Your mental health is a crucial part of your overall well-being. So it’s important to understand how you can use your health insurance to pay for mental health expenses.
Mental health coverage can help you manage depression, anxiety disorders, trauma, bipolar disorder and other issues. Depending on your condition, you may need:
- Therapy and counseling, which are sessions with licensed mental health professionals, such as psychologists or counselors. These sessions can help you manage emotional and psychological issues. You can have these sessions as an individual, couple, family or group.
- Medication, which some mental health professionals can prescribe to treat a range of mental health conditions. Your insurance plan may cover generic and brand-name medications. You can check your plan’s formulary, a list of drugs the plan will cover.
- Inpatient or outpatient care: Inpatient care is full-time care in a hospital or a specialized mental health facility. You might need it for severe conditions that need more care. With outpatient care, you go home when you’re not having treatment. Outpatient care may include regular therapy sessions, psychiatric evaluations and appointments to make sure your medication is working correctly.
- Preventive care, which includes screenings and assessments. These tests can help spot mental health concerns early so they can be treated before they get worse.
- Telehealth services, where you can have counseling or medication management through online appointments.
This guide from Banner Health and Cedar (a health care financial engagement platform) can help you find the health insurance plan that gives you the mental health coverage you need.
What to know about reviewing your mental health coverage
Insurance plans must provide equal coverage for mental health and other health services.
For example: If you have a $30 copay when you see your primary care doctor, you can’t have a copay higher than $30 to see a mental health provider. This makes sure that people with mental health conditions aren’t discriminated against and don’t have higher costs.
“Even though mental health conditions need to be covered fairly, coverage can vary from one insurance plan to another,” said Emily Phillips, commercial insurance specialist for Cedar.
You may be responsible for deductibles, copayments and coinsurance. It’s important to review your policy and talk to your insurance provider so you understand the details of your coverage.
Open enrollment is a time at the end of every insurance year when you can change your health insurance if you like. “It’s a good idea to review your policy during open enrollment,” Phillips said. Plans may change from year to year, so you can see what’s different. You can also estimate your costs and see whether your plan is still the best choice, or if you should switch to another plan.
You can usually find this important information on your health insurance provider’s website or member portal:
- Your full policy.
- Summary of benefits and coverage, which outlines your plan’s key features and expenses.
- Explanation of benefits, which explains what claims were processed and what you may owe.
- Provider network directory, which lists the in-network mental health care providers for your plan. In-network providers have contracts with your insurance company, so your costs are lower. It can also be easier to process your claims with an in-network provider.
- Customer service, whom you can contact if you have any questions.
Costs to consider
You may want to look at these costs when you are reviewing your mental health coverage:
- Deductible: This expense is an amount you pay toward health care expenses before your insurance plan starts to pay. It could be $500 or $1,000 per year, or more if you choose a high-deductible health plan. So you’ll pay your health care expenses – including mental health needs – in full until you reach your deductible.
- Copayments (copays): You pay these costs when you see a health care provider or fill a prescription. They are a set amount every time, like $20 or $30. So you will pay this amount every time you see a therapist (Note: Sometimes, insurance plans cover preventive care services at no cost to you.).
- Coinsurance: This expense is the percent of a health care cost you must pay (after you have met your deductible). If you have an 80/20 plan, your insurance company pays 80% of covered expenses and you pay 20%. So if a therapist appointment costs $100, your insurance pays $80 and you pay $20.
Here are some ways to help lower your costs:
- Use in-network providers.
- Choose generic medications, if possible.
- Consider having telehealth appointments instead of in-person sessions. Depending on your provider and insurance plan, they can sometimes be more cost effective, especially when considering travel and time off for in-person sessions.
- Ask your therapist if they have sliding-scale fees. If they do, your fees may be less if you have lower income.
- Appeal any claims that are denied. Sometimes, they are denied by mistake.
- Keep track of your health care expenses. They may help you save money on your taxes. You can also check them to see if you should change your insurance plan for the next year.
Other factors that can affect your costs
Along with expenses, you’ll want to check your policy for:
- Pre-authorization: You or your provider may need approval from your insurance company before you get certain mental health services.
- Session limits: Your plan may cover a certain number of therapy or counseling sessions per year. For example, you may have coverage for up to 20 sessions per year. Your therapist may be able to help you get coverage for more sessions, if you need them.
Using employee assistance programs (EAPs)
If you have health insurance through your job, you might have an EAP. “With an EAP, you can get help for mental health concerns, such as stress, addiction, relationship problems and other issues,” Phillips said.
EAP services are usually free since the coverage is part of your employee benefits. Your discussions are confidential unless you allow them to be shared or if there’s a concern about the law or safety.
EAPs usually have a 24/7 helpline so that you can connect with a trained professional right away. They can give you guidance, referrals and short-term counseling if your issue is urgent. If you need further counseling, they may help you find someone and schedule an appointment.
You can reach out to your company’s human resources (HR) department to find out how to connect with your EAP. You might also find the helpline phone number in your employee handbook.
The bottom line
Mental health care is important for your overall health. Insurance companies must cover mental health expenses the same way they cover other health expenses. By reviewing your policy, coverage and costs, you can choose the health insurance plan and mental health coverage that is best for you and your needs.
