Insurance Coverage for Mental Health Care

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. Under recent laws, 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, such as:

  • 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 by all individual and small employer plans, including all the ones offered through the insurance Marketplace

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

WebMD Medical Reference Reviewed by Sarah Goodell on June 01, 2020

Sources

SOURCES:

Kaiser Health News: "After Newtown Shootings, Questions About Mental Health Insurance Coverage."

Kaiser Family Foundation: "Mental Health Financing in the United States: A Primer."

American Psychological Association: "Mental health insurance under the federal parity law" and "How Does the New Mental Health Parity Law Affect My Insurance Coverage?"

HealthCare.gov:

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