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Does Health Insurance Cover Therapy and Other Mental Health Treatments?
Nearly one in 25 adults experiences a serious mental illness that interferes with major life activities each year, according to the National Alliance on Mental Illness. If you’re among them, you might be worried about whether health insurance covers therapy or other treatments. Gratefully, health insurance increasingly covers mental health as well, which, according to MentalHealth.gov, includes psychological, social, and emotional well-being at all stages of life. Recognizing that good mental health is as important as physical wellness, federal law has greatly expanded insurance coverage for mental illnesses.
Mental disorders can lead to poor decisions that cause physical health problems, such as obesity or drug-use disorders, says Sabra Matovsky, executive vice president of Integrated Health Partners, a nonprofit organization that represents community-based medical centers.
“There are a lot of people who die in this country from behavioral choices: eating, drugs, lack of exercise,” Matovsky says. “Mental health treatment can help people make better choices.”
Rachel Kazez, a clinical social worker and therapist based in Chicago, agrees. “Our mental health impacts how we care for ourselves physically, from our motivation to stay clean and active to the unhealthy physical behaviors we use to cope with our emotions or thoughts,” Kazez says.
The 2008 Mental Health Parity and Addiction Equity Act states that if mental health insurance benefits are offered by employers, they can’t have more restrictive requirements than those that apply to physical health benefits. That means that if your insurance requires a $20 co-pay for most doctor’s visits, you’d owe a similar co-pay when seeing a psychologist.
According to the American Psychological Association (APA), the majority of large group health insurance plans provided mental health benefits before the parity law took effect.
Under the Affordable Care Act, which was approved in 2010, all health plans sold on insurance marketplaces must cover mental health and substance abuse services as essential health benefits. According to HealthCare.gov, these plans must cover:
- Behavioral treatments, such as psychotherapy and counseling
- Inpatient services for mental and behavioral health issues
- The treatment of substance use disorders
The trend of offering mental health benefits to the insured extends to most employer-provided plans, which don’t have these federal requirements. In a 2015 study, the Society for Human Resource Management found that only 9% of employer health plans in the U.S. don’t extend mental health treatment benefits to workers. There are some plans that are exempt from the parity rule, however.
According to the APA, companies with fewer than 50 employees don’t have to follow the parity rule. Medicare isn’t subject to the federal parity law. Also, some state government employee plans, including those that cover state university workers and teachers, may opt out of parity requirements.
Learn How Your Insurance Applies to Mental Health
According to HealthCare.gov, you have the right to an easily understood summary of your health coverage. Insurance companies and job-based health plans must provide you with a short, plain-language summary of benefits and coverage. They also must provide a glossary of health insurance terms to help you understand your coverage.
To learn how your health insurance coverage applies to mental health treatment, read the summary of your policy. The APA says the description of benefits should include information on behavioral health services or coverage for mental health and substance-use disorders.
If it doesn’t appear that you are covered for mental health issues, contact your insurer to be certain.
Finding Alternatives for Mental Health Care
Kazez notes that people without insurance coverage for mental disorders still have a variety of options for access to care.
According to the nonprofit Mental Health America, 18.5% of U.S. adults with a mental illness were uninsured in 2012-2013. If you aren’t insured for mental health disorders, there are a variety of treatment alternatives available. They include:
- The U.S. Department of Veterans Affairs. Eligible veterans can call 1-877-222-8387 or go online to www.va.gov/health.
- Affordable mental health services can be found through the Substance Abuse and Mental Health Services Administration. You can visit their website or call 1-800-662-HELP.
- Local health departments have mental health divisions or community mental health centers. Typically, they offer free or reduced-cost treatment and services.
- The National Mental Health Consumers’ Self-Help Group Clearinghouse maintains an online Directory of Consumer-Driven Services.
It can take time and effort to find local mental health services for the uninsured, but there are programs available, says Stacy Haynes, a counseling psychologist in Turnersville, N.J.
“It’s a matter of finding these services and then being patient if there is a wait list,” she says. “Emergency and crisis care is always available through hospital emergency rooms.”