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Mental Health Insurance - Purchasing Coverage For Your Needs

Meredith Miller | Published: August 24, 2018

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Mental health in the US is a major topic of discussion among medical professionals, politicians, and media outlets, and for good reason. The majority of Americans are either affected by or have a friend or family member who struggles with mental health. For that reason, there has been a bipartisan push for mental health reform, ensuring that the millions of people who suffer from mental health disorders in this country have access to the mental health services they need.

However, access to mental health care still has a long way to go in the US, and furthermore, access is only half the battle. Just because someone has access to the mental health services they require doesn’t always mean they can afford the associated costs. So the question is, does health insurance cover mental health services?

Does Your Insurance Cover Mental Health Services?

Yes, the vast majority of health insurance plans cover mental health services, although that wasn’t always the case. Globally, there have been tremendous strides made in the field of behavioral and mental health, and thankfully health insurance companies are finally on the same page, even if it wasn’t by choice.

As recently as 2013, nearly 40% of health insurance plans didn’t offer mental health coverage, but that all changed the following year. President Obama’s Affordable Care Act revolutionized healthcare in the US when it required health insurance companies to offer coverage for what are known as Essential Health Benefits, which included mental health services.

How Obamacare Changed The Game

Obamacare was, and largely still is, one of the most controversial pieces of legislation to be passed by the 44th President of the United States. Prior to 2014, the health insurance industry heavily favored the insurers rather than the insured. Companies were free to exclude services on their plans, turn high-risk patients away, and essentially create a pool of healthy individuals who paid high monthly premiums. That changed.

Aside from the Mental Health Parity Act from 1996, which forced group health plans to cover mental health services, individuals and families were generally on their own when it came to paying for treatment. However, under the Affordable Care Act, all qualified health plans sold through the marketplace for individuals and families, now cover basic mental and behavioral health services, along with substance abuse and addiction services.

Medicaid And Medicare

Both Medicaid and Medicare are government sponsored health insurance programs, and both come with fairly comprehensive health benefits. However, there are some differences:

  • Medicaid - Benefits are largely determined by individual states, but if you qualify for Medicaid Alternative Benefit Plans, you’ll be covered. Otherwise, you’ll need to check with your state to see whether or not you’re covered for mental health benefits.
  • Medicare - Run by the federal government for seniors over 65 years old, mental health coverage falls under Part A and B, along with Part D prescription coverage. However, if you are enrolled in a Medicare Advantage plan, you will want to check with your provider to see what services are covered.

Social Security And Disability Insurance

As of 2013, about 35% of the almost 9 million Social Security Disability Insurance (SSDI) beneficiaries qualified for benefits based on their mental health conditions. Disability benefits may not offer services for your mental health needs, but qualifying for SSDI may mean you’re eligible for other programs that may.

What’s Covered Under Your Plan

Health insurance is a fickle beast. Even if you’re covered for certain medical services, you may still end up paying a fortune in bills, or your benefits may be restricted. If you’re wondering what exactly your insurer means when they include mental health services in your benefits, here’s a look at what you can expect.

Psychiatric Services

Your health insurance will cover psychiatric care. In fact, thanks to the parity act, mental health services such as seeing a psychiatrist can’t be treated or reimbursed differently than any other medical service, like a regular doctor visit. For example, if you typically pay a $20 copayment for a checkup with your primary care physician, a visit with your psychiatrist has to offer the same $20 copay.

Mental Health Retreats

You will probably be surprised to hear that some of the biggest health insurance companies in the country work closely with mental health retreat programs to reduce your out-of-pocket costs. For example, Promises, a women’s treatment center, lists Aetna, Cigna, Human, and other health insurance companies on their website.

You want to check with your provider to see just how comprehensive your coverage is. While some policies may include mental health retreats in their benefits, it is likely that you will end up paying a big chunk of the bill out-of-pocket.

Prescription Drugs

If you are enrolled in Medicare, then any drugs you are prescribed for your mental health will be covered by your Medicare Part D plan. If you aren’t enrolled in Medicare, then your health insurance company will outline whether or not your prescriptions are covered. Typically, and medication for mental health will be covered, but are usually accompanied by a small copayment.

What If You Don’t Have Health Insurance?

If you don’t have health insurance, it is strongly recommended that you enroll today. Finding coverage will keep you protected from the high costs associated with mental health treatment. However, even if you don’t have health insurance, there are still ways to get the care you need without paying for everything on your own.

Government Sponsored Emergency Mental Health Care

If you are experiencing a mental health emergency, you should get immediate help. Your first option, which is recommended by the government’s mental health initiative, is to dial 9-1-1. Emergency mental health services are available 24 hours a day, 7 days a week. Trained professionals will talk you through your emergency, or will be dispatched to help you.

If you are experiencing suicidal thoughts, or are suffering from emotional distress, there is also a free hotline you can call. Calling the National Suicide Prevention Lifeline will connect you with trained crises workers who are also available 24/7. All conversations are confidential and free, and the national network even provides crisis counseling and mental health referrals. To call the National Suicide Prevention Lifeline, call 1-800-273-TALK (8255).

Purchasing Mental Health Insurance

If you don’t already have mental health coverage, you came to the right place. FirstQuote Health specializes in helping individuals and families find the best coverage available in their area by comparing health insurance quotes from some of the top companies in the country. Enter your zip code to start your search, and get covered as early as today.

Best Plans And Providers For Mental Healthcare

Since most health insurance plans offer mental health services, and coverage for substance abuse, picking out the best plans from the crowd can be difficult. To make things easier, here is a list of the health insurance companies that offer the best mental health insurance plans:

  • Kaiser Permanente: Kaiser Permanente may be the most affordable option when it comes to mental health coverage. Kaiser also has the advantage of operating their own internal healthcare system, which means a coordinated effort between your physician and mental health specialist.
  • Blue Cross Blue Shield: Boasting one of the largest provider networks in the country, Blue Cross Blue Shield offers some of the best mental health coverage. While plans may be a bit more expensive than others, it’s hard to beat Blue Cross Blue Shield’s online Cognitive Behavioral Therapy (CBT) program and doctor on demand service, which gives you quick and easy access to mental health professionals.
  • Aetna: Aetna not only offers extensive mental health coverage at an affordable price but has programs dedicated to bettering behavioral health for its members. The only drawback is that they only offer employer-sponsored coverage plans.

How To Find Out If Your Policy Covers Mental Health Services

As with all your medical benefits, the first thing you want to do is looking through your enrollment materials to find out what is covered and what isn’t. Ever since the Affordable Care Act was passed, health insurance companies are required to provide you with an easy to understand summary of your benefits. If you can’t find what you are looking for, you can do one of two things, call your insurance agent or broker, or contact your health insurance company directly.