Health Insurance 101: How Does Mental Health Coverage Work?

Has it been a headache to determine the difference between your copay and coinsurance, or your deductible and your premium? Well, here’s how to figure out your insurance plan’s mental health coverage, without adding more anxiety or stress to your plate. After all, insurance should help you afford your mental health needs — not make them worse.

Does health insurance cover mental illness?

The Affordable Care Act established several important guidelines to help more people access health care. For example, children up to 26 years old could remain on their parents’ health insurance plans, and there would be public options for all through the Health Insurance Marketplace. One of the other major achievements of the ACA was a list of “Essential Health Benefits.” These are services that all insurers must cover, and it includes both mental health and behavioral health services.

Offerings may vary by location and income, but most insurance plans will cover (to some extent):

• Therapy and/or counseling

• Inpatient mental health services at hospitals

• Substance abuse treatments

• Prescriptions for mental health medications

There are also benefits under “parity protections” under federal law. These state that any mental health service coverage that a plan offers can’t be more limited than its medical and surgical coverage. This has helped to expand benefits for mental health needs. After all, your mental health is an important component of your overall health, and it deserves similar coverage.

Mental health is physical health

More good news: Insurers aren’t allowed to put spending limits for mental health coverage. Plus, they can’t deny you insurance if you have pre-existing mental illnesses before enrolling. This is important since untreated mental illness can put someone at risk for other issues, such as substance use disorders or even suicide.

However, the law doesn’t require that insurers cover all diagnoses. Call your insurance representative to understand what your insurance plan covers for your mental health. You can also use your insurer’s website to help find mental health providers in your area that accept your insurance.

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Written by:

Hilary Weissman

Hilary Weissman has been a health writer for the past 6 years. She was a senior copywriter at WW (Weight Watchers) before joining GoodRx and was also a copy editor in S&P Global’s structured finance ratings group for 3 years prior.

Reviewed by:

Mera Goodman, MD, FAAP

Dr. Mera Goodman is a board-certified pediatrician. Prior to medicine, she worked as a management consultant.

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