Mental healthcare is just as crucial to overall wellness as physical healthcare. However, even people who have health insurance sometimes have trouble understanding what mental health services are available to them.
So, does health insurance cover mental health care?
It’s not always clear which mental health diagnoses are covered or how many annual appointments you are allowed per year. Talk therapy, counseling, and substance abuse treatment can be expensive to pay for out of pocket, and the stigma around mental illness makes it even more challenging to get help.
That’s why it’s essential to learn what mental health benefits your employer or ACA plan must provide. Find out how you can navigate your insurance plan to get the best possible mental healthcare.
Do Health Insurance Plans Have to Cover Mental Healthcare?
While most insurance plans do provide mental health coverage, the law does not actually require health insurance providers to cover mental health services.
In 2008, lawmakers passed the Mental Health Parity Act to promote and expand access to these services. The law dictates that if mental health services are covered, copays, visit limits, and deductibles must be comparable to physical health services.
For example, your insurance provider cannot charge you a $30 copay to visit a talk therapist if you only pay a $10 copay for all of your physical doctor’s appointments. The Parity Act also requires the same annual visit limit for both mental and physical appointments.
The Parity Act also applies to your deductible. This is the amount you pay out-of-pocket each year before your insurance provider covers any healthcare expenses. Whether your deductible is $50 or $5,000, it must be the same for both mental and physical treatments.
Employer-Sponsored Healthcare Plans
Counseling, therapy, substance abuse treatment, and other types of mental healthcare are not required to be included in any employer’s healthcare plan. However, if they are included, equal coverage must be offered according to parity law.
Your employer is allowed to specifically exclude certain diagnoses, whether mental or physical, from their healthcare plan. These should be disclosed to you up front and stated in your Summary of Benefits and Coverage.
You can visit Human Resources at your workplace to get a better understanding of your healthcare plan.
ACA Marketplace Plans
Mental healthcare is one of 10 essential health benefits that plans purchased through the Affordable Care Act (ACA) marketplace must cover. This includes behavioral health treatment, inpatient services, and substance abuse treatment.
The specifics of your coverage options vary depending on what state you live in and which plan you purchase. You can visit Healthcare.gov or call your insurance provider to find out which mental health diagnoses your marketplace plan covers.
Medicaid and Medicare
All state Medicaid programs will cover some form of mental health and substance abuse services. You will often be able to get therapy or counseling covered on a Medicaid plan, but it’s not always guaranteed.
Medicare, a federal program offering healthcare benefits to seniors, covers a wide range of mental health treatments.
To find out your options for government-sponsored mental and behavioral health services, contact your state or federal healthcare agency.
Children’s Health Insurance Plans (CHIP)
Children enrolled under Medicaid have access to a wider range of mental health benefits than many adults. Children’s Health Insurance Program offers treatments that may include:
- Counseling
- Behavioral therapy
- Medication management
- Social work
- Peer supports
- Substance use disorder treatment
What Mental Health Services are Covered?
Ever since the Parity Act’s final regulation was passed in 2014, most individual and small group health insurance plans now cover mental health and substance use disorder services. This includes employer-based insurers covering more than 50 employees, as well as Marketplace plans. Treatment options vary but often include some form of:
- Psychotherapy
- Talk therapy
- Counseling
- Mental and behavioral health inpatient services
- Substance use disorder treatment
Parity law dictates that pre-existing conditions, such as substance abuse disorders, must be given the same coverage as new or existing mental health conditions. This means that the same copayments, deductibles, and visit limits will apply.
How Can You Make Sure Your Therapy Appointments are Covered?
The quickest way to ensure that your therapy appointment is covered is by reviewing your plan’s documentation. Your insurance company is required to provide a Summary of Benefits and Coverage that explains your plan in an easy-to-read format. You may be able to access this online or have a paper copy.
If you can’t figure out your coverage from looking at your plan summary, it’s often helpful to contact your insurance company directly. If you have an employer-sponsored healthcare plan, you may also visit Human Resources at your workplace.
You may be able to find further resources through your state’s Consumer Assistance Program or by visiting the Mental Illness and Addiction Insurance Help Portal.
Mental Healthcare Options Without Insurance
If your health insurance plan doesn’t cover the mental health treatments you need, there are other paths to receiving care. Explore your community, workplace, or local government programs to see if they offer options like these:
- Employee assistance programs
- Disability benefits
- Local social services
- Lower-cost university services
- Non-profit services
How Much Will My Mental Healthcare Cost?
The cost of a therapy, counseling, or inpatient session varies greatly depending on your plan. You will be responsible for copays and deductibles, which will cost the same as you would pay for a physical healthcare appointment. Any amount you pay out-of-pocket for your mental healthcare will go towards your total deductible.
The cost of a specific therapist or mental health specialist depends on whether or not they’re in-network. To ensure you’re paying the lowest possible amount for your healthcare, seek treatment from a physician who accepts your insurance.
To Sum Up
Although many people choose to pay out-of-pocket for treatments like talk therapy, it might not be necessary. This may be an option if the medical provider you need is not available in-network. In cases like this, even though you have health insurance, you will pay the full amount of the visit and then file a claim with your insurance provider to seek reimbursement.
Finding the perfect mental health insurance coverage for you might take some effort, but it will be well worth it.