In recent years, conversations surrounding mental health have shifted from whispers behind closed doors to open discussions among friends, families, and healthcare professionals. As mental well-being gains more recognition, more people are seeking treatment for their symptoms.
However, a common concern that often comes up is whether or not insurance pays for the costs associated with therapy, counseling, and other mental health services. The good news is that, in many cases, insurance does offer coverage for mental health treatment. However, the specifics can vary depending on your state, the type of insurance you have, and the level of care you are seeking.
Let’s look closer at how insurance coverage for mental health works and how to make the most of your benefits. Please note that this article is for informational purposes only and should not be taken as financial or legal advice. Always consult with your insurance provider or a qualified professional to determine the specific details of your coverage.
The Importance of Mental Health Parity
Thanks to legislation like the Mental Health Parity and Addiction Equity Act (MHPAEA)—passed in the U.S. in 2008—most group health insurance plans are required to provide mental health coverage that’s comparable to coverage for physical health services. In simpler terms, if your health plan offers unlimited doctor’s visits for medical concerns, it cannot arbitrarily limit the number of therapy sessions for mental health conditions.
Additionally, the Affordable Care Act (ACA), passed in 2010, classified mental health services as an essential health benefit for many insurance plans. This means most marketplace (ACA) plans must provide some level of coverage for behavioral and mental health treatment.
Types of Insurance Plans and Their Coverage
Employer-Sponsored Plans
Most employer-sponsored health plans are subject to mental health parity requirements. While coverage is more robust than it used to be, the exact benefits can vary. For instance, one plan might have a higher copay for mental health specialist visits, while another plan might require pre-authorizations for therapy.
Some employers also offer short-term counseling sessions through EAPs, which might be free or low-cost. While EAP benefits are often limited (for example, 3–6 sessions), they can serve as a stepping stone for those who need immediate support and referral to longer-term treatment.
Individual and Marketplace (ACA) Plans
Under the ACA, most marketplace plans are required to cover mental health and substance use disorder services. The level of coverage and out-of-pocket costs will vary depending on whether you have a bronze, silver, gold, or platinum plan.
Just like any other health service, you’ll save money if you see providers within your plan’s network. Going out-of-network typically means higher deductibles or coinsurance.
What If You Don’t Have Insurance?
If you do not currently have insurance or your plan does not adequately cover mental health, see if you qualify for a Special Enrollment Period (SEP) or wait for Open Enrollment to sign up for a plan that does include mental health coverage.
Verify Your Insurance Coverage Today
Recovery Cove is a recovery center that provides treatment services for mental health issues and substance use disorders. We accept most major insurance plans, including Blue Cross Blue Shield, Aetna, United Healthcare, Anthem, and Cigna. We do our best to minimize out-of-pocket costs, as we believe that treatment should be affordable and accessible for everyone. Contact us today to verify your insurance coverage at 484-549-COVE.
