Does Health Insurance Cover Mental Health Issues?
The emergence of COVID-19, the recent economic downturn, and the 2020 Election have contributed to a sharp rise in mental health issues over the last 12 months. Anxiety, depression, PTSD, eating disorders, addiction, and social disorders have skyrocketed. However, not everyone with a mental disorder has an individual or group health insurance plan covering mental health disorders.
Sadly, most people assume that their policy has provisions for mental disorders. As a result, they are surprised when the provider does not cover psychiatry, counseling, recovery centers, or prescriptions. Even plans with mental health treatment coverage may have high limits on what type of treatment is covered or how much the policy pays out.
Health Insurance Laws for Mental Health Coverage
As mental health continues to be an issue for many Americans, the federal government has responded by enforcing laws and regulations regarding insurance coverage for mental health treatment. For instance, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act passed in 2008 requires mental health services coverage, including behavioral health and substance use disorders.
The law requires health insurance companies to treat mental and behavioral health and substance use disorder coverage equal to medical/surgical coverage. Insurers must treat financial requirements equally. An insurance company can’t charge a $40 copay for office visits to a mental health professional such as a psychologist if it only charges a $20 copay for most medical/surgical office visits.
The law also covers non-financial treatment limits, eliminating annual limits. However, it does not prohibit the insurance company from implementing medical necessity limits. Overall, the law applies to individual and group health plans, including children’s plans.
What Types of Mental Health Issues Does Health Insurance Cover?
Each health insurance provider offers different plans and coverage at various rates. Before choosing a health insurance company, make sure the plan covers your mental health treatment needs. Health insurance plans that offer mental health services typically covers the following mental health issues.
Behavioral Health Treatment
Behavioral health treatment can cover mental disorders such as anxiety, depression, bipolar disorder, ADHD, eating disorders, personality disorders, post-traumatic stress disorder (PTSD), or schizophrenia. You can get coverage for talk therapy, psychotherapy, or counseling.
Inpatient Services
If you have a mental disorder that requires ongoing supervision and care, health insurance can cover the time you spend and services you receive within a facility. Treatment options may include inpatient full-time or partial care. So, whether you stay in the facility 24/7 or only a few hours each day, you can still get coverage for treatment.
Substance Use Disorders
Substance use disorders include drug and alcohol addictions, including prescription drug addiction. Treatment often includes detox, rehab, aftercare, and medication. Health insurance companies offer plans that cover substance abuse assistance at all treatment stages.
What Will I Pay for Mental Health Treatment If I Have Insurance?
You’re responsible for the same types of copays and deductibles for mental health services that you’d pay for physical healthcare. However, you are not subject to two different deductibles. Any amount paid out-of-pocket for mental healthcare goes toward your plan’s overall deductible. If you have a $3,000 deductible and pay $1,500 for physical healthcare and $1,500 for mental healthcare, you’ve met your deductible for the year.
Mental healthcare professionals can choose whether to accept insurance and what providers/plans they want to work with. To minimize cost, seek treatment with a provider in your health insurance plan’s network. This provider will have negotiated rates for service with the insurance company and will handle filing claims and other paperwork.
You always have the option of treatment with an out-of-network provider who does not accept your insurance. In this case, even if you have mental health coverage, you’ll likely have to pay the entire amount out-of-pocket (usually at the time of service). Then you will be responsible for filing claims with your healthcare plan to receive any available reimbursement.
Does Group Health Insurance Cover Mental Health Treatment?
Most individual and small group health insurance plans, including plans sold on the Marketplace, are required to cover mental health and substance use disorder services. Employer-based coverage is required to comply with federal and state requirements regarding mental and behavioral health, including parity protection.
Make sure you review your health insurance plan carefully to see the coverage levels for all your benefits. The ACA requires insurers to provide easy-to-understand summaries of benefits, including mental health benefits. An employer-provided program (EAP) may include mental health counseling and support for a limited time and relatively moderate issues.
Which Health Insurance Plan is Best for Me?
You may be wondering which health insurance company is the best? When choosing a plan, you first need to assess your personal healthcare needs, look at all your options, and choose a health insurance plan that fits your budget. How do you determine which health insurance is best? Ask yourself these questions:
- How often do you visit your doctor?
- What type of treatment do you need in the next 12 months?
- What prescription drugs do you currently take?
- Which healthcare providers/physicians do you prefer?
Once you decide your healthcare needs, you can narrow your search to health insurance companies in your state.
Contact Insurance Enterprise for Premier Health Insurance
If you have questions about group or individual health insurance and need health insurance quotes, contact Insurance Enterprise at 888-350-6605. Speak to a licensed agent and find out more about how you can get an affordable health insurance plan.