Mental Health Coverage: What Your Insurance Plan Covers

Mental health is just as important as physical health, and thanks to federal legislation, your health insurance plan is required to treat it that way. The Mental Health Parity and Addiction Equity Act (MHPAEA) ensures that insurance companies cannot impose stricter limitations on mental health and substance use disorder benefits than they do on medical and surgical benefits.

What the Mental Health Parity Act Means for You

Under parity laws, if your health plan covers mental health services, it must provide those benefits on equal terms with physical health coverage. This means your copays, deductibles, and visit limits for therapy or psychiatric care cannot be more restrictive than those for a doctor's visit or surgery. Most ACA-compliant plans are required to cover mental health and substance use disorder services as one of the ten essential health benefits.

Common Mental Health Services Covered by Insurance

• Outpatient therapy and counseling — including individual, group, and family sessions with licensed therapists, psychologists, or social workers
• Psychiatric consultations and medication management — visits with a psychiatrist for diagnosis and prescription of medications
• Inpatient mental health treatment — hospitalization for severe mental health crises or intensive stabilization programs
• Substance use disorder treatment — including detox, rehabilitation, and ongoing counseling for addiction recovery
• Preventive screenings — depression screenings for adults and behavioral assessments for children are covered at no cost under most ACA plans

How to Verify Your Mental Health Benefits

Even with parity protections, the specifics of your coverage can vary by plan. Some plans may require prior authorization for certain services, or they may limit coverage to in-network providers. It is important to review your Summary of Benefits and Coverage (SBC) document, call your insurance company's member services line, or check your online portal to confirm what is covered and what your cost-sharing responsibilities will be.

If you are struggling to understand your mental health benefits or have been denied coverage for a mental health service, you may have the right to appeal. Resilience Health Advisors can help you navigate your coverage options and ensure you are getting the mental health support you deserve. Contact us today for a free consultation.