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Are Mental Health Services Covered?

Are Mental Health Services Covered? Medicaid, Medicare, Blue Cross Blue Shield, Kaiser Permanente, ACA

Are Mental Health Services Covered?

For many people, your insurance may cover mental health services in certain circumstances. It all depends on the person’s situation and the type of plan that they have. Different health insurance plans may have various mental health coverage options for treatment. It is essential to talk about your options with your insurance provider to find the most cost-effective treatment for your needs. 

We will get into more detail about whether health insurance covers therapy and what to expect. 

Does Health Insurance Cover In-Person Counseling?

Health insurance may or may not cover treatment for in-person talk therapy. This uncertainty is because, in private practice, many therapists can choose which plans to accept, with only some counselors accepting the same plans. Also, depending on your policy, you might only be able to see a therapist located in your state.

Some insurance plans will limit you by cost, the number of sessions, and certain therapists you can see. Many insurance plans also have mental health care as a covered item, which may mean it will only cover part of the session. Sometimes, you may have to pay upfront, with your insurance plan reimbursing you afterward. If you haven’t been diagnosed with any mental health condition, then an insurance policy could require you to have one before seeing a counselor. In addition, there may be a requirement for a referral from a medical practitioner. 

Is Online Counseling an Option?

Many mental health providers have started to offer online counseling as a more accessible option to clients with mental health issues. However, not all online therapy is covered through insurance plans. You’ll have to check the insurance information on their website if you’re looking for individual therapists or companies with telehealth therapy offerings. You can also contact them by phone or email.

Attending counseling online also depends on the online platform. In other words, you might not be able to use insurance according to the website’s terms and conditions or policies. However, many online platforms, in general, are significantly cheaper than face-to-face therapy.

What about Rehabilitation Programs? 

Many mental health and addiction rehab programs, both private and public, accept insurance. However, the treatment must be covered by the patient’s plan. In addition, some people seek care within a state-funded program for people with lower incomes or who don’t have insurance.

The policies themselves can be a barrier. While insurance might cover many applications, like medical detox programs, there can be some limits. For example, some plans might exclude specific programs, especially if they are non-medical. However, most detox centers offer suggestions to prospective patients and help them determine how much of their treatment will be covered. 

What are Some Ways to Get Therapy Covered?

Here is an extensive list of different acts, insurance providers, and more that can help cover mental health services:

Affordable Care Act (ACA)

The Affordable Care Act (ACA) was passed in 2010 and minimizes the cost of health insurance. It provides tax credits and cost-sharing reductions to make insurance more affordable. 

In addition, it offered a Health Insurance Marketplace and implemented plans that cover essential health benefits. Essentially, any plan that’s purchased through the Health Insurance Marketplace must incorporate mental health and substance use disorder services. 

For mental health specifically, the Health Insurance Marketplace offers:

  • Mental health and behavioral health inpatient services

  • Behavioral health treatments (like counseling and therapy)

  • Coverage for any pre-existing conditions

  • Parity protections ensure that coinsurance, co-pays, and deductibles are the same or close to any medical and surgical benefits. 

The Mental Health Parity Act of 2008

The Mental Health Parity and Addiction Equity Act (MHPAEA) is a federal law that enables group plans from offering fewer mental health benefits than medical or surgical benefits. 

One of the most important goals of this organization was to implement a system that provides equal coverage for treating addiction and mental health conditions. Before this act was passed, 49 million Americans didn’t have insurance, 2% had coverage without mental health benefits, and 7% had no substance use benefits.

CHIP (Children’s Health Insurance Program)

The Children’s Health Insurance Program (CHIP) provides states federal funding to offer low-income households with children affordable health insurance. Even though the coverage varies according to whichever state you reside in, most plans will cover all mental health services. For example:

  • Therapy

  • Counseling

  • Medication management

  • Peer support

  • Social work services

  • Substance use disorder treatments

Medicaid

Medicaid offers state-run plans that must cover anything known as an essential health benefit. This list includes substance use services and mental health services. In addition, Medicaid plans will vary from state to state but must meet MHPAEA requirements.

Medicare

Part A of Medicare covers substance use services and inpatient behavioral treatment. However, remember that you may be responsible for deductible and coinsurance costs for any hospitalizations. 

Part B covers many types of treatment for outpatient mental health services, like annual depression screenings. However, out-of-pocket costs can occur if you have to cover the cost of therapeutic services and any Part B deductible, co-pays, or coinsurance.

Medicare Advantage (aka, Part C) will generally cover therapeutic services, at minimum, the level of your initial Medicare plan or better.

Blue Cross Blue Shield

Due to the Affordable Care Act (ACA), most Blue Cross Blue Shield insurance plans include therapy. For plans that started before 2014, your plan may not cover any mental health services. However, there are some stipulations; for example, Blue Cross Blue Shield only covers evidence-based services (like psychoanalysis, for instance). In other words, sessions with a life coach, career coach, and other non-evidence-based practices are not covered.

Kaiser Permanente

Kaiser Permanente features mental health treatment plans that are unique and tailored to each member. In general, they will include therapy with a nurse practitioner or psychiatrist in their plans and group therapy. However, Kaiser also takes it to the next level by providing management and mental health classes and addiction counseling.

Takeaway 

Your mental health services may be covered by insurance, but ultimately, it depends on your coverage. The information in this article is an excellent start for finding out how to get your mental health services covered or find affordable options for mental health treatment. 

If you are looking for a mental health services provider, browse our listings at LGBTQ and All. We have a wide variety of mental health practitioners that take insurance, so that you can easily access mental health resources. 

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Agata Slezak – M&H English speaking Clinical Psychologist – Therapist – Sexologist

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