MENTAL HEALTH • FINANCES • SALT LAKE CITY

Your benefits package probably covers therapy. Here's how to actually use it, and why the system makes it so confusing on purpose.

Let's get one thing out of the way: the American mental health system was not designed with you in mind. It was designed around billing codes, insurance bureaucracy, and a whole lot of fine print that makes accessing care feel like a second job.

But here's a small win hiding inside that mess, and it's one a lot of people in Salt Lake City aren't using: your HSA or FSA. If you have one of these accounts through your employer, you may already have money sitting there that can pay for therapy, right now, tax-free.

This post breaks down exactly how HSA and FSA accounts work for mental health care in SLC, what they actually cover, and what to watch out for. No jargon. No fluff.

First, What Even Is an HSA or FSA?

HSA stands for Health Savings Account. FSA stands for Flexible Spending Account. Both are special accounts tied to your health benefits that let you set aside pre-tax dollars to pay for qualifying medical expenses , including therapy.

The key word is pre-tax. That means if you're in the 22% federal tax bracket, every $100 you spend from your HSA or FSA on therapy effectively costs you about $78 in real money. That's not nothing.

Think of it this way: you've already been taxed enough. These accounts are one of the few places the system actually gives you a small break.

Here's a quick breakdown of the difference between the two:

HSA (Health Savings Account):

Only available if you have a High Deductible Health Plan (HDHP)
Money rolls over year to year, it's yours to keep
You can invest it and let it grow over time
2024 contribution limit: $4,150 for individuals, $8,300 for families

FSA (Flexible Spending Account):

Available with most employer health plans, not just HDHPs
"Use it or lose it" - most FSAs expire at the end of the year (some offer a grace period or small rollover)
2024 contribution limit: $3,050

If you're not sure which one you have, check your benefits portal or ask HR. Most people have one or the other, sometimes both.

Does Therapy Actually Qualify?

Yes, and this is where a lot of people are leaving money on the table.

The IRS considers mental health treatment a qualifying medical expense. That includes:

Individual therapy and counseling sessions
Couples or family therapy
Psychiatric evaluations
Medication management appointments
Intensive outpatient programs (IOPs)
Telehealth therapy sessions

The therapist or center does need to be a licensed provider, think licensed clinical social worker (LCSW), licensed professional counselor (LPC), psychologist, or psychiatrist. The good news: most reputable therapy centers in Salt Lake City qualify.

The IRS doesn't care about your diagnosis. Anxiety, depression, trauma, life transitions, it all qualifies as long as you're seeing a licensed mental health professional.

How to Actually Use Your HSA or FSA for Therapy in SLC

Here's where people get tripped up. Using these benefits isn't as automatic as swiping a card — though sometimes it is exactly that simple.

Option 1: Pay directly with your HSA/FSA card

Many therapy centers in Salt Lake City will accept your HSA or FSA debit card directly at checkout, the same way you'd pay with any card. Ask the front desk before your first appointment if they accept HSA/FSA payments.

Option 2: Pay out of pocket and reimburse yourself

If your provider doesn't take HSA/FSA cards, you can pay out of pocket and submit a claim for reimbursement through your benefits portal. You'll need a receipt or a Superbill ,a detailed invoice that includes the provider's name, license number, diagnosis code, and service date. Your therapist can generate this for you.

Option 3: Use it to cover your deductible or copay

If you're running therapy through your insurance, you can use HSA/FSA funds to cover whatever your insurance doesn't, copays, coinsurance, and your deductible. This is huge if you're mid-year and haven't hit your deductible yet.

The System Problem Nobody Talks About

Here's the part that deserves to be said out loud: the reason most young adults don't know about HSA/FSA benefits for therapy isn't because they're not paying attention. It's because the system has never made it easy to understand.

Employer benefits packets are intentionally dense. Insurance websites are a maze. Mental health billing is coded in a language designed for administrators, not patients. And when you're already dealing with anxiety or depression, wading through fine print is the last thing you have energy for.

This isn't a personal failure. It's a design failure. The mental health care system in this country puts the burden of navigation almost entirely on the people who are least equipped to carry it , people who are struggling.

In Utah specifically, access to affordable mental health care is a documented issue. The state consistently ranks among the highest in the country for depression rates while simultaneously having some of the worst access to mental health services. That's not a coincidence. It's a structural problem.

HSA and FSA accounts don't fix that. But they are a real, accessible tool, and if you have one, you deserve to know it exists and how to use it.

A Few Things to Watch Out For

Before you start paying for therapy with your HSA or FSA, here are a few things worth knowing:

Coaching is NOT covered. Life coaches, wellness coaches, and unlicensed counselors don't qualify as medical providers. Only licensed mental health professionals count.
Apps may or may not qualify. Some mental health apps (like Calm or Headspace) don't qualify, while others that offer live therapy sessions (like Talkspace or BetterHelp) may. Check with your FSA administrator before assuming.
Keep your receipts. Even if you pay with your HSA card, the IRS can audit HSA withdrawals. Save your receipts and any Superbills your provider gives you.
FSA deadlines are real. If you have an FSA and it's October or November, check your balance now. Unused funds often expire December 31st.

Ready to Start? Here's What to Do This Week

If you've been putting off therapy because of cost, and you have an HSA or FSA through your employer, here's a simple starting point:

Log into your benefits portal and check your HSA/FSA balance
Confirm whether your account comes with a debit card or requires reimbursement
When you contact a therapy center, ask: 'Do you accept HSA/FSA payments, and can you provide a Superbill if needed?'
Book the appointment

That's it. The money is likely already there. It's yours. You've earned it.

We Can Help With the Rest

At Rivercourse Counseling, we work with clients in Salt Lake City who are navigating the real-world barriers to mental health care, including the financial ones. We accept most major insurances, HSA and FSA payments, can provide Superbills for reimbursement, and offer sliding scale fees for clients who need them.

If you're a young adult in SLC who's been curious about therapy but not sure how to make it work financially, we'd love to talk. Reach out to us here, no pressure, no jargon, no insurance runaround.

Have questions about using your benefits for therapy in Salt Lake City? Drop them in the comments or send us a message - we read everything.