Does insurance cover therapy or mental health counseling?
Since 2014 most health insurance plans are required to cover mental health and substance use disorder services at costs similar to that for physical health.
Insurance companies haven’t always covered services to treat mental health problems the same as physical health even though both are important for overall health. However, a law passed in 2008 established parity requirements for mental health and substance use disorder services and physical health coverage.
That legislation, known as the Mental Health Parity and Addiction Equity Act, applied to group health plans and group health insurance coverage. With the passage and implementation of the Affordable Care Act, coverage was expanded but there still remain some exemptions to following the parity rules.
What mental health services are covered?
Insurers are not required to include mental health benefits in healthcare plans. But the law does require that if mental health services are offered, the coverage must be comparable to the physical health coverage offered. Those that do offer mental health services must cover behavioral health treatment such as psychotherapy, talk therapy, and counseling as well as mental and behavioral health inpatient services. Additionally, substance use disorder, commonly referred to as substance abuse, treatment.
Coverage varies across plans as well as by state, and not all services will be automatically covered. If you purchase health insurance through the HealthCare.gov Marketplace you can use its online tool to compare plans.
For those who already have an insurance plan, you can check the enrollment materials for your plan. Health insurers are required by law to provide you with an easy-to-understand summary about all the benefits available to you. If your insurance is through your company, you can consult with the Human Resources department.
How do parity protections work?
As stated, the law does not require health insurers or healthcare plans to provide mental health services. When included though, mental health services coverage must be comparable to, or even better than, coverage for medical and surgical health services.
This goes for the cost of co-pays, number of visits permitted and must be covered under the same deductible. Pre-existing mental or substance abuse conditions must be covered just as they are for physical health issues.
If you need help to better understand the parity protections, the Substance Abuse and Mental Health Services Administration, part of the US Department of Health and Human Services, provides some of the common limits placed on services. To locate where to direct your inquiry for your state the webpage for the Centers for Medicare and Medicaid Services (CMS) Consumer Assistance Program has a list of resources to get help with a problem or question. Additional information resources may be available at the Mental Health and Addiction Insurance Help consumer portal and at MentalHealth.gov.