Health Insurance

Are you using your insurance plan’s mental health benefits?

Are you using your insurance plan’s mental health benefits?

Though many Americans may not realize it, their health insurance plan likely affords them the mental health care many of us need.
A woman looking happy at home.
A woman looking happy at home. Source: Getty Images

Almost anyone who has health insurance—whether privately or through an employer—should some form of mental health coverage. Finding out how you can access the mental health benefits available to you can sometimes make a literal life-and-death difference.

What services are covered?

The architects of the Affordable Care Act (ACA) applied similar rules to mental health benefits as they did with other types of medical coverage. While individual plans do vary wildly in the amount and type of mental health benefits offered, the ACA requires all health plans on its marketplace to include mental health coverage.

Unfortunately, there some exceptions outside of the ACA marketplace plans that omit or offer only scaled-down mental health coverage—although most large-group plans provided by employers offer some sort of mental coverage.

The best way to find out if you're covered isn't to assume you are, but to contact your insurance company or your employer's human resources department to determine your exact benefits.

Mental health services

The types of mental health services typically covered by health insurance often include visits to psychiatrists, psychologists and social workers, as well as substance abuse treatment.

As mentioned earlier, any ACA health marketplace plan must provide "Mental health and substance use disorder services, including behavioral health treatment," per the ACA's 10 essential health benefits. These services include visits with a mental health professional at their office, and also the use of inpatient care facilities like psychiatric hospitals and substance abuse centers.

However, not every recognized mental-health disorder is covered by every insurance plan. If you need to see a mental health professional, ask your insurance company if you need a referral from your primary care physician in order to have the visit covered by your insurance.

Coverage and copays

The 2008 Mental Health Parity and Addiction Equity Act made it a law that the coverage and co-pays of mental health care benefits need to be similar to that which you would have with any other kind of health care professional on that plan.

This means your insurance company can't expect you to pay an $80 co-pay for a visit to your therapist, while seeing your ophthalmologist only requires a $20 co-pay. While prices will vary depending on your plan, the co-pay of seeing an in-network mental health care professional typically runs from $30 to $50, which may be less expensive than most people think.

Educate yourself about mental health

The stresses of life can take a toll on anyone. Fortunately, there should be some form of help available through your insurance provider. To find out more details on the information presented above, visit the government's website devoted to mental health to learn more.