Getting Health Insurance Coverage for Mental Health Treatment

How to Find Help for Mental Health and Wellness

two women hugging in a mental health support group
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According to the 2021 State of Mental Health in America Report issued by Mental Health America (MHA), more than 47 million Americans have a mental health condition, and more than 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 have coverage for mental health care with their health insurance plan. Although not all health plans are required to offer such coverage, most do as a result of health care reform during the Obama administration. It is important to understand what your options are and how to access and get coverage with your plan.

Key Takeaways

  • Most health insurance plans, including Medicare and Medicaid, offer some coverage for mental health services.
  • Contact your health insurer to better understand the benefits and coverage included in your policy.
  • Some plans may have limitations based on diagnosis, the kind of treatment, and even the number of therapy sessions.
  • There are many federal and local low-cost resources available for mental health services.

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.

The 2022 Open Enrollment period for Medicare is Oct. 15- Dec. 7, 2021. The ACA (Obamacare) Open Enrollment period is Nov. 1, 2021, through Jan. 15, 2022; however, to get coverage starting Jan. 1, 2022 you need to be enrolled by Dec. 15, 2021.

While employer-sponsored group insurance plans vary, most of them cover mental health services.

What Should You Ask Your Health Services Provider?

Your health insurance policy may specify who you need to get services from, in order for them to be covered. Find out from your health insurance provider if the service you need is covered before you get it, so that you do not run into any surprises when you file a health insurance claim.

Here are some questions to ask your health insurer in order to better understand the extent of your coverage:

  1. Ask if the provider uses a health insurance network and find out how it works. Networks limit who you can go to for treatment (and have it be reimbursed), so it is important to understand your options.
  2. Ask if you need a referral from a physician or a pre-approval from your insurance company before you see a mental health professional.
  3. Ask about co-payments and coinsurance. These 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.
  4. Ask about the deductible. Deductibles differ based on the type of health plan you have.
  5. Ask about dollar limits on coverage, limitations due to specific diagnoses or any constraints based on whether it was an inpatient or outpatient treatment.
  6. Ask about limitations on the number of sessions.
  7. Ask if you need to notify the insurer if you need emergency care in order to have it covered, or if the hospital staff can do that.

What Additional Services and Resources Are Available?

Getting medical help and services from professionals is often an important part of managing mental health issues. But you may also benefit from additional support that does not cost a lot of money.

The following resources may be helpful to consider:

  • Health Center Program by the Health Resources and Services Administration (HRSA)—offers options based on what you can afford, regardless of your ability to pay.
  • National Alliance on Mental Illness and its various programs
  • Other federal resources such as the National Institute of Mental Health or The National Library of Medicine (NLM) MedlinePlus.
  • Local services, such as those that can be found using this locator from the Substance Abuse and Mental Health Services Administration (SAMHSA) and community support groups like those affiliated to Mental Health America.
  • Some organizations, such as the National Institute of Mental Health and its affiliated medical centers, conduct and keep track of clinical trials you may be eligible to participate in. You could also look up the U.S. Library of Medicine's Clinicaltrials.gov, a database of ongoing trials across the globe, to see if you qualify for ongoing trials. Always consult your healthcare provider before considering participation in a trial to understand its potential risks as well as benefits.
  • Those enrolled in colleges and universities are often able to receive free or significantly reduced mental health services through their school's counseling office.

Is the Plan You Have Right for You?

Your mental and emotional wellness should be a top priority, so you may want to re-evaluate your current health insurance plan. If your plan falls short on benefits you need to access the help you need, consider other resources like those listed above, and consider getting better coverage during your company's annual open enrollment period or through the Health Insurance Marketplace.