Does insurance cover mental health?

If your insurance plan falls under the Mental Health Parity and Addiction Act (and since the ACA, most health plans do), your insurance company is required to cover mental health treatment. In addition to the federal requirements, many states have additional rules that apply to mental health care, expanding the reach of the federal law.

Not only are they required to provide coverage, but your plan also can’t charge higher copays than for physical health care or restrict behavioral health coverage. Insurers are also restricted from capping mental health services.

As with any treatment plan, however, your insurer can review the medical necessity of the treatment and decide whether to approve future visits.

Does health insurance cover therapy?

Health insurance covers mental health visits just like it handles all office visits.

Previously, a health plan in the individual market could deny you or charge much higher rates if you had pre-existing conditions, including mental health conditions. The ACA changed that.

Health insurance covers the following mental health and substance abuse treatment:

  • Outpatient mental health care
  • Inpatient treatment for mental health
  • Prescription drugs
  • Emergency care
  • Labs

Depending on the plan, you will pay more for out-of-network providers or have no out-of-network coverage at all. For instance, preferred provider organization (PPO) plans usually allow for out-of-network care, but charge higher deductibles and copays. Health maintenance organization (HMO) plans typically don’t cover any out-of-network care.

How much does inpatient mental health treatment cost with insurance?

Mental health costs vary by health plan. If you are receiving inpatient care, you can expect to pay the same out-of-pocket costs (coinsurance amounts and deductibles) that you would be charged for any other inpatient treatment.

Of course, the type of treatment you receive and how long you require treatment will determine the overall cost of your care.

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COBRA

The Consolidated Omnibus Reconciliation Act, better known as COBRA, allows you to stay on your former employer's health insurance plan to bridge the gap until you get new coverage. COBRA is expensive, as you will pay the full premium without help from your employer. It should be considered a short-term solution.
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Medicare

Most people over the age of 65 qualify for Medicare. Original Medicare includes Parts A and B, for medical and hospital care. Medicare Advantage plans, administered by private health insurers, are called Part C, and include everything in Parts A and B. Many Advantage plans also include extra benefits like vision, hearing and dental coverage. Medicare Part D, which covers prescription drugs, can be added to either option.
Medicare costs vary depending on which option you choose.
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Medicaid

You may qualify for Medicaid based on your income. Guidelines for eligibility differ by state. To find out if you qualify in your state, contact the local Medicaid office.
You may also want to consider an ACA plan. The ACA provides subsidies for lower-income people. Learn more:
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Parent's employer-sponsored health insurance

You can stay on your parent's health insurance plan until age 26 under the Affordable Care Act. For most people, this is the cheapest option. A dependent usually costs less to insure than a spouse or an individual.
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Spouse's employer-sponsored health insurance

If your spouse can add you to their employer-sponsored plan, it will likely be more affordable than seeking coverage on your own. In most cases, coverage for a spouse is available, but not always.
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  • HDHP
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Employer-sponsored health insurance

Health insurance through your employer is generally the most affordable option since employers pay a large portion of the monthly premium. If an employer-sponsored plan is available, it's likely the best choice. You may have more than one plan option to choose from.
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Learn more about each plan type
  • PPO
  • HMO
  • HDHP
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Employer plans are often one of these types of four plans. Click on each one to find out more.
  • PPO
  • HMO
  • HDHP
  • EPO

Preferred-provider Organization (PPOs)

  • Pay higher premiums with a lower deductible
  • You have access to more providers, but pay much more for health insurance
  • You don't want to choose a primary care physician
  • You don't want to get a referral
  • You want the ability to get out-of-network care
Preferred-provider organization (PPOs) plans are the most common type of employer-based health plan. PPOs have higher premiums than HMOs and HDHPs, but those added costs offer you flexibility. A PPO allows you to get care anywhere and without primary care provider referrals. You may have to pay more to get out-of-network care, but a PPO will pick up a portion of the costs.
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Health maintenance organization (HMO)

  • Pay higher premiums with a lower deductible
  • Restricted network of providers with lower premiums
  • You want to choose a primary care physician
  • You don't mind getting a referral
  • You don't care about the ability to get out-of-network care
Health maintenance organization (HMO) plans have lower premiums than PPOs. However, HMOs have more restrictions. HMOs don't allow you to get care outside of your provider network. If you get out-of-network care, you'll likely have to pay for all of it. HMOs also require you to get primary care provider referrals to see specialists.
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High-deductible health plans (HDHPs)

  • Pay lower premiums with a higher deductible
High-deductible health plans (HDHPs) have become more common as employers look to reduce their health costs. HDHPs have lower premiums than PPOs and HMOs, but much higher deductibles. A deductible is what you have to pay for health care services before your health plan chips in money. Once you reach your deductible, the health plan pays a portion and you pay your share, which is called coinsurance.
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Exclusive provider organization (EPO)

  • Restricted network of providers with lower premiums
  • You don't want to choose a primary care physician
  • You don't want to get a referral
  • You don't care about the ability to get out-of-network care
Exclusive provider organization (EPO) plans offer the flexibility of a PPO with the restricted network found in an HMO. EPOs don't require that members get a referral to see a specialist. In that way, it's similar to a PPO. However, an EPO requires in-network care, which is like an HMO.
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Individual insurance
You should compare individual insurance plans, including those on the health insurance exchanges created by the Affordable Care Act (ACA). ACA plans have no restrictions on pre-existing conditions and must include certain coverage basics.
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To learn more about ACA plans, choose the option that best fits your needs
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Individual insurance
The Affordable Care Act created insurance exchanges that allow people to compare plans. The health law also requires insurers to accept everyone and not charge them exorbitant rates. People who make below 400% of the federal poverty level qualify for subsidies to help pay for an ACA plan.
Know more individual insurance / ACA
These plans have lower monthly premiums and higher out-of-pocket costs
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Silver plans provide a good balance of monthly premiums with out-of-pocket costs. Coinsurance is 70% with a silver plan, meaning you will pay 30% of the costs after your deductible is met, up to the out-of-pocket limit. Silver plans are a good choice for people who are in generally good health but don't want high out-of-pocket costs if something goes wrong.

Bronze plans are a popular choice with those who value low monthly premiums and are willing to pay more when they need care. Coinsurance is set at 60%, meaning you will pay 40% if you do need care, up to the out-of-pocket limit. Bronze plans are good for those who don't expect to need many services outside of preventative care throughout the year.

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Individual insurance
The Affordable Care Act created insurance exchanges that allow people to compare plans. The health law also requires insurers to accept everyone and not charge them exorbitant rates. People who make below 400% of the federal poverty level qualify for subsidies to help pay for an ACA plan.
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These plans have higher monthly premiums with lower out-of-pocket costs
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ACA platinum plans have the highest monthly premiums, but the lowest out-of-pocket costs. You'll pay more monthly in return for lower deductibles, copays and coinsurance amounts. Coinsurance with platinum plans is 90%, which means you pay 10% after the deductible, up to your out-of-pocket limit. Platinum plans are good for those who anticipate a lot of medical needs throughout the year.

Gold plans cost a little less than platinum plans, and come with higher out-of-pocket costs. The coinsurance amount on a gold plan is 80%, which means you pay 20% after the deductible, up to your out-of-pocket limit. A gold plan is a good idea if you think you'll need a lot of care throughout the year, but don't want to pay platinum premiums.

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Best health insurance for mental health coverage

Health insurance companies must cover mental health, so any health insurance should cover you, but plan costs and access to providers will vary. When choosing a plan, it’s best to consider the balance of monthly premiums and out-of-pocket costs.

If you anticipate needing regular mental health treatment, it might be worthwhile to choose a plan with a higher monthly premium but lower out-of-pocket costs. It’s also vital to look at the network and make sure the doctors and clinics you need are covered.

The best insurance for mental health really depends on your specific needs, so compare your options and consider your budget before you buy

Do short-term health plans cover mental health care?

Short-term health plans don’t usually cover mental health and substance abuse care.

Most states allow short-term health plans, which let people sign up for a year with the chance to extend the plan for three years. These low-cost plans don’t offer the same protections found in other plans and are only meant to be a temporary solution.

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