The demand for mental health care is at an all-time high. Mental health problems have increased over the last decade, with statistics showing one in five adults have a mental health condition.
However, high mental health care costs deter many people from visiting therapists and other such professionals. They’re often higher than physical health care costs, and the lack of proper insurance coverage only escalates the problem.
As a result, there has been a push to make mental health services more affordable and accessible. Federal laws like the 2008 mental health parity law have made this possible. Here’s more about the law and health insurance plans covering mental health services.
Should Health Insurance Providers Pay for Mental Health Services?
The federal parity law requires health insurance companies to make mental health services equal to medical or surgical coverage. This law prevents providers from charging patients a higher copay for therapy visits than they would for ordinary checkups.
Some people get rich by overcharging others, but their wealth will be given to those who are kind to the poor. (Proverbs 28:8)
It also removes annual limits on the number of therapy visits covered, but doesn’t prevent an insurance company from determining limits regarded as medical necessity. However, patients must inquire if a health provider offers mental health benefits and the kind of mental health diagnosis it covers.
That’s because the mental health parity law applies to all mental health conditions, but a provider can exclude specific diagnoses depending on the company’s policies.
Which Health Insurance Plans Cover Mental Health Services?
Certain health insurance plans cover mental health care costs:
Employer-sponsored Insurance in Companies with 50+ Employees
Companies with more than 50 employees are legally required to provide health insurance. Although the requirement doesn’t specify if mental health services are part of the benefits, many large companies provide coverage.
Employer-sponsored Insurance in Companies with less than 50 Employees
Small companies with less than 50 employees aren’t legally mandated to provide health insurance to employees. However, companies that offer these benefits must include mental health care services regardless of how the plan is purchased.
Health Insurance Marketplace Plans
The Affordable Care Act requires plans purchased under this method to cover ten essential health benefits, including mental health care and substance use disorder services. This means family plans, individual plans, and small business plans cover mental health care costs.
Medicare
Part A of the Medicare program takes care of inpatient behavioral health and substance use services. As such, if you’ve been hospitalized, you’re entitled to a deductible per benefit period as well as the co-insurance costs.
However, if you’ve Part B of the Medicare program, the insurance provider pays for outpatient mental health care costs, including the annual depression screening costs.
The patient may incur out-of-pocket costs for therapeutic services, including co-insurance, Part B deductible, and copays. The last Medicare plan-Part C covers therapeutic services similar to or greater than the original Medicare.
Medicaid Program
Medicaid programs cover mental health care costs, but their requirements vary based on the program and the state.
Children’s Health Insurance Program (CHIP)
This is an insurance program designed for families with children who aren’t eligible for Medicaid. It funds states to provide affordable health insurance to low-income households such kids. Families under this plan enjoy coverage for a range of mental health services, including:
- Therapy
- Counseling
- Peer support
- Social work services
- Medication management
- Substance use disorder treatment
- Note that the Mental Health Parity and Addiction Equity Act requires CIHP programs to provide parity protection for mental health services. This means that deductibles, copays, and co-insurance for therapy and other mental health care services must be the same or comparable to other medical or surgical benefits.
Which Mental Health Services are Covered?
Health insurance providers pay for mental health services like:
- Online therapy
- Telehealth services
- Treatment for addiction
- Psychiatric emergency costs
- Inpatient services for behavioral health of rehabilitative care
- Talking therapies, including cognitive behavioral therapy and psychotherapy
- Outpatient sessions (unlimited) with a clinical social worker, psychiatrist, or clinical psychologist. Note that the insurer may limit the number of visits allowed annually unless your doctor states they’re medically necessary for care
So, How Do You Leverage a Mental Health Coverage?
If you’re in need of mental health but are worried about the cost, check if your plan covers mental health costs. If they do, find out the company’s in-network providers. That’s because patients are required to pay more out-of-pocket costs when visiting out-of-network providers.
Also, ask about the copayments; they shouldn’t be higher than those for medical or surgical visits. It would also help to determine the amount you must pay as a deductible to avoid paying higher deductibles for mental health services.
The mental health parity law requires patients to pay a single deductible for mental health and medical services. Patients with plans that don’t cover mental health services can appeal the decision with the U.S. Department of Labor or the Federal Center for Medicaid and Medicare Services. These organizations can enforce the parity law to ensure a provider helps you get therapy costs covered.
Conclusion
Healthcare providers are keen to provide the best services, but mental health services have always taken a back seat. This guide can help patients with mental health conditions find healthcare plans to cater to such costs to improve their quality of life.
