of insurance contracts, in-network therapists cannot reduce fees, offer sliding scales, or negotiate costs before the deductible is met. All hands are tied by the contract.
This is why “taking insurance” doesn’t actually make care more affordable at the start of treatment for many people — it only becomes financially helpful after the deductible is met.
This is a critical point that is often missing from the information clients receive from insurance companies about insurance-based therapy.
Why Clear Water Wellness Chooses to Be Out-of-Network
We practice out-of-network intentionally — not by accident — because we believe it allows us to provide better, more ethical, and more personalized care.
Here’s why our model can actually be better for you:
1. You choose the best fit — not an insurance panel
Your therapist is chosen based on your needs, goals, and clinical fit, not on whether they are approved by an insurance company or platform.
2. Your care isn’t shaped by corporate rules
We are not required to limit sessions, shorten treatment, or structure therapy around billing codes rather than your real progress.
3. You can still use your insurance
If you have out-of-network benefits, we provide you with a superbill that you can submit for reimbursement. Many clients receive partial reimbursement after meeting their deductible.
In other words: you get greater clinical freedom, continuity of care, and therapist choice — while still having access to your benefits.
At CWW, we intentionally practice as out-of-network providers. This means:
1. You pay us directly for sessions.
2. We provide you with a superbill.
3. You submit that to your insurance for possible reimbursement.
Most PPO plans will reimburse a portion of your session cost after your out-of-network deductible is met — often anywhere from 50–80%, depending on your plan.
This model gives you choice, flexibility, and continuity of care, rather than limiting you to whoever happens to be in your insurance panel.
What Is a Deductible (In Plain English)?
A deductible is the amount you pay out of pocket before your insurance starts sharing costs.
Most commonly:
You pay toward your deductible first.
Once it is met, your plan reimburses a percentage of eligible therapy costs.
You continue receiving care while working toward that deductible rather than waiting for the “perfect” financial moment.
Many families find that investing in therapy early — even while meeting a deductible — prevents bigger emotional, academic, or relational problems later.
What to Ask Your Insurance Before Starting Therapy
If you’re considering therapy, call your insurance and ask:
Do I have out-of-network mental health benefits?
What is my out-of-network deductible?
What percentage do you reimburse after it’s met?
We are happy to help you interpret this — you do not have to figure it out alone.
At Clear Water Wellness, our commitment is to high-quality, ethical, independent mental health care — not platform-driven or insurance-controlled treatment.
You deserve a therapist who knows you, works for you, and practices with clinical freedom and integrity.
If you’re in Wyomissing, Reading, or anywhere in Berks County, we’re here to support you every step of the way.