Start with who you will be talking to
Every service here includes therapy, so the first cut is the clinicians sitting alongside it. Talkspace lists therapist and psychiatrist, which makes it a specialist mental health service rather than a general telehealth provider. MDLIVE lists doctor, therapist and psychiatrist, Sesame Care lists doctor, nurse practitioner and therapist, and Pague Menos includes a therapist within a wider team of doctor, nurse practitioner and pharmacist.
That split decides whether medication is a realistic option. A psychiatrist can review and prescribe, a doctor can cover physical health, and the pharmacist and dietitian in the Pague Menos team point to a service built around a pharmacy. Use the online therapy rankings to see the wider field before you book a first appointment.
Put the per consultation prices side by side
This is where cost differences are clearest. A consultation at MDLIVE is priced at $0 to $89, a spread running from the cheapest visit to the most expensive. Sesame Care lists $34 for a visit, while Talkspace lists $69.
Across the brands in our data the consultation figure runs €0 to €113.13, so two services can sit at opposite ends of a single list. Compare the same thing on each side: one visit, the same clinician type, the same length of session. A headline price only means something next to the appointment length it buys.
Separate the monthly plan from the visit price
Two of these services publish a plan price on top of a visit price. Sesame Care charges $10.99 per month, and Pague Menos lists BRL 0 per month. Across our data the monthly plan figure runs €0 to €70.
Work out which side of that you land on before you sign up. Multiply the per visit price by the number of sessions you expect in a month and compare the result with the plan price. A low plan price helps if you expect regular sessions, while paying per visit keeps the cost down if you book occasionally. Ask each service directly whether the plan price is charged on top of the visit price or instead of it.
Availability, apps and support
Access matters if your schedule is unpredictable. MDLIVE, Sesame Care, Talkspace and Pague Menos all publish the same round the clock availability: 24 7, 24 7, 24 7 and 24 7. Each of the four also has a mobile app, so booking and messaging work from a phone.
Support after a session is a separate question. MDLIVE lists email, phone and help centre and Sesame Care lists email, phone and help centre, both including a phone line, while Pague Menos lists email and help centre, without a phone line. If you would rather call than write, that gap can decide the choice on its own.
Check the market, the insurer and the company
A service can be strong and still be unusable where you live. MDLIVE covers US and PR, Sesame Care covers US and Pague Menos covers BR, so readers outside those markets should look elsewhere. Check your own country against the market list first, before any price comparison.
Insurance changes the final cost more deeply than any headline figure. MDLIVE and Pague Menos accept insurance, while Sesame Care does not. If you intend to claim costs back, that answer is worth more to you than the visit price.
For reassurance about who is behind the service, each brand lists its legal entity and, where available, its founding year: MDLIVE, INC. was founded in 2009, Talkspace in 2012, and Sesame Care operates as Sesame, Inc.. Pague Menos runs as Empreendimentos Pague Menos S.A.
Note what sits outside therapy
Pague Menos is the outlier in this group, and that shapes expectations. Its service list is online gp, pharmacy and prescriptions, its product range is multivitamins, vitamins minerals and omega 3 with vegan options, and delivery is free. If you want therapy inside a pharmacy and supplement service, that is a different proposition from a dedicated therapy provider. MDLIVE covers online gp, prescriptions and weight loss and Sesame Care covers online gp, prescriptions and weight loss, both broader than therapy alone.
Read the reviews next to the rankings
Read the MDLIVE review and the Sesame Care review alongside the Talkspace review and the Pague Menos review. Score all four on the same points: clinician types, per visit price, monthly plan price, and whether the market they cover includes you.
If none of these fit your situation, there are more providers to weigh, with reviews of Teladoc and PlushCare among them. Hold each one to the same four checks, and the cheapest option on paper stops being the only option on the table.