Insurance Coverage for Mental Health Care

Medically Reviewed by Sarah Goodell on June 20, 2024
2 min read

Insurance coverage for mental health problems has changed -- for the better.

In the past, your insurance might have paid 80% of the cost of seeing your primary care doctor but only 50% of the cost for seeing a psychologist. But a law that took place in 2010 changed the rules. Under the law, if a private insurance plan provides coverage for mental health and substance use services, the plan's coverage must be equal to physical health services.

For example, benefits must have equal treatment limits, such as:

  • Number of days you can stay in the hospital
  • How often you get treatment

Also, the amount you pay on your own needs to be the same for similar categories of physical and mental health services. For instance:

  • Out-of-pocket maximums (the total amount you have to pay)
  • Co-payments (a fixed amount you pay for a health care service)
  • Co-insurance (your share of payment for a health care service)
  • Deductibles (the amount you have to spend before your insurance company starts to pay)

If your health insurance covers some or all of the cost of going out of network for a physical health problem, it has to do the same for a mental health problem.

 In addition, the Affordable Care Act requires mental health and substance abuse to be included in all individual and small employer plans, including all the ones offered through the insurance Marketplace. Marketplaces are websites where people who don't get insurance through their job -- or don't have insurance for any other reason -- can buy a plan.

The Affordable Care Act also makes it illegal for insurance companies to deny you coverage for pre-existing conditions, including a mental health condition.