If you're seeking treatment for your mental health, chances are you're already feeling overwhelmed. Navigating insurance benefits can be confusing. For many, this complicates or even delays pursuing therapy.
Research shows that lack of insurance is a significant barrier to seeking mental health care. The truth is most insurance plans offer mental health coverage, but it may be difficult to tell what is covered and how much you'll have to pay.
This article discusses health insurance for mental health and substance use services, what may be covered, and how to find a provider.
At least half of the U.S. population will receive a mental health diagnosis in their lifetime. This makes access to care and transparency about cost incredibly important. Many adults with mental health conditions don't receive the services they need, and cost can be a significant factor.
One study noted that 72% of adults with mental health conditions experience at least one barrier to getting care, with many reporting lack of insurance as that barrier.
Some therapists take insurance, although some do not, as healthcare providers who are on insurance panels often receive much less than their typical rates by going through insurance. However, since many people have health insurance privately or through an employer, this can open up a wide pool of potential clients.
If you have a specific therapist in mind you'd like to work with, you can check with them to see if they accept your insurance. Therapists can apply for an insurance panel, but the approval process may take some time. So, if you're looking to work with someone out of network, it may be faster to talk to them directly about their rates.
Therapy can cost anywhere between $50 and over $200 per session, depending on the type of provider and their location. So, going through insurance may feel like a reasonable option to lower costs. With insurance, you're likely to have a copay and pay a specific amount toward sessions while your carrier covers the rest, or you may pay full price until you meet your deductible before insurance starts to cover services.
The laws around mental health coverage have changed over time.
The Mental Health Parity Act passed in the 1990s, which kept insurance companies from minimizing their contribution to mental health benefits. However, this did not require coverage for mental health and substance use concerns. That didn't come until the Mental Health Parity and Addiction Equity Act passed in 2008.
In addition to covering more services, this law keeps insurance carriers from charging high copays. Insurance companies are required to keep the cost of mental health and substance use services similar to medical services.
Since 2016, Medicaid and the Children's Health Insurance Program (CHIP) have followed these parity rules.
If you have insurance through an employer, you may have mental health services offered under your health coverage or through an Employee Assistance Program (EAP) if they provide it. Through an EAP, you may get access to a certain number of counseling sessions per year per condition.
The Marketplace provides access to many healthcare plans from different insurance carriers. Plans offered in the Marketplace are required to cover mental health and substance use services and keep costs comparable to other medical services.
The specific behavioral health benefits will depend on your state and the particular health plan.
The Children's Health Insurance Program (CHIP) provides low-cost insurance options for individuals with lower incomes.
Covered services by this federally funded program vary by location, but the following may be included:
Medicaid is required by law to provide coverage for some substance use and mental health services. Because they can limit how many sessions you receive, calling your state-run agency is the best way to get informed.
Medicaid offerings may not be standard and may vary by state or plan.
Medicare (federally-funded health care for people over age 65) covers the cost of some mental health services. However, it's essential to note that certain parts of Medicare contribute to certain services.
There are a few steps you can take to find out if your insurance plan covers therapy. These include:
Questions you may want to ask when reaching out to your insurance company are:
Types of services that may be covered by insurance include:
Keep in mind that insurance companies will only pay for services they deem medically necessary. The best way to know what services are covered is by contacting your insurance carrier. They can share information about whether something is covered, how many sessions or days of treatment are allotted, and your personal responsibility for care.
Finding not just a therapist but also the right one for you may require some work.
Here are some factors you may want to consider before choosing a mental health provider:
Evaluating cost is just one factor to consider. Make sure to identify other factors that are important to you.
Though there have been strides in the mental health field, therapy is not accessible to everyone. Research shows that people with mental health conditions are less likely to be insured, which creates issues with access to and coverage of care.
If you are uninsured or are simply looking for other ideas about how to get mental health support, you can try:
Lack of insurance or mental health coverage is a commonly noted barrier to accessing mental health care. While most insurers offer some level of mental health coverage, it can be challenging to determine your level of coverage and how to navigate benefits. There are also other avenues for getting coverage, including many government programs.
You can learn more about getting care by contacting your insurance carrier, inquiring about services a therapist covers, discussing payment options, and exploring other options for support.
Navigating insurance for mental health services can be overwhelming. However, taking the time to thoroughly research your benefits and potential therapists can help you make an informed decision about your care and how to afford it. Fortunately, there are many avenues available to get the mental health services you need.
It depends. Insurance companies will pay for what they deem medically necessary services. A documented diagnosis often helps you obtain coverage. For example, an insurance provider may be more likely to pay for couples therapy if at least one of the partners is diagnosed with a mental health condition. However, the best way to know if and how much of the cost insurance will cover is to reach out directly to the carrier.
Is therapy worth it?Therapy can be a life-changing experience, and it is proven to be effective in treating mental illness. Getting started can seem like a hassle. Doing your research and finding a therapist who feels like a good fit, has training in your specific needs, and offers services at a rate you can afford can make it easier to start and stick with the process.
Sticking with an in-network provider may seem like a great way to reduce the cost of treatment. However, it may be helpful to determine what factors are most important to you when seeking services. Other things you might consider include a therapist's education, training, and specialties, and whether they deliver in-person or telehealth services.
Are some insurers better than others for mental health coverage?Most insurance companies have therapists in-network. It's difficult to say which insurer is the best because the services they cover and the number of sessions allotted may vary. If you're looking to determine which carrier is right for you, some research may be required. You can contact insurers to find out about services, costs, and in-network providers.
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By Geralyn Dexter, PhD, LMHC
Dexter has a doctorate in psychology and is a licensed mental health counselor with a focus on suicidal ideation, self-harm, and mood disorders.