Does My Health Insurance Cover Mental Health Treatment?

March 29, 2016 Health, Managing Health Insurance
health insurance mental health treatment

Mental health care is just as important as medical care, and avoiding mental health treatment due to cost is as risky as avoiding medical care.

Since the passage of the mental health parity law in 2008 and the Affordable Care Act in 2010, most people with insurance now have mental health coverage. This is a significant improvement compared with the situation before the laws, in which many plans didn’t offer coverage and the importance of mental health care was minimized.

However, mental health coverage is sometimes not as comprehensive as you might expect, and some health plans are still exempt from having to provide it. Treat mental health services just like any other medical service: Check your insurance coverage beforehand so you don’t overpay.

Here’s more on how mental health coverage works and how you can tell if you’re covered.

Mental health requirements

The Affordable Care Act requires all plans sold on state or federal marketplaces to cover mental health services as an essential benefit, including:

  • Behavioral and cognitive therapy.
  • Substance abuse treatment.
  • Inpatient care at a full-service mental facility.

While employer-offered plans don’t have this requirement, most do offer mental health coverage. A Society for Human Resource Management survey of 2015 employee benefits found that 91% of employer health plans covered mental health treatment, up 4% from 2014.

The parity law requires most health plans to cover mental health care at the same level at which they cover medical care, meaning that if you pay $50 for a medical specialist, your copay to see a mental health specialist such as a psychiatrist must also be $50 or less. However, this doesn’t apply to all health plans. Exempt from the parity requirement are:

  • Employer plans with fewer than 50 workers.
  • Medicare.
  • State government employee plans, such as those for teachers and university employees.

Understanding your own mental health coverage

Whether or not your plan covers mental health treatment will be stated clearly in your insurance policy summary. Normally, this document is available on your health insurer’s website, is about six to 10 pages long and looks like a chart rather than a letter or plain writing. Most often, the chart is in two shades of blue; you can look at an example here. On your policy’s chart explaining coverage, there should be a section explaining mental health coverage alongside other services.

If your policy summary does not include mental health treatment in that list, you may not be covered. In that case, call your insurer’s customer service line to make sure. The staff may be able to point you toward other options for mental health treatment, like free services that may still help you.

Resources to reduce your mental health treatment costs

If you don’t have health insurance or your plan doesn’t offer mental health coverage, here are some resources that may be able to help:

If you think you need mental health treatment and aren’t getting it due to cost, consider reaching out to one of these resources. Getting the care you need today can help you have a brighter tomorrow.

Lacie Glover is a staff writer at NerdWallet, a personal finance website. Email: lacie@nerdwallet.com. Twitter: @LacieWrites.
This story was updated. It was originally published on Aug. 18, 2014.


Image via iStock.

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