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What to Know About Health Insurance Coverage for Mental Health

Medically Reviewed by Dan Brennan, MD on October 25, 2021

If you’re thinking about going to therapy for your mental health, you may be wondering if insurance will cover the cost. While there are federal and state laws made to help you get accessible mental health treatment, some insurances might deny claims if they don’t believe the treatment was medically necessary.

Below you’ll find more on what’s covered under law, and how to appeal your health insurance’s decision. 

Which Therapy Is Covered by Insurance?

You may be seeking mental health treatment on your own, or have been referred by a doctor. Yet, the biggest barrier to getting help may be the cost. The average cost of one session can range from $100 to $200. However, this may change based on the insurance, location, and experience level of your therapist.  

According to the CDC, a quarter of U.S. adults have a mental illness during any given time. Additionally, half of U.S. adults will have a mental illness at some point in their life. Because of this, there’s been a push in federal programs to make therapy and mental health services more accessible.

Many people need therapy for their mental illness. However, health insurance has a big impact on whether or not you're likely to get treatment. Studies show that 72% of adults with mental illness have at least one barrier to treatment, like cost or lack of needed health insurance.  

In 2008, a mental health parity law was passed that requires health insurance companies to cover mental health, behavioral health, and substance use disorder services. This law is meant to keep your health insurance from charging you a higher copay for office visits to your therapist than they would for an average checkup at your doctor's office. 

Another benefit to it was removing annual limits on how many therapy visits would be covered. One limitation to this law, however, is that your health insurance company gets to determine what mental health treatment is a medical necessity. 

Which Plans Cover Therapy

Whether you have insurance or are looking for insurance, below are the types of health insurance that are affected by the parity law.

Employer-sponsored health coverage. If you have insurance from your company, and there are more than 50 employees, your health insurance is required to provide equal mental health services to you. 

Health insurance purchased under the Affordable Care Act. By purchasing health insurance through an exchange under the health care reform law, you have greater access to mental health services. 

The Affordable Care Act helped more than 21 million Americans get access to health coverage. This included classifying mental health services as an essential health benefit.

Children’s Health Insurance Program (CHIP). This insurance program is designed specifically for families with children who don’t qualify for Medicaid. 

Medicaid programs. Most Medicaid programs are required to give you equal access to mental health care. These requirements could change depending on your program. 

How to Get the Help You Need

If you need mental health help but are worried about the cost, there are options. First, if you don’t have health coverage you can look into Medicaid. If you’re not insured, you could find one with reasonable rates by looking around for mental health professionals.

If you have health insurance, you should check with your provider before your first therapy session. If your insurance plan isn’t covering your therapy costs, you can appeal their decision. The way you'd appeal depends on what type of insurance you have. However, you can always appeal your case to the Federal Center for Medicaid and Medicare Services or to the U.S. Department of Labor. They can enforce the parity law and help you get your therapy costs covered.

If you need help paying for medication related to your mental illness, there are county, state, and national programs available to you. These programs are designed to help you afford your medication through discounts based on financial need. 

Mental health services are not as accessible as physical health services. However, there have been a lot of improvements to the system.

Show Sources

SOURCES:

American Psychological Association: “Does your insurance cover mental health services?”

HealthCare.gov: “The Children’s Health Insurance Programs (CHIP).”

JAMA Psychiatry: “Acceptance of Insurance by Psychiatrists and the Implications for Access to Mental Health Care,” “Recent Changes in Health Insurance Coverage and Access to Care by Mental Health Status, 2012-2015.”

Mental Health America: “Paying for Care.”

National Alliance on Mental Illness: “What to Do If You’re Denied Care By Your Insurance.”

Psychiatric Services: “Insurance status, use of mental health services, and unmet need for mental health care in the United States.”

Psychology Today: “Cost and Insurance Coverage."

U.S. Department of Health & Human Services: “Health Insurance and Mental Health Services.”

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