Every year, millions of Americans seek professional help for mental health issues, yet there are many others who do not do so because of fear that they won’t be able to afford the bills. The costs associated with mental health (and indeed medical billing in general) can be confusing, so it’s unsurprising that many folks may forgo treatment rather than spend their time trying to navigate a labyrinthine system. Know everything about Health Insurance for Mental Health in detail.
But if you’re considering seeking mental health treatment, you may be one of many Americans who can access affordable care via their insurance policies.
Mental Health Care and Health Insurance
It’s estimated that 20 percent of American adults are living with some form of mental health issue. Many of those who are experiencing mental health difficulties fail to seek help for them, either due to a perceived stigma or fear of the cost.
The good news is that it’s possible to get mental health services, including therapy and counseling, via most health insurance policies. This brings such treatments within reach of a much wider range of people.
Does Health Insurance Cover Therapy?
In most cases, health insurance policies purchased via the marketplace do cover therapy. This means you can access therapy services that are delivered by a provider approved by the insurance company. If you’re not sure which providers are a part of your network, you can usually log into your online account and search for a provider or call your insurance company.
There are some exceptions, however. If you are still on a plan that started before the Affordable Care Act came into effect, then you may find its mental health provisions to be less robust. Non-marketplace plans are required to have some level of mental health coverage, but the law is less restrictive, and not all plans cover all forms of therapy or counseling.
Depending on the terms and cost of the plan, switching to a newer affordable health insurance plan could save a person money while giving them more extensive and flexible coverage.
The Affordable Care Act and Therapy
The Affordable Care Act requires health insurance companies to cover the ten essential categories of health service. They are:
- Ambulatory patient care services
- Emergency services
- Hospital stays
- Pregnancy, maternity and newborn care
- Mental health and substance abuse services
- Prescription medications
- Rehabilitative and habilitative services
- Lab services
- Preventative care and wellness services
- Pediatric services (including oral and dental care)
The Affordable Care Act also requires insurance companies to cover a person even if they suffer from a mental health issue that existed before purchasing their plan. Moreover, insurance companies cannot place a yearly or a lifetime dollar limit on the mental health service coverage they provide.
Which Medicare Parts Relate to Mental Health Services?
Mental health is covered by Medicare, although each component relates to a different area of mental health services.
- Medicare Part A relates to the mental health care received following admission to a hospital.
- Medicare Part B relates to mental health services delivered in a clinic or community health center or sessions with a therapist. It also covers outpatient appointments at a hospital.
- Medicare Part D covers some (but not all) of the prescription medications used in the treatment of mental illness, such as antidepressants.
Is Therapy Covered by Employer-Sponsored Health Insurance?
Most employer-sponsored health insurance plans will include an element for mental health treatment. This is true for both small employers and for companies that have more than 50 employees.
The main exception to this would be if for plans that begun in 2013 or earlier, because those plans are not subject to the same requirement as ones offered since the introduction of the Affordable Care Act.
Can a Health Insurance Company Refuse to Cover Someone With a Preexisting Condition?
The Affordable Care Act states that insurance companies cannot deny a person coverage because of a preexisting condition. This means an insurer offering a plan on the marketplace cannot refuse to cover someone or limit the amount of coverage available to them due to a mental health issue or any other issue.
Off-marketplace plans are also required to cover therapy, although the Affordable Care Act does not specify what types of counseling the plans must offer, or to what extent the plans must cover those conditions.
Anyone considering purchasing an off-marketplace plan should check the list of in-network services, and the extent of coverage and co-pays for the plan offers for any services they are interested in.
What If My Health Provider Won’t Accept My Insurance for Therapy?
Individual mental health care providers can choose whether they are willing to accept customers who are using health insurance to pay for their sessions. Some therapists are happy to do this, but many prefer customers who can pay up-front.
Insurance companies have strict requirements for counselors and therapists, and not all providers are willing to go through the work to get reimbursement, especially if the payment rates are not very high for the therapy they deliver.
Many therapists offer a sliding scale of fees for customers who can pay up-front and prefer to know they’re getting the money directly from the customer.
If you need to access mental health services via an insurance policy, it’s best to find an in-network service that has a good relationship with your insurance provider to keep any financial friction to a minimum.
Is It Cheaper to Pay for Therapy Directly or Should I Go Through an Insurer?
Fees for therapy can vary massively depending on the area you live or work and the type of therapist that you wish to see.
Many therapists set their fees based on ability to pay (sometimes known as a sliding scale), so those with lower incomes are offered discounts. For those who are employed and whose income is above the federal poverty line and benefits thresholds, it’s likely that paying for a therapist directly would cost far more than any co-pay an insurance company is likely to charge.
Health insurance providers can set different co-pays for each type of service, so a co-pay for a simple appointment with a primary care physician may cost far less than the same plan’s co-pay for an appointment with a therapist.
Ask for a list of co-pays and deductibles for your policy before you book an appointment so you have an idea of what you’ll be charged.
Do I Need Health Insurance to Access Mental Health Services?
The tax penalties that were originally a part of the Affordable Care Act are no longer enforced, so the coverage mandate portion of the ACA (while technically still in effect) has been rendered toothless. However, it is still a good idea to take out a policy. The Emergency Medical Treatment and Labor Act means it’s possible to access emergency services without insurance, but even basic treatments can be very expensive for an uninsured person.
There are many free mental health services available to those who are in a crisis. These resources include helplines and referral services for those who need urgent support.
Ongoing therapy services are available through Medicaid, via private payment, or via health insurance through the insurer’s network. For many people, accessing therapy via their insurance policy is the most affordable and simplest option.
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