Millions of Americans seek professional help for mental health issues every year. Many others could benefit from doing the same, but don’t for various reasons. Can health insurance help cover some or even all of these costs?
Around one out of every five U.S. adults lives with a mental illness, according to the National Institute of Mental Health. That statistic represents a whopping 45 million Americans.
Less than half of those people received treatment for their mental illness in the last year, says the NIMH
What’s keeping them from seeking help? The social stigma attached to mental illness is one reason. A lack of access to care is another. And cost is a factor, too.
Those hurdles don’t just keep diagnosed individuals from counseling or therapy, of course. They also get in the way of millions who don’t have diagnosable disorders but still need professional help.
What role does insurance play in this kind of situation? Could it help all of these Americans get the assistance they need? Or does it usually just serve as another annoying speed bump on the road to good mental health?
You’ll find answers to those questions and many more here.
Most health insurance plans cover at least some forms of mental health care. This is true even of companies with more than 50 employees.
As is often the case with job-based health insurance, coverage can be all over the map. One company may thoroughly cover psychotherapy or counseling sessions. Another may only cover the minimum.
If you’re currently looking for a job, keep this in mind as you consider your options. Ask any potential employer what kind of coverage their health plans offer in this area.
What if you’ve already got health insurance through an employer? If your policy doesn’t make things clear, talk with someone in human resources. Or contact the insurance company that provides your job-based plan.
You’ve heard of the 'essential health benefits' all health insurance plans sold through the marketplace have to cover, right?
If not, the gist is that the ACA requires marketplace policies to cover 10 categories of health services. 'Mental health and substance use disorder services' is one of those categories.
What does that mean to Americans who get health insurance through the ACA marketplace? According to healthcare.gov it means the plan they buy must cover:
A few other things the law requires of marketplace health policies:
Unfortunately, that’s about as specific as the Affordable Care Act gets in this area. Which means these benefits still vary quite a bit from state to state and policy to policy.
Given that, do as much research as you can while shopping for one of these health plans. And don’t be shy about contacting insurance companies you're not sure about what's covered and to what extent.
Planning to enroll in a marketplace health plan next time you’re able to do so? Read this article of ours first: 'Which Type of Obamacare Plan is Right for You?'
Yes. The Affordable Care Act requires off-marketplace plans to cover counseling and therapy.
However, the ACA doesn’t specify which types of counseling or therapy off-marketplace plans have to cover. It also doesn’t say how fully they have to cover them.
Because of this, don’t assume that any health insurance plan bought directly from an insurer post-ACA law will pay for your mental health care.
And if you can’t figure out what your off-marketplace plan will and won’t cover in this area, contact your insurer. You don't want to go in for therapy or counseling only to find out that your policy won’t cover it.
All state Medicaid programs cover some mental health services and some substance abuse services for adults.
This usually means they’ll help you pay for therapy or counseling, to an extent. But not always. To find out if your state Medicaid program covers therapy or counseling, contact your local agency.
Medicaid and the related CHIP program provide a wider range of these services to children, by the way. If you have a financial need and you have a child who needs mental health care, reach out to a CHIP agency.
Medicare covers therapy, counseling, and related kinds of care in various ways.
Here is how each of the main Medicare components--Part A, Part B, and Part D--can help you pay for these services:
For more information, read our article, 'What Kinds of Mental Health Care Do Medicare and Medigap Cover?'
If you have a Medicare Advantage plan, it may offer more coverage here than Original Medicare, or Parts A and B.
The fastest way to determine if your plan covers this kind of mental health care is to look at its documentation.
If that doesn’t make things clear, contact the insurance company. Or, if you get your health coverage through an employer, talk with someone in its human resources department.
You may want to take one of these last two steps even if you’re pretty sure your health plan will help you pay for mental health care. That’s because there’s often some nuance to this situation that your policy documentation might not cover.
Not all U.S. health plans have to cover counseling or therapy. And even those that have to cover it don’t have to cover all forms of it.
Laws require certain health insurance to cover mental health care similar to how they cover physical health care. They only need to do this if they actually cover mental health care, though.
While the ACA requires some plans to cover counseling, therapy, and other mental health care, it doesn’t require all of them to cover it. And, again, even those that must cover it usually don’t cover every type.
If you got your health insurance plan from the ACA marketplace, it should help you pay for some therapy or counseling. If it doesn’t, get in touch with the insurance company and ask for clarity.
Mental health care providers can choose whether or not to accept insurance. Although some do accept it, many do not.
Why? One reason many therapists and counselors give is insurers don’t pay them very well for their services. According to the American Psychological Association, "many insurance companies have not increased the reimbursement rate for psychologists in 10 or even 20 years despite the rising administrative costs of running a practice." Others have even reduced their reimbursement rates in that time.
Also, insurers have made it increasingly difficult for counselors and therapists to get paid. That's another reason many mental health care professionals balk at accepting insurance.
The short answer here is that some health plans cover this kind of counseling, but most do not.
Many health plans that say they cover couples therapy actually cover something quite different from marriage counseling. What they usually cover is a procedural code that allows a spouse to be present in therapy.
There is a procedural code for “Counseling for Marital and Partner Problems.” But insurance companies tend to reject it for not being medically necessary.
Make sure to contact your insurer before you schedule a couples therapy session. Do this even if it seems obvious your health plan covers such treatment. If you don’t, you may have to pay the resulting bill out of your own pocket.
It’s nearly impossible to say how much you’ll pay for counseling or therapy even if you're covered.
That’s because every health plan is different. One may force you to pay a high deductible before it’ll help pay for your psychiatrist or therapist visits. Another may tie lower deductibles to its coverage of these sessions.
To figure out how much of your therapy is covered, examine your policy. Look for information related to your deductibles, copays, co-insurance, and out-of-pocket limits. If that doesn’t help, contact the insurance company that provides your coverage.
For more information on this topic, read our article, 'How Much Does Health Insurance Cost?' Also, check out our 'Health Insurance Rate Factors' article to learn how insurers calculate what to charge for these policies.
It’s also tough to tell you how much you’ll pay for counseling or psychotherapy without insurance.
The reason: what you pay often depends on where you live. Therapists in one part of the country charge more than therapists in another part of the country. Those in New York or San Francisco, for example, will charge more than therapists in a small town.
Also, even therapists within the same city can charge different amounts for their services. And therapists with private practices usually charge more than those at public health clinics.
According to various sources (including Good Therapy), the an average 45 minute therapy session costs $75 to $150. You may find somebody who charges a lot more or a lot less than those amounts, though. If you decide to pay for counseling out of your own pocket, shop around before you settle on one.
Your most obvious option is to pay for it out of your own pocket. A lot of people do this even if their health plan will pay for their therapy or counseling. Keep reading to learn why this is the case.
If you can’t afford to pay for your counseling or therapy yourself, search for a public or community treatment center. Many offer low-cost and even free treatment options to people with financial needs.
If you can afford therapy but want to save money, a health savings or flexible spending account may help. Both let you pay using pre-tax dollars.
Some people pay for this kind of mental health care themselves even if their insurance plans cover it.
Why? One reason is they don’t want their mental health treatment added to their permanent medical record. And that is what happens if you use your insurance to pay for your therapist visits.
This is because insurers usually require a diagnosis to be made before they pay claims. During that process, they can ask your care provider what caused you to seek counseling. Anything they learn during that conversation goes onto your medical record.
Also, it's often easier get an appointment with a therapist that doesn't take insurance. According to Tampa Therapy, most counselors who accept health insurance are booked out for months. Sometimes it's easier to simply pay the fee than jump through insurance hoops.
So, if you want to see an insurance-accepting therapist, it may take time before your sessions start. If you pay for that treatment with your own money, you might be able to get in sooner.
There are a few U.S. laws that address health insurance coverage of counseling or therapy.
One noteworthy example is the Mental Health Parity and Addiction Equity Act. This 'federal parity law' requires coverage of mental health to be comparable to coverage of medical services.
This means health plans can’t treat things like therapy and counseling differently than they treat a trip to the doctor. Deductibles, copayments, co-insurance, and out-of-pocket limits tied to the former must be similar to the latter. Though they don’t need to be exactly the same.
For example, an insurer can charge you a $10 copay when you see your primary care physician but a $20 copay for therapy if your other medical or surgical copays are $20 or more as well.
The same is true when it comes to treatment limits. A health plan can’t limit the number of counseling sessions it covers more than it does on hospital visits.
This law doesn’t cover every health insurance policy. It covers the majority of them, however. According to the American Psychological Association, it generally applies to:
The federal parity law doesn’t apply to Medicare coverage, though. It also doesn’t apply to some state government employee plans.
The law doesn’t actually require the health plans listed above to cover mental health care or treatments. It just says that if a plan does cover mental health care or treatments, it can’t charge you a lot more for them or tie stricter limits to them than it does for physical health care.
As for the Affordable Care Act, it expanded the federal parity law by requiring most of the health insurance plan types mentioned earlier to cover mental health services in various ways. It also required 'small group' as well as off-marketplace health plans to provide this kind of coverage.
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