Does Health Insurance Cover Therapy? Dealing with mental health issues can be daunting, and the process of understanding insurance benefits often adds to the stress. This confusion can deter or postpone individuals from seeking the therapy they need. Evidence suggests that not having insurance is a major obstacle to accessing mental health services.
Although most insurance policies include provisions for mental health and substance use treatment, determining the extent of coverage and your financial responsibility can be challenging. This article explores the coverage of mental health services by health insurance, including what is typically covered and tips for locating an in-network provider.
What To Know About Insurance Coverage for Therapy
Possessing health insurance does not automatically equate to having mental health services covered, and the level of coverage offered can greatly differ. Many are unaware of the potential limitations that could be in place.
The enactment of the Mental Health Parity and Addiction Equity Act (MHPAE) in 2008, also known as the federal parity law, was a significant turning point. This law does not compel insurers to cover mental health services, but it mandates that if these services are included, their coverage must be equivalent to that of other medical services. This means insurance companies are prohibited from charging higher co-pays for mental health therapy than they would for other medical specialist visits.
Naomi Angoff Chedd, LMHC, BCBA, LBA, a therapist with Counslr, highlights, “The vast majority of insurance policies provide only partial coverage for mental health services. It is essential to carefully review what is covered and what is not in the plans your employer offers before you commit to one.”
Does Health Insurance Cover Therapy?
Therapy for recognized mental health conditions is typically included in most health insurance policies.
Without an official mental health diagnosis, your therapy sessions may not qualify as medically required. Insurance providers are more inclined to approve therapy costs if you are diagnosed with conditions. Like depression, anxiety, PTSD, an eating disorder, or phobias, particularly if therapy is a crucial component of your care strategy.
Conversations with a therapist about everyday stressors or mild anxiety might not be deemed medically necessary by your insurer, leading to potential non-coverage.
Even with insurance that covers therapy, out-of-pocket expenses often still apply. For instance, you might need to satisfy a deductible before your insurance begins to pay, and co-payments for each session could also be part of your financial responsibility.
Plans That May Cover Therapy
If you already have a policy or you are seeking an insurance policy that may cover therapy, here are the types of health insurance that can help you:
- Firstly, Medicaid Programs.
- Employer-Sponsored Health Coverage.
- Children’s Health Insurance Program (CHIP).
- Lastly, health Insurance Purchased Under the Affordable Care Act.
Medicaid Programs
Generally, Medicaid mandates equal mental health care access, although specifics can vary by the individual program.
Employer-Sponsored Health Coverage
The policy is mandated to offer comparable mental health services for those with workplace-provided insurance in companies with over 50 employees.
Children’s Health Insurance Program (CHIP)
This program aims at families whose children are ineligible for Medicaid, CHIP provides a vital insurance option.
Health Insurance Purchased Under the Affordable Care Act
Securing health insurance through an ACA exchange means enhanced access to mental health services, thanks to healthcare reform. The Affordable Care Act significantly widened health coverage access for over 21 million Americans, making mental health services a mandatory essential benefit.
How Do I Know If My Insurance Covers Therapy?
To ensure you are covered for mental health treatment, take these steps:
- Firstly, reach out to your insurance provider to obtain your benefits summary document. This will detail your coverage and outline any out-of-pocket costs for mental health care. Often, this information is accessible online through your insurer’s website. Derek Lee, the VP of insurance operations at Grow Therapy, notes. “The details of your plan will specify your cost-sharing amounts for mental health services.”
- Then, if your health insurance is provided by your employer, your HR department can be a valuable resource for information.
- For those with a plan from the ACA marketplace, detailed information about mental health coverage can be found on healthcare.gov.
- Medicare recipients should consult the Centers for Medicare and Medicaid Services for specifics on mental health coverage. If you have a Medicare Advantage plan, it is advisable to contact your insurer directly to understand your mental health benefits.
- Finally, individuals on Medicaid can find information on behavioral health benefits through the Medicaid and CHIP Payment and Access Commission websites.
What Treatments Are Usually Covered?
Health insurance undoubtedly covers a wide range of treatments related to mental health like psychotherapy. However, as long as the therapist diagnoses the illness and gives the necessary things for treatment, the insurance plan can cover mental health therapy.
Here are the treatments that are typically covered by health insurance:
- Inpatient hospitalization.
- Substance abuse treatment.
- Medications.
- Emergency care.
- Psychotherapy.
- Lastly, partial hospitalization.
On the other hand, these are treatments that you may not be able to receive coverage for:
- Halfway houses.
- Educational programs.
- Third-party treatment.
- Genetic testing for psychotropic medication.
- Addiction or mental health treatment.
- Experimental therapies.
- Long-term addiction or mental health treatment.
In summary, the coverage you get or receive from health insurance is determined by the insurance company or provider. Nevertheless, you can still purchase a separate policy for any additional treatment coverage.