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The Transition House, Inc.

How do I know if I am covered for mental health services?


When it comes to your overall well-being, mental health is just as important as physical health. Whether or not your health insurance will cover mental health benefits depends largely on what company holds your plan, but these days, most health plans do.

The federal parity law requires insurance companies to treat behavioral health and substance use disorder coverage at least equal to regular medical and surgical coverage. For example, an insurance company can't charge you a $20 copay for most medical/surgical office visits, and then charge you a $40 copay when you see a mental health professional. 

To be clear, the mental health parity law does not require insurance companies to cover mental health and substance abuse treatment, but fortunately most large group plans already provided such coverage before the law took effect in 2008. Additionally, individual plans purchased from a health insurance exchange are required to cover behavioral health/substance use disorder services under the Patient Protection and Affordable Care Act.

Employer-sponsored health plans

To discover whether your employer-sponsored health insurance plan covers mental health services, talk to someone in your Human Resources department, or check your explanation of benefits, a description of plan benefits that was provided to you by your employer (typically, you can access your explanation of benefits online by logging in to your account on your insurance company's website).

Many employer-sponsored benefit programs include an Employee Assistance Program (EAP). EAPs were designed to identify and assist employees who are struggling with personal issues (marital, grief, substance abuse, etc.) that may be adversely affecting their performance at work.

While some EAPs provide direct counseling and treatment, most offer short-term (often phone-based) counseling, or just make referrals to mental health professionals and treatment centers. But those that only make referrals can help you understand what is and is not covered by your health insurance plan. Your company's Human Resources professional(s) should be able to help you understand the scope of coverage provided by your EAP.

Individual health plans

If you purchased an individual health plan, you won't have an EAP, but the Affordable Care Act does require that insurers provide mental health and substance use disorder coverage for plans purchased through the health insurance exchanges. Access your explanation of benefits to see what coverage you have.

Government-sponsored health plans (VA, Medicaid, CHIP, Medicare, state employee plans)

Many mental health and substance abuse services are covered by VA benefitsMedicaid, CHIP, and Medicare Part B. Some state government employee health plans may opt out of the federal parity requiredment, so if you are covered by a state-sponsored health insurance plan, talk to your Human Resources department or access your explanation of benefits.

Keep in mind that regardless of your plan, your health insurance deductible functions the same for mental health services as it does for medical and surgical office visits and procedures. You'll have to pay out of pocket for copays (or, in the case of high deductible health plans, a contracted rate) until you meet your deductible for the year.

Insurance companies haven't always treated mental health coverage on a level playing field with medical and surgical coverages, but the federal parity law and the Affordable Care Act have both significantly increased access to mental and behavioral health services and substance use disorder treatment over the last decade.

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