PlushCare vs. Sesame (2026): Insurance or Cash Price for Online Therapy and Prescriptions?

PlushCare and Sesame look similar from a distance: both offer online therapy, both have clinicians who can prescribe non-controlled medications by video, and both offer same-day appointments. The dividing line is insurance. PlushCare bills insurance; Sesame deliberately doesn’t, and shows you a cash price upfront instead.

The short answer

• PlushCare is the better choice if your insurance covers it.
• Sesame is the better choice if you’re paying cash — it is usually cheaper and gives you more choice of clinician.

Cost and insurance

Prescribing

Both services prescribe non-controlled medications such as common antidepressants, and neither prescribes stimulants or benzodiazepines. Sesame also lists psychiatrists and psychiatric nurse practitioners, and non-stimulant ADHD options, which can matter if your needs go beyond a first-line prescription. PlushCare prescribing is handled by its physicians.

Choosing your clinician

Sesame is a marketplace: you compare profiles, reviews, prices and time slots and book whoever you like. PlushCare is a single practice with set prices, which makes it simpler — and keeps your records with one organization for both mental and physical health.

Therapy options

PlushCare offers individual video therapy for adults. Sesame offers individual and couples therapy sessions, booked per visit.

Insurance-billing practice versus cash-price marketplace

The biggest difference is how you pay. PlushCare is a telehealth practice that accepts many insurance plans, so what you pay depends on your coverage. Sesame is a marketplace that doesn’t bill insurance: each provider sets an upfront cash price that you see before you book. That distinction decides which is cheaper for most people. Read our individual reviews of PlushCare and Sesame for detail.

Cost scenarios

These prices come from each service’s published pricing as summarized in our reviews; confirm before booking.

• Therapy without insurance. PlushCare charges $169 per session. Sesame says mental health visits start around $34, but that is a starting price: each provider sets their own, prices vary by state, and therapy sessions often cost more, so check the exact price and the therapist’s experience before comparing it with $169.
• Therapy with in-network insurance. PlushCare may reduce the cost substantially, whereas Sesame doesn’t bill insurance, though HSA and FSA payments are accepted.
• Medication visits. PlushCare doctor visits are $129 without insurance, plus a membership of $19.99 a month or $149 a year; PlushCare says most patients with in-network insurance pay $30 or less. On Sesame, psychiatrist appointments average about $132 for 45 minutes, and the Mental Health Rx subscription is $79 a month for ongoing prescriptions, visits and messaging, with medication costs separate.

Choice, continuity and convenience

PlushCare offers therapy and doctor care within one practice and app, which keeps records together and makes referrals between a therapist and a physician straightforward. Sesame lets you choose among many clinicians and see open slots, often the same day, but you assemble your own care: therapy and prescribing are separate bookings. If you value choice and price transparency, Sesame fits. If you value an integrated practice and insurance, PlushCare fits.

What each can prescribe

Neither service prescribes controlled substances. That rules out ADHD stimulants and benzodiazepines at both, though Sesame providers can prescribe non-stimulant ADHD medicines such as atomoxetine, viloxazine and guanfacine when appropriate. PlushCare says conditions such as ADHD usually need a psychiatric or physician diagnosis. Sesame says psychiatrists aren’t available in every state, in which case primary care providers manage certain mental health prescriptions. See online ADHD treatment and online psychiatry for more.

Who each tends to suit

• PlushCare: insured adults who want therapy and medical care in one place, and who prefer paying per session.
• Sesame: uninsured or high-deductible adults who want a visible price, a choice of clinician and quick access, or who want couples therapy sessions.

PlushCare’s therapy is for individual adults only, so couples, families and anyone under 18 will need another service. Sesame lists online couples therapy sessions.

Questions to ask before you choose

1. Does my plan cover PlushCare, and what is the real out-of-pocket cost?
2. What is the exact price of the Sesame clinician I’m considering, and how often will I need to book?
3. Will I need medication, and does the service prescribe it?
4. How do I keep seeing the same clinician?
5. What’s the cancellation policy?

Compare more in our guide to online therapy without insurance and our affordable therapy guide.

Our verdict

If PlushCare is in network for you, its simplicity and insurance billing make it a strong choice. If you’re paying yourself, Sesame is usually cheaper, offers psychiatric specialists and lets you choose exactly who you see.

For emergencies, call 911 or call or text 988 in the US — see Get Help Now.