The recent suicides of celebrities Kate Spade and Anthony Bourdain put a public face on a growing mental health crisis plaguing the nation, with the Centers for Disease Control and Prevention reporting that suicide rates increased by 25% from 1996 to 2016. The statistic is a clear reminder that a person's mental well-being is just as important as his or her physical health, a reasoning the architects of the Affordable Care Act (ACA) took to heart when requiring health plans to apply similar rules to mental health benefits as they would to other types of medical coverage. Almost anyone who currently has health insurance—whether privately or through an employer—has 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 Gets Covered?
Nobody will ever accuse the health insurance industry of being too simple, and individual plans vary wildly in the amount and type of mental health benefits offered. Some health care plans omit mental health coverage entirely—though most large-group plans offered by employers offer some sort of mental coverage. In addition, the ACA requires any health plans offered on the marketplace to provide mental health coverage, effectively making a plan that ignores mental health a rarity. Still, the best way to find out if you're covered isn't to assume you are, but to contact your insurance company or the human resources department of your employer to find out your exact benefits.
The types of mental health services typically covered by health insurance include visits to a mental health care professional—such as psychiatrists or psychologists—as well as substance abuse treatment. As mentioned earlier, any plan on the health marketplace most provide "Mental health and substance use disorder services, including behavioral health treatment," per the ACA's 10 essential health benefits. This includes not only visits to a mental health care professional at his or her office, but also the use of inpatient care facilities—think psychiatric hospitals and substance abuse centers.
Not every recognized mental-health disorder is covered by every insurance plan, and you often need a referral from a primary care physician before the insurance company will deem your visits to a mental health care professional medically necessary.
Thanks to the 2008 Mental Health Parity and Addiction Equity Act, 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. That means your insurance company can't expect you to pay a $80 co-pay for a visit to your therapist while seeing your opthamologist only requires a $20 co-pay. While prices, of course, will vary depending on your individual 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.
The stresses of life can take a toll on anyone, even those who don't suffer from a mental illness. Fortunately help in some form is 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.