Getting Health Insurance Coverage for Mental Health Treatment

An Overview of Options to Finding Help for Mental Health and Wellness

two women hugging in a mental health support group
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According to the 2020 State of Mental Health in America Report issued by Mental Health America (MHA), approximately 45 million Americans have a mental health condition, and approximately 26 million individuals have mental health illnesses that are left untreated. Getting help when you have a mental health condition is crucial.

Many people do not realize that they may have coverage for mental health with their health insurance plans. Although not all health plans are required to offer such coverage, most do as a result of health care reform by the Obama administration. It is important to understand what your options are and how to access and get coverage on your plan.

Is Mental Health Treatment Covered by Health Insurance?

Since the Affordable Care Act (ACA), health insurance plans are required to cover essential services, and mental health services are considered essential care. Medicaid and Medicare also cover a range of mental health services.

While employer-sponsored group insurance plans vary, most of them will cover mental health services. For instance, if an employer has 50 or more employees, it is required to provide mental health services in its insurance plan.

It is important to find out from your health insurance provider if the service you need is covered, in order to make sure that you do not run into any surprises when you try and file a health insurance claim.

What Should You Ask Your Health Services Provider?

Your health insurance policy may specify who you need to get your services from, in order for them to be covered. In turn, it is important to contact your health insurance provider to get details about who you can get services from and how much will be covered.

Here are some questions to ask:

  1. Ask if the provider uses health insurance networks and find out how they work. Networks limit who you can go to for treatment that can be reimbursed, so it is important to understand your options.
  2. Ask about co-payments. Co-payments are fees you will pay out of pocket, so you need to understand that even though the service may be covered, you may have some out-of-pocket costs.
  3. Ask about the deductible. Deductibles differ based on the type of health plan you have.

What Additional Services and Resources Are Available?

Getting medical help and services from professionals is always an important part of managing mental health issues, but you may also be able to benefit from additional support that may not cost money. The following resources may be helpful to consider:

  • HRSA Health Center Program which offers options based on what you can afford and regardless of your ability to pay.
  • National Alliance on Mental Illness and its various programs.
  • Local services and community support groups.
  • Clinical trials.

Is the Plan You Have Right for You?

Once you have checked all your options, you may want to re-evaluate your health insurance plan. Your emotional wellness is top priority, so be sure to explore all your options.

Article Sources

  1. Mental Health America. "Mental Health in America - Adult Data." Accessed Jan. 25, 2020.

  2. Healthinsurance.org. "How Obamacare Improved Mental Health Coverage." Accessed Jan. 26, 2020.

  3. HealthCare.gov. "Essential Health Benefits." Accessed Jan. 26, 2020.

  4. HealthCare.gov. "Mental Health & Substance Abuse Coverage." Accessed Jan. 26, 2020.

  5. MentalHealth.gov. "Health Insurance and Mental Health Services." Accessed Jan. 26, 2020.

  6. American Psychological Association. "Does Your Insurance Cover Mental Health Services?" Accessed Jan. 26, 2020.

  7. HRSA Health Center Program. "About the Health Center Program." Accessed Jan. 26, 2020.

  8. National Alliance on Mental Illness. "NAMI Programs." Accessed Jan. 26, 2020.

  9. Mental Health America. "Finding Other Local Services." Accessed Jan. 26, 2020.

  10. Mental Health America. "Understanding Clinical Trials." Accessed Jan. 26, 2020.