During the past few years, there has been a tremendous amount of focus on mental health. It is important for you to protect your mental health, and that means you need to be familiar with mental health habits that can help you do exactly that. But above and beyond that, many people need mental health care. 

Getting medical coverage for your mental health is just as important as covering your physical health. 

Is mental health covered by insurance? Fortunately, the Affordable Care Act (ACA) requires private health insurance sold on the individual and family health insurance marketplace to include mental health insurance coverage. Caring for your mental health is always essential, but it has become especially important since the COVID-19 pandemic. Finding the best health insurance for mental health is critical for ensuring your health overall during this challenging time. In the past, mental health issues were not always covered by health insurance companies, and a lot of people may still believe this to be the case. However, based on the requirements set forth in the ACA, any qualified health insurance plan purchased through the ACA marketplace must provide coverage for mental health conditions.

Does insurance cover mental health?

The ACA was enacted in 2010, with the goal of making health care more affordable to Americans. ACA-compliant plans cover mental health care as one of 10 essential benefits, along with preventive services and maternity care. This means that if you enroll in an ACA-compliant plan, you will have mental health coverage. Most employer-sponsored plans must also include mental health services under the ACA.

In addition, the ACA requires insurance companies to cap customers’ out-of-pocket spending and prohibits limits on annual or lifetime coverage for mental health care. These steps ensure mental health insurance is both available and affordable.

All health plans sold on the Marketplace include mental health and substance abuse services as essential health benefits. Coverage encompasses a variety of services:

• Behavioral health treatment, including psychotherapy and counseling.
• Inpatient services for mental and behavioral health.
• Treatment for substance use disorders.

The specific benefits related to behavioral health will vary based on your state and the chosen health plan. When comparing plans in the Marketplace, you can view a detailed list of what each plan offers in terms of behavioral health benefits.

Pre-existing Conditions and Coverage Limits

Marketplace plans are required to cover pre-existing mental and behavioral health conditions from the day your coverage starts. Importantly, these plans cannot impose annual or lifetime dollar limits on coverage for any essential health benefit, including services for mental health and substance use disorders.

Parity Protections for Mental Health Services

Marketplace plans are also subject to federal parity protections. These regulations ensure that the limitations applied to mental health and substance abuse services are no more restrictive than those applied to medical and surgical benefits. Parity protections cover several aspects:

• Financial aspects such as deductibles, copayments, coinsurance, and out-of-pocket maximums.
• Treatment limitations, including restrictions on the number of days or visits allowed.
• Care management requirements, such as obtaining pre-authorization for treatment.

Understanding these provisions can help you make informed decisions about the coverage you need and ensure you receive the benefits to which you are entitled under your health plan.

Before the ACA went into effect, individual and family health insurance plans were not required to cover mental health care. People could be denied coverage based on pre-existing conditions – including mental health conditions like depression. Those with pre-existing conditions had trouble finding mental health insurance coverage at an affordable rate – or were denied coverage outright.

Under the ACA, those with pre-existing mental health conditions can get mental health insurance without being denied coverage or charged a higher rate. According to an AHIP survey published June 6, 2022, approximately 60% of insured Americans reported that their mental health support was fully covered by insurance.

Why it’s beneficial to have mental health insurance

According to the National Institute of Mental Health, “in 2021, among the 57.8 million adults with AMI, 26.5 million (47.2%) received mental health services in the past year”. There are many reasons why it is beneficial to have health insurance that provides coverage for mental health needs. Just about anyone can develop mental health issues at any time, and there are some people who require ongoing treatment for these conditions.

The cost of therapy and prescription medications can add up quickly. If you do not have mental health insurance, you could be responsible for paying for prescription medications as well as patient and outpatient visits out-of-pocket. This could cost tens of thousands of dollars. An insurance plan that provides you with coverage for mental health issues can help you make sure you can afford these services.

Above and beyond financial benefits, mental health services can be life-saving. Having insurance that covers those services can be essential for many. The value can truly not be overestimated if you are someone who suffers from a mental health condition.

What mental health care services are covered by ACA-compliant plans?

All ACA-compliant plans should include mental health insurance coverage as an essential health benefit. Your plan should cover some part of the cost for mental health care, just as it would for other medical conditions. If you think your plan is denying you covered mental health insurance coverage, talk with your plan provider or write a formal appeal.

All ACA plans must cover the following mental health care services:

• Behavioral treatment (such as psychotherapy and counseling), including:
  • Outpatient individual counseling or group therapy sessions
  • Diagnostic services, such as psychological testing and evaluation services
  • Ongoing outpatient treatment, including psychiatric treatment programs and medication management therapy
• Substance use disorder (also known as substance abuse) treatment, including:
  • Outpatient diagnostic and treatment services for alcohol or chemical dependency
  • Medical services for withdrawal symptoms, such as inpatient detoxification services
  • Substance abuse recovery services, including counseling and education resources
• Mental and behavioral health inpatient services
  • This covers inpatient mental health care if you’re hospitalized at a psychiatric facility.

Do Medicaid and Medicare cover mental health services?

Yes, all Medicaid and Medicare plan options provide some coverage for mental health services, but some plans provide more coverage than others. Medicaid is a federal program administered on a state-by-state basis. Some states provide more coverage for mental health issues than others. Furthermore, there are plenty of options for Medicare plans. Similarly, certain Medicare plans also provide more coverage for mental health issues than others. For more information on what mental health coverage Medicare you can read more about it here.

What is the best health insurance for mental health coverage?

The National Institute of Mental Health not only confirms that mental illness is common in the United States, but “It is estimated that more than one in five U.S. adults live with a mental illness (57.8 million in 2021).“

Specific mental health insurance coverage details vary depending on the plan and its ACA metal level. The higher your plan level, the more coverage you will receive overall. For example, a platinum plan is likely to offer more benefits than a gold, silver, or bronze plan.

If you use mental health services often, you might consider a plan type with lower out-of-network costs, such as a Preferred Provider Organization (PPO) plan. This allows you to see providers out of your network, while maintaining coverage for your mental health services.

Keep in mind that you need to read the details of that coverage. Some insurance plans may cover the cost of prescription medications and outpatient therapy, but they might not provide coverage for inpatient visits. That is why you should trust an expert who can help you find the right mental health insurance plan.

How much does mental health insurance cost?

The cost of mental health insurance will vary based on the specific plan you choose. Generally, plans with higher premiums offer more coverage for services. Plans that allow you to use providers outside the network may also cost more, while  short-term health insurance plans designed to cover you when you are temporarily out of work might cost less but include other drawbacks.

If you do not have health insurance for mental health issues, it is not unusual for a visit to a therapist to cost up to several hundred dollars. Then, when all of this is added to the prospect of paying for prescription drugs or going to an inpatient treatment center, it is easy to see why mental health insurance is so important.

At the same time, the potential costs of treatment are also factors in the cost of health insurance. Health insurance companies understand that mental health issues can be expensive, and some people could require mental health treatment for the rest of their lives. Therefore, the cost of getting a plan with strong mental health coverage can also be expensive.

Fortunately, there are ways for you to save money on the cost of mental health insurance. For example, if you go to the ACA marketplace, you will have an opportunity to compare mental health insurance coverage options and find the best insurance for mental health conditions that you have.

At eHealth, our licensed brokers have the experience and expertise to help you find the plan that best meets your needs and budget. We offer plans in every state and you can enroll on our website, through our live chat, or by phone. Once you are enrolled, we provide 24/7 support to help you manage your plan.

Does insurance cover mental health during the COVID-19 pandemic?

It’s become more important than ever to care for your mental health during this time of COVID-19. You may live in fear of getting the virus or spreading it to loved ones. Over the last few years, the pandemic has also left millions without jobs and wreaked havoc on parents trying to juggle work and childcare. To make matters worse, social distancing has left people isolated at a time when they need support more than ever. Needless to say, there are many reasons you may be feeling more stressed, anxious, or overwhelmed.

If you’re experiencing greater stress and anxiety and noticing changes in your eating, sleeping, or alcohol consumption, you might consider talking with a health professional. Some plans have updated mental health insurance benefits during COVID-19 to include:

• Telehealth services: Many health plans have expanded their telehealth services during this time to provide medical care, including mental health care, in a safe, virtual environment. You may be able to schedule a virtual visit with your primary care doctor or a licensed counselor to discuss your concerns. Many plans are even waiving cost sharing at this time.
• Telephone support lines: Some insurance plans cover phone support services for members with mental health or substance abuse conditions. Others have joined with local organizations to offer free counseling with mental health professionals.
• Virtual resources: Some health plans offer online resources to help you manage your mental health, including webinars and blogs on anxiety management and coping strategies.

How to shop for mental health insurance

If you are looking for a place to shop for health insurance that provides coverage for mental health issues, you may want to go to the ACA marketplace. That way, you can feel confident knowing that the plans you’re looking at should provide the minimum mental health care coverage we outlined earlier.

You can find plans with mental health insurance coverage at your state or federal marketplace, as well as private insurance brokers like eHealth.com. As the first and largest online health insurance brokerage, eHealth offers a wide selection of individual and family health plans for different needs and budgets. We make it easy to compare plan benefits and prices side by side so you can find coverage that fits your needs at the best value.

To browse for plans with mental health insurance coverage, simply enter your zip code on this page to get started. If you need help at any point, give us a call during business hours to speak with a licensed insurance agent and get personalized assistance with your coverage needs.

 

MMR 1977 – 2024