If you have insurance, choose Rula. It averages about $15 a session, accepts 100+ commercial plans plus Medicare, and offers psychiatry. If you are paying out of pocket and want messaging between sessions, choose BetterHelp. It costs $70 to $100 a week, offers financial aid, and has the largest therapist network.
Rula and BetterHelp both connect you with licensed therapists online, but they are built for different people. One is designed around your insurance; the other around a weekly subscription. Here is how they compare where it matters.
Side by side
| App | Best for | Price (annual) | Rating | Platforms |
|---|---|---|---|---|
| Rula | Insurance, Medicare, medication | ~$15 avg copay or $150/session | 8.4 | iOS, Android, Web |
| BetterHelp | Out-of-pocket, messaging | $70-$100/week | 8.5 | iOS, Android, Web |
Cost
Rula charges per session with no subscription. With insurance, Rula says patients pay about $15 per session on average. Without insurance, therapy is $150 per session. Cancelling within 24 hours or missing a session costs $99. See our Rula cost guide.
BetterHelp costs $70 to $100 a week, billed weekly or monthly. Where insurance covers it, the average copay is about $23. BetterHelp offers financial aid to some eligible users who are not using insurance. See our BetterHelp cost guide.
Winner: Rula if you have insurance; BetterHelp if you don’t.
Insurance, Medicare, and Medicaid
Rula is in-network with more than 100 commercial plans, accepts Medicare in all 50 states, and accepts Medicaid in select states.
BetterHelp accepts select plans from carriers including Aetna, Cigna, UnitedHealthcare, and Optum in some states. It does not accept Medicare, Medicaid, or TRICARE.
Winner: Rula, clearly.
How therapy works
Rula uses scheduled, hour-long sessions by video, with in-person options in some areas. There is no ongoing messaging with your therapist between sessions. When you book your first appointment, Rula schedules four follow-ups automatically.
BetterHelp combines unlimited messaging with a weekly live session by video, phone, or live chat, typically 30 to 45 minutes. It suits people who like to process things in writing between sessions.
Winner: depends on you. Rula for longer, traditional sessions; BetterHelp for flexible, ongoing contact.
Finding a therapist
BetterHelp has the largest therapist network in online therapy. Matching is fast, usually within a day or two, and switching therapists is easy.
Rula matches you with licensed therapists credentialed in your state who accept your insurance. Its network is smaller, but every match is in-network for you.
Winner: BetterHelp for choice and speed.
Medication
Rula offers psychiatry alongside therapy: $225 for an intake and $175 per follow-up without insurance, or your copay with it. Its prescribers can prescribe some controlled medications, including stimulants for ADHD, but Rula’s help center lists eight states where they cannot prescribe any controlled medication and seven more where Rula cannot currently serve patients who need Schedule II medications such as stimulants. Rula does not guarantee any specific medication.
BetterHelp offers psychiatry through UpLift, an add-on alongside therapy delivered by licensed psychiatrists and psychiatric nurse practitioners in states where they are licensed. BetterHelp says UpLift’s providers are in-network with many insurers and that eligible members pay an average copay of $26 per session. Controlled substances are not prescribed, and BetterHelp’s own therapists cannot prescribe medication.
Winner: Rula, for psychiatry on the same platform as your therapy and the option of controlled medications in most states.
Privacy and track record
BetterHelp settled with the FTC in 2023, agreeing to pay $7.8 million over allegations that it shared consumers’ health data for advertising after promising to keep it private. The final order bans it from sharing health data for advertising.
We found no comparable regulatory action against Rula. See our look at whether Rula is legit.
Which should you choose?
Choose Rula if you have insurance, especially Medicare or Medicaid in a covered state; you want full-length sessions; or you want psychiatry on the same platform as your therapy.
Choose BetterHelp if you are paying out of pocket; you want to message your therapist between sessions; or you want the widest choice of therapists and easy switching.
Consider neither if you have Medicaid in a state Rula doesn’t cover (try a community mental health center) or cost is a hard barrier (see our cheapest online therapy guide).
Common questions
Is Rula cheaper than BetterHelp? With insurance, usually yes: about $15 a session versus $70 to $100 a week. Without insurance, BetterHelp costs less per month.
Does BetterHelp take Medicare? No. Rula does, in all 50 states.
Can I message my therapist on Rula? Not for ongoing therapy between sessions. Care happens in scheduled appointments.
Which offers medication? Both, in different ways. Rula offers psychiatry on its own platform, and its prescribers can prescribe some controlled medications outside certain states. BetterHelp offers psychiatry through UpLift, which does not prescribe controlled substances.
Can I switch from BetterHelp to Rula? Yes. Cancel BetterHelp before your next billing cycle and check your coverage on Rula.
The bottom line
Rula and BetterHelp solve different problems. Rula is the better choice for insured people, especially on Medicare, and for anyone who wants traditional sessions or psychiatry on the same platform. BetterHelp is the better choice for people paying out of pocket who value messaging and the largest therapist network.
For more, see our Rula review, BetterHelp review, and BetterHelp alternatives.
One important note: if you are in crisis or considering harming yourself, please reach out now. In the US, call or text 988 for the Suicide & Crisis Lifeline. Immediate human support is available.