Important 2027 Insurance Changes – Please Review Before January 1

As we approach January 1 and open enrollment is underway, please take a few minutes to review your health insurance benefits for 2027. This year there are several changes that could directly affect your access to therapy, including telehealth restrictions, new session limits from some Medicaid plans, and reduced out-of-network coverage. Here’s what you need to know so your care isn’t interrupted.

Important Change #1: Telehealth Coverage Is Being Restricted by Some Plans

Many of the temporary telehealth allowances put in place during COVID have ended or are ending. As a result, some insurance plans are reducing or eliminating reimbursement for telehealth sessions. Some insurance companies now require members to use only the plan’s own contracted telehealth companies for virtual therapy. That means you may lose the ability to see the therapist you choose by telehealth, even if that therapist is in-network for in-person sessions.

If telehealth is important to you, please check the following before choosing your plan for 2027:

Does the plan cover telehealth therapy with in-network providers of my choice?
Does the plan limit telehealth to a specific company or app?
Are copays or coinsurance different for telehealth than for in-person visits?

If your plan no longer covers telehealth with your clinician, in-person sessions may still be covered. Please talk with your clinician about your options.

Important Change #2: Molina Medicaid Session Limits

Molina Medicaid is now limiting therapy to 12 sessions per year without prior authorization. There is no guarantee Molina will approve sessions beyond those first 12. If you or your child needs regular ongoing services, this limit may interrupt care partway through the year.

What you can do:

Share your concerns with Molina. If this restriction affects you or your child, we encourage you to call Molina Member Services (the number is on the back of your card) and let them know how this limit affects your care. Member feedback matters.
Consider your plan options. South Carolina Medicaid members can change health plans during their annual plan-change period. You’ll receive a letter from Healthy Connections telling you when your period is open. You can also contact South Carolina Healthy Connections Choices at (877) 552-4642 or SCchoices.com. In our experience, Healthy Blue has been easier to work with and currently allows 24 sessions before requiring prior authorization.

Important Change #3: Out-of-Network Benefits May No Longer Be Available

Many insurance companies have reduced or eliminated out-of-network reimbursement for all health services, not just therapy. If you currently see your clinician using out-of-network benefits, those benefits may not be included in your plan for 2027, even if you keep the same insurance company.

Before you choose a plan, please confirm:

Does the plan include any out-of-network benefits?
If so, what is the separate out-of-network deductible, and what percentage will the plan reimburse?

If your new plan has no out-of-network coverage, you will be responsible for the full cost of sessions with a clinician who is not in-network with your plan.

What Happens When Benefits Reset?

Many health insurance plans reset their deductibles on January 1. A deductible is the amount you must pay out of pocket for covered services before your insurance begins to pay. Until your deductible is met, you may be responsible for the full cost of your sessions, which will be charged to the payment method we have on file. For Medicare Part B beneficiaries, the 2027 deductible is projected to be $292, up from $283 in 2026. Official confirmation from Medicare is still pending. If your plan has a copay or coinsurance, these may also increase and will apply after your deductible is met.

What Happens If Your Benefits Change?

Because we are in open enrollment, your insurance company or policy may change for the coming year. Please tell our office about any changes to your insurance coverage, both primary and secondary. Insurance companies do not notify us when your coverage changes. If you want your new plan to pay for services, you need to confirm that your clinician participates in it. Not all of our clinicians participate in all insurance plans.

What Happens If Your Insurance Benefits Are Terminated?

If your insurance benefits end or lapse for any reason, including Medicaid, you are responsible for the full cost of services provided after coverage ends. If your benefits are no longer active, we completely understand if you need to pause services temporarily. Please note:

We cannot carry balances or offer payment plans. Payment is due at the time of service. (Court-related services require pre-payment and are not considered medically necessary services and are not reimbursed by insurance.)
Unpaid balances may result in a pause or termination of services.

How to Prepare:

Review your benefits: Contact your insurance provider or log into your insurance portal and check:

Deductible amount
Copay/coinsurance rates
Telehealth coverage and any provider restrictions
Session limits or prior authorization requirements
Whether your clinician is in-network
Out-of-network coverage, if your clinician is not in-network with your plan

Verify your personal information:

Log into our portal and confirm your address, phone number, and email are current. Most insurance companies deny claims when the address on the claim doesn’t match their records.
Update your insurance information: If your plan changes, please send us your new information before your first appointment in January.
Verify your payment method: Make sure the card on file is current, especially if your deductible resets.
Plan ahead: Setting aside funds for early-year out-of-pocket costs can make the transition easier.

Your Responsibility as a Client

Insurance policies are a contract between you and your insurance company. We do not set deductibles, copays, session limits, or telehealth rules, and we cannot guarantee what your plan will pay. Your insurance provider is the best and only source of information about your coverage.

Important 2027 Insurance Changes – Please Review Before January 1