One in every five Americans is affected by a mental illness – more than 43 million, according to the data from the National Alliance on Mental Illness (NAMI). Truth be told, there are many adults in the U.S. who suffer from mental illness and are yet to get assistance for managing their conditions. Nearly 60% of people with mental illness don’t get any counseling or treatment for their mental health. Seeking help when you suffer from mental health issues is more important than you think.
Health insurance policies that prioritize mental health coverage make it easy and accessible for people to seek help for mental illness.
Many people don’t even understand that they may have coverage for mental health covered in their health insurance plans. Even though, health plans are not obligated to offer mental health coverage, the Obama administration compelled many to include it by introducing a crucial healthcare reform, known as the Affordable Act.
What Will You Need to Pay for Mental Health Services If You Have insurance?
You are responsible for any deductibles and copays for mental health services that you would pay for physical healthcare. But the parity law says that you can’t be subjected to two separate deductibles. Any amount paid out-of-pocket for mental healthcare contributes to the overall deductible of your plan. For example, if you have a $2,000 deductible and pay $1,000 for mental healthcare and $1,000 for physical healthcare, you have met your deductible requirement for the present year.
It’s up to the mental healthcare providers to decide whether they need to accept insurance or not. They can also choose which plans to work with. To minimize the associated costs, get help from a provider listed in your plan’s network. Such a provider has an agreement with the insurance company and will manage paperwork, such as filing claims.
There is always the option to get treatment from an out-of-network provider. However, in such a scenario, even if your mental health is covered, you are required to pay the full amount out-of-pocket. Then you will be expected to file claims with your healthcare plan to receive any available reimbursement.
What Do Health Insurance Companies Cover?
The Affordable Care Act expands health insurance coverage for mental health and specifies minimal essential benefits, which every insurance provider has to include in their long-term plans.
Some parts of the earlier iterations of ACA have been amended, particularly the individual mandate that requires Americans to pay a fee or maintain some type of insurance. Still, the essential benefit protections are untouched, and thus your health insurance provide have to comprise of the following mental health services:
Your doctor might have prescribed medications to manage symptoms. They are used alogside therapy to treat mental illnesses, such as obsessive-compulsive disorder, attention deficit disorder, schizophrenia, depression, and anxiety.
General practitioners recommend prescription refills, but mostly, healthcare professionals refer you to a psychiatrist, so you are diagnosed and get a prescription accordingly.
Insurance providers often categorize prescription drugs into tiers, based on their pricing. Typically, they rely on a five-tier ranking system for categorizing drugs. Tier 1 is made of the least-expensive generic medication and prescriptive drugs, whereas Tier 5 includes highly specialized and brand-name drugs.
Therapy is used for identifying the underlying causes of self-sabotaging behaviors, phobias, and mental illness. A therapist uses certain exercises to assist you with thinking problems in a different way, changing your behavior, and managing symptoms. Some of the types of therapy include the following:
Psychotherapy is about discussing your triggers, stressors, and problems with a therapist who monitors your condition and manage symptoms. Your therapist may talk you about trauma, a negative event which may have affected you subconsciously in the childhood and assesses your interpersonal relationships.
Cognitive Behavioral Therapy
This therapy helps you address negative patterns of self-abuse and self-thought, so you can resolve effectively. A cognitive behavioral therapist assists you with managing symptoms of depression or anxiety. For this purpose, they teach you, so you can learn coping strategies to manage your mental illness.
Behavioral therapy is similar to cognitive behavioral therapy. However, it is more centered on learning behaviors and the impact of environments that have those triggers. Usually, behavioral therapy helps in treating obsessive-compulsive disorder, posttraumatic stress disorder (PTSD), and anxiety.
If you are suffering from severe mania or depression that hasn’t alleviated or improved with other treatment, then your psychiatrist may recommend this form of therapy as the last resort. It includes passing electrical currents in the brain to invoke a temporary seizure.
Electroconvulsive therapy is conducted under general anesthesia, which is why patients don’t feel any pain or feel awake during this procedure. The seizure resets various areas of the brain’s chemistry, enabling the patient to view drastic and sudden changes through their mental health.
A few years back, electroconvulsive therapy was notorious for administering extreme electrical current. Today, the modern procedures and technology has made it safer.
Still, many detractors find electroconvulsive therapy riskier than other medications and therapies. Hence, consider it as a last option when other treatment options don’t work. Your psychiatrist and insurance provider will make sure that they exhaust all other alternative treatments before going ahead with electroconvulsive therapy.
Mental Health Requirements
The ACA requires health insurance plans to include the following:
- Cognitive and behavioral therapy
- Substance abuse treatment
- Inpatient care at a full-service mental facility.
Although employer-offered plans don’t have this requirement, usually they do cover mental health. According to a survey, more than 90% employer health plans include mental health coverage.
As per the parity law, most health plans need to include mental healthcare, similar to how they offer medical care. This means that if you pay $50 for a medical specialist, your co-pay to consult a psychiatrist or a mental health specialist has to be $50 or less. However, this requirement is exempted for the following:
- State government employee plans
- Employer plans with fewer than 50 workers
Understanding Mental Health Coverage
Whether or not your health plan includes coverage for mental health is mentioned in your policy’s summary. You can check this document on your insurer’s website; it is around five to ten pages long and often appears in the form of a chart. On your policy’s chart, locate the section that explains the mental health coverage.
If your policy’s summary doesn’t mention mental health treatment, it is likely that you are not covered. To be certain, contact your insurance’s customer service department. Even if they don’t provide any coverage, they may help you consider alternative options for getting mental health treatment.
Buying Mental Health Insurance
Usually, you have to buy mental health insurance within the framework of a medical health insurance policy. What you can do is that review the health insurance exchange in your state for an Obamacare plan. Alternatively, look for the individual policies available in your region that is not mentioned on the exchange.
After the enforcement of the Affordable Care Act, all individual health insurance policies that were bought after January 1, 2014 were required to offer mental health benefits.
Individuals with moderate income can check whether they are eligible to pay monthly premiums for health insurance, provided they pick a health plan from their ACA insurance exchange.
Those individuals, who have a basic health insurance plan without mental health services, can consider converting it into a High-Deductible Health Plan (HDHP) that offers coverage for mental health. You may benefit if your current yearly out-of-pocket expenses are higher than HDHP’s deductible amount. You can also use pre-tax money to pay the deductible since many HDHPs can be combined with Health Savings Account.
If you don’t want to buy separate insurance for mental health, find out whether you are eligible for the following.
If you meet eligibility and income criteria, you can go for Medicaid. Medicaid is available in the entire country, but benefits vary in each state. Some states offer mental health insurance coverage, so check whether with your state’s program.
If you are over 65, you can be eligible for Medicare. Medicare offers mental health benefits for outpatient services, inpatient treatment, and prescription drugs.
Also, keep in mind that Medicare has a specific category, Special Needs Plan (SNP). If your mental healthcare needs are significant, you can become eligible for this sub-category. Additionally, based on your exact mental health condition and its severity, SNPs may provide expanded benefits.
If you have severe or chronic mental illness due to which you can’t work in a standard work environment, you may meet the eligibility criteria for disability benefits. Even if it doesn’t necessarily offer health insurance, after two years of its coverage, you can meet the eligibility criteria for Medicare, which includes mental health benefits even if you are under 65. Disabled individuals can also become eligible for Medicaid. However, the process to apply for disability is arduous, complex, and long. Therefore, only choose it if your mental health issue is too severe and you don’t have an alternative option.
Those who served in the military may be eligible for Veteran Affairs (VA) health benefits, which include the mental health benefits. The VA has quite a lot of mental health programs to help the former members of the Armed Services.
Getting a mental health insurance can help you live a better life. Contact us so we can find a suitable insurance plan for you.
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