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 State of Mental Health in America Study, over 40 million Americans have a mental health condition and more than 10 million adults in the U.S. have an unmet need for mental health treatment.Getting help when you have a mental health condition is important. Many people don't realize that they may have coverage for mental health treatment on their health insurance plan. Although not all health plans are required to offer coverage for mental health treatment and services, most of the plans on the marketplace and many employer group insurance health plans do offer the coverage since the health care reform. It is important to understand what your options are for mental health coverage, how to access and get coverage on your health insurance plan, as well as what additional options are available to you. If you are wondering what are the best health insurance options for mental health treatment, here's what you need to know.

Is Mental Health Treatment Covered on Health Insurance?

Since the Affordable Care Act, essential services are required to be covered by health insurance plans in the health care marketplace. Mental health services are considered essential care.

Medicaid and Medicare also cover a range of mental health services including preventative care.

The Children's Health Insurance Program (CHIP) also has provisions and coverage for preventative services and mental health services.

Employer-sponsored group insurance has different criteria, however, most employer health plans will cover mental health services as well. For example, if your employer has more than 50 employees, then they likely fall into the category where they may provide mental health services in their health group insurance plan.

What Are the Requirements for Mental Health Services to Be Covered on Insurance?

Every health insurance policy has conditions of coverage, deductibles that have to be met, co-pays, co-insurance and exclusions. For example, if the mental health service you are seeking reimbursement for is excluded, you may be out of luck even though your policy may cover other types of mental health services. It is really important to find out from your health insurance provider if the service you are going for is covered before you get services to make sure you don't have any surprises when you try and file a health insurance claim.

Can You Choose Any Provider of Mental Health Treatment and Be Covered By Health Insurance?

Like any other coverage, your health insurance policy may have specifications of who you need to get your services from in order to be paid. If your health insurance plan has a network, then you need to find out if the psychologist, therapist, or mental health services provider is "in- network"in order to expect to be covered. Again, it is really important to contact your health insurance provider to get all the details about who you can get services from and how much will be covered. Learn more about different types of Health Plans here.

3 Things To Ask Your Health Insurance About Mental Health Services and Treatments

Always ask your health insurance provider what they will cover so you understand if you have coverage for treatments and what you can expect. Here are some questions to ask about to help you understand your coverage:

  1. Ask if your provider uses health insurance networks and find out how they work (this limits who you can go to to get treatment and expect to 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 it is important to understand that even though the service may be covered, you may have some out of pocket costs.
  3. Ask about the deductible. Depending on the type of health plan you have, you might have a very small deductible, or if you have a high deductible health insurance plan you may have a very high deductible to pay before they will start paying out on benefits. Your health insurance provider is the best person to ask to make sure you understand this.

What Are Alternatives For Mental Health Support or Help?

An additional option to consider for people who have a domestic partner or spouse is to check if you qualify on your spouse's health insurance for coverage. Be sure and find out if using coordination of benefits might help you get even more coverage than from your policy on it's own.

Additional Services and Resources for Mental Health Support and Treatment

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 you any money if you are not covered by a health plan from these resources:

The National Alliance on Mental Illness also provides resources for people through a variety of courses and resources.

Choosing a Health Insurance Plan to Cover Mental Health Treatment

Once you have checked all your options, you may want to re-evaluate your health insurance plan, learn more about choosing the best health insurance plan here, or about switching plans outside of open enrollment here. The most important thing is to find help when you need mental health services, your emotional wellness is the first priority so be sure and explore all your options, including additional services, local and community support groups.

Article Sources

  1. Mental Health America "The State Of Mental Health In America," Accessed Sept. 29, 2019

  2. Healthcare.Gov "Health benefits & coverage: Mental health & substance abuse coverage," Accessed Sept. 29, 2019

  3. "Health Insurance and Mental Health Services," Accessed Sept. 29. 2019

  4. American Psychological Association "What you need to know about mental health coverage," Accessed Sept. 19, 2019