A complex question concerning healthcare and insurance is whether health insurance plans cover therapy and mental health services. As mental health awareness is more mainstream now, it’s crucial to know if one’s insurance plan supports mental health services. Statistics have shown that 1 in 5 adults in the United States experiences mental illness each year. Consequently, mental health therapy should ideally be a component of every health insurance plan. This article will delve into the facets of insurance coverage for therapy and mental health services, essential facets of holistic health.
Mental Health Parity
The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 was a significant milestone in ensuring mental health is part of health insurance coverage. The Act mandates that health insurance providers cannot impose less favorable benefits limitations on mental health and substance use disorder (MH/SUD) benefits than medical/surgical benefits. This act covers most employer-sponsored health insurance, CHIP, Medicaid, and all health insurance coverage sold on individual and small group markets, including the Health Insurance Marketplace.
Private Health Insurance
The majority of private insurance plans must cover mental health and substance use disorder services. As an extension of the MHPAEA, it’s mandatory for most individual and small employer health insurance plans, including all plans offered through the Health Insurance Marketplace, to cover mental health and substance use disorder services.
These mental health services generally include behavioral health treatment, such as psychotherapy and counseling, mental and behavioral health inpatient services, and substance use disorder treatment. Nevertheless, the extent of coverage and the co-payment might differ across plans. Hence, it’s crucial to verify with your insurance provider concerning what all your plan covers.
Medicaid
Medicaid programs must cover a minimum set of services, including behavioral health services, also known as essential health benefits (EHB). Nevertheless, the specific mental health services and supports that are covered vary across states, as states have substantial discretion in determining these services. At a bare minimum, however, federal law requires states to provide certain mandatory benefits, such as inpatient and outpatient hospital services, physician services, laboratory and x-ray services, and home health services, among others.
Medicare
Medicare also provides coverage for mental health services. They provide benefits for a variety of services, such as psychiatrist or other doctor visits, tests to ensure appropriate treatment, and prescription drugs. Moreover, if a beneficiary needs partial hospitalization for a mental disorder, Medicare helps cover these services.
Employer Group Health Plans
Under the MHPAEA mentioned earlier, mental health benefits must be provided, if the employer group health plan covers mental health and substance use disorder benefits. The plan cannot apply additional financial requirements or treatment limitations to these benefits that are any more restrictive than the predominant requirements or limitations applied to substantially all medical/surgical benefits.
Conclusion
While the reality is that most health insurance plans do cover mental health therapy, the specifics of coverage vary between insurance providers and plans. And even though the law mandates coverage for mental health services, it remains important to know exactly what is covered and to what extent.
We are living in an era where holistic health, which includes mental health, is more crucial than ever before. Therapy and mental health services form an integral part of ensuring all-round well-being, and it’s vital that health insurance covers these services.
Sources
- National Alliance on Mental Illness – Mental Health By The Numbers
- Centers for Medicare & Medicaid Services – The Mental Health Parity and Addiction Equity Act
- MentalHealth.gov – Health Insurance and Mental Health Services
- Medicaid.gov – Benefits
- Medicare.gov – Mental Health & Substance Use Disorder Benefits