How To Find Mental Health Coverage

The Mental Health and Substance Use Disorder Coverage Parity law requires that health plans treat mental health benefits the same way they treat medical and surgical benefits. The Affordable Care Act also requires that marketplace health plans cover mental health services, and Medicare and Medicaid plans fall under the same rules. You should never be denied mental health coverage from an insurer who provides other medical benefits.

The Parity Law

The original Mental Health and Substance Use Equity Act (parity law) came about in 2008 as a way to combat inequal treatment for mental health and substance abuse patients. This was game-changing for the mental health community.

The parity law does not technically require that insurers provide mental health benefits. Instead, it requires that if a plan offers mental health benefits, they cannot be more restricted than most other benefits. “Most” is a key word here because costs can still differ. For example, a copay may be higher for a mental health specialist than for a primary care physician. However, costs for specialists are almost always higher than for primary care physicians, regardless of the type of care.

What’s Covered?

Unfortunately, some mental health and substance abuse disorders are considered preexisting conditions. This means anything from alcoholism to anorexia or depression can be considered a preexisting condition that prevents you from receiving the coverage you need at a good price. Preexisting conditions in any category can make it difficult to receive coverage.

In general, your mental health coverage will depend on your plan. You’ll want to first check if your plan covers mental health at all, then check coverage limits and out-of-pocket costs. However, most plans that cover mental health will provide some coverage for things like:

1. Depression screenings and well-visits
2. Psychiatric evaluations
3. Therapy and counseling
4. Hospital stays
5. Medication and injections

Our Advice

When picking a new mental health provider or a new insurance plan, take these steps to make sure you get the coverage you deserve:

1. Check if your plan includes a mental health network. Doctors and pharmacies that are in-network are almost always cheaper.
2. Check your plan for numbers – copayments, deductibles, and coinsurance are all fees that you will have to pay (on top of your premium) before your plan covers you, regardless of the service provided.
3. Call the provider first. Doctors, specialists, and pharmacies get these questions all the time. Ask if they accept your insurance and how their payment plan works. Will you be billed later?
4. Get help from a licensed agent. You can give us a call to get started at 615-541-4257.