A Guide to Obtaining Insurance for Mental Health Care

Name: A Guide to Obtaining Insurance for Mental Health Care
Item: A Guide to Obtaining Insurance for Mental Health Care
Author: Erin C. Perkins

To navigate insurance for mental health treatment, check what services are covered by your plan. Calculate out-of-pocket costs and include them in your budget to manage expenses effectively.

By Erin C. Perkins

Reviewed by Andrea Rosenhaft

Contributions by 6+ experts

Updated: November 6, 2024

Advertising & Editorial Disclosure

Mental health is an essential aspect of our everyday life. It impacts how we think, feel, handle stress, interact with others and make decisions. Yet each year, according to the National Alliance on Mental Illness (NAMI), more than 26 million Americans struggle to find accessible mental health care, partly because they have to navigate a complicated and costly system.

The demand for mental health services is growing as 1 in every 5 Americans has a mental health condition. The guide provides several resources, tips and insights on understanding health insurance coverage and finding mental health support.

In the U.S., 1 in 5 adults and 1 in 6 youth **experience mental illness or a mental health disorder** each year.

The average delay between symptom onset and treatment is 11 years.

10.9% of American adults with mental illness had no insurance coverage in 2019.

Depression and anxiety disorders cost the global economy $1 trillion each year in lost productivity.

Sources:

National Alliance on Mental Illness

Finding the Right Mental Health Care

When determining what type of mental health care provider is right for you, be sure to choose a professional who is licensed to provide mental health services and understands that the mental health parity law requires coverage of services for mental health, behavioral health and substance abuse to be comparable to physical health coverage.

Choosing the Right Mental Health Professionals

A huge component to achieving successful mental health treatment is choosing the right mental health provider. Where do you start? Should it be a professional who specializes in a specific condition like anxiety? Should it be a social worker? Figuring these things out may not seem easy, but these pointers can help guide you to the right fit for your needs.

1
Determine what you need
Start with a physician for a physical exam to rule out other conditions or illnesses with symptoms that may present similar to mental illness symptoms.
2
Talk to your health insurance provider
If you already have insurance, call your provider and find out what your plan provides for mental health coverage. Most insurance plans cover therapeutic services. Start with your insurer’s network of mental health providers and note if they have a subspecialty that may be relevant to your needs, such as depression or bipolar disorder, and their approaches to care.
3
No insurance? Get recommendations
Check with the psychiatry or psychology department at a local university and ask for recommendations of people trained in that program. Call a large clinic for recommendations there. And don’t be shy about checking with friends and family.
4
Make an appointment
If it’ll be a while before a mental health specialist can see you, ask if you can join the waiting list for cancellations so if another patient cancels, you can get that appointment. Need help sooner? Check if your primary care doctor can provide treatments and support to tide you over. If it's an emergency, go to a hospital emergency room.
5
Ask plenty of questions
In your first session, learn as much as you can about the mental health professional to determine if they make sense for your long-term goals and needs. Here are some questions to consider asking:
- How long have you been in practice?
- Have you had patients with similar issues as me, and what were the results?
- How will you work with me and evaluate my progress?
- What are your policies and fees? If concerned about the amount, ask if you can pay on a sliding scale or at a discount.
- If cultural considerations are important, ask if the therapist is familiar with your community.
  — Do you have experience treating others from my cultural background?
  — If not, are you willing to learn about my cultural background and respect my perspective?

Treatments Health Insurance Can Cover

Mental and behavioral health services are essential health benefits that are covered under the mental health parity law.

That means plans must cover services for mental health, behavioral health and substance use disorders. Specific mental and behavioral health benefits will depend on your state and the health plan you choose, but here are some specific treatments that may be covered.

Psychotherapy and counseling: This is also known as “talk therapy” and can help patients cope with daily life, trauma, grieving the loss of a loved one or specific mental disorders like depression or anxiety.
Psychiatric emergency services: This may include attempted suicide, substance abuse, depression, psychosis, violence or other sudden changes in behavior that result in needing urgent attention.
Telemedicine and online therapy: This type of therapy allows patients to get help without seeing a mental health specialist in person, usually via telephone or video chat.
Addiction treatment: Helps those battling substance abuse stop compulsive drug seeking and use. It can include cognitive-behavioral therapy as well as medications, or a combination.
Co-occurring medical and behavioral health conditions: This refers to those dealing with a dual diagnosis such as coexisting addiction and depression.

Paying for Mental Health Care Using Insurance

Cost is one of the most significant barriers to mental health treatment. Unlike Medicare, which the government funds and sets pricing, costs for private insurance varies as each insurer negotiates pricing with health care providers. According to Good Therapy, therapy sessions generally range from $65 to $250 an hour, and in most parts of the U.S., patients can expect to pay $100 to $200.

If you need to see a psychiatrist for medication or an evaluation, you may pay additional costs, depending on the medication you need. Prescription costs can be high if you purchase the medicine by its brand name. For example, Prozac — known by its generic name as fluoxetine — (20 mg) could cost between $4 to $530 for a 30-day supply. The lowest price at $4 is based on its generic name, while the highest at $530 is based on its brand name.

MONEYGEEK TIP

You can use GoodRx’s price comparison tool to help you find low rates on medication. The “Prescription Setting” allows you to toggle between the generic name and the brand name.

In addition, you may also need a medication management follow-up session to ensure you are using your medication as prescribed. These 15-20-minute sessions allow you to discuss with your psychiatrist about side effects you may have, if your medicine is working for you and make sure you’re receiving the care you need. Medication management sessions could cost similarly to therapy sessions. Check with your psychiatrist on the rates.

The best health insurance policies can make receiving — and paying for — mental health services more manageable. Those who have coverage tend to pay less. In the face of COVID-19, it's especially tough for the uninsured, but finding affordable health care during the pandemic is possible.

Navigating Insurance for Mental Health Care

According to Kaiser Health News, research shows most people find understanding and picking health insurance difficult. With confusing terms, complex pricing options and difficult-to-decipher options, it's an enduring task for many. What helps is learning the terms, researching and figuring out the math.

1
Understand the common insurance terms
Learning the basic health insurance terms can help you find your way through health insurance benefits. Here's a quick rundown:
- Deductible: How much you pay out of pocket before your insurance kicks in coverage.
- Copay: A fixed amount you pay for a health-care visit or service.
- In-network: Refers to the set of health-care providers (physicians, hospitals, clinics, etc.) who accept your insurance.
- Out-of-pocket maximum (OPX): The most you have to pay in a year for covered services before your insurance starts to pay 100%.
2
Get a clear understanding of your coverage
Review your schedule of benefits, which outlines the costs associated with all of the health-care services covered by your plan. This will give you a realistic sense of your plan offerings and what the cost might be. You can also call your insurance. This is helpful for anything you have specific questions about, like, "Why does my plan cover?", "Is there a maximum number of mental health visits?", "How much will I pay if I see an out-of-network provider?"
3
Nail down the cost
Figuring out the math upfront will help you understand what your actual out-of-pocket cost is so you'll be less caught off guard and budget-stricken when you receive a health provider's bill or owe a copay. Determine how many sessions you may have in a year's time, along with any prescriptions. That, including your insurance premium, should give you a good idea of what the plan will cost you in a year.
4
File a claim correctly
Claims will often be filed on your behalf by your health care provider, and they will usually bill you what’s not covered by your insurance. But in some instances, policyholders may be required to submit their own claims. In that case, get an itemized bill from your health care provider with the reason for the visit and service date and include your policy number. Obtain the claim form, review it carefully before submitting and make copies for your records.

Choosing the Right Health Insurance

There are three critical things to consider when choosing health insurance that makes sense for your needs — and budget.

If you’re buying on your own from the health-care marketplace, you can choose from four categories of health insurance plans: Bronze (insurance covers 60%), Silver (insurance covers 70%), Gold (insurance covers 80%) and Platinum (insurance covers 90%).
It's easy to focus on your monthly premiums. But for a more accurate picture, consider the total costs, including your monthly premium, deductible and potential out-of-pocket costs. It's important to think about the entire cost when shopping for a plan to help you budget for your health care.
Know the plan and network types: HMO, PPO, PO and EPO. Based on your plan type, you may be able to use almost any mental health provider. Some plans limit your choices or charge you more if you use out-of-network providers.

Common Health Insurance Questions Answered

Curious about accessibility, complications and how to choose the right mental health specialist? Explore three common questions and answers below to help clarify some of the complexities around mental health treatments and health insurance.

If I don’t have health insurance, how does that affect my access to mental health services?

People without insurance have less access to health care than people who are insured. More than half — 56% — of American adults with mental illness did not receive care in the last year. Studies show that lack of health insurance is associated with lower rates of preventive care and delays in necessary care, leading to major health conditions and chronic diseases.

Why is medical coverage for mental health issues complicated?

There are several factors, including insurance companies limiting benefits, restricting the annual amount of services covered and requiring you to pay a higher portion of the cost for service (cost-sharing). Some insurers may also not cover what they perceive to be pre-existing conditions. For example, if you had a diagnosed mental condition for several years, acquiring coverage may be hard or cost more.

What should I keep in mind when trying to choose the right mental health professional?

Before contacting a mental health provider, consider how you’ll pay (with insurance or out of pocket), your issues and what you hope to achieve. From there, review the profiles of different therapists to make sure that they accept your insurance (if that’s a goal) and that they have the training and experience to address your concerns.

If you want to talk to someone regularly about making changes for yourself or discuss stressors in your life, consider a licensed counselor, therapist or clinical psychologist who offers individual or group therapy. If you think you might need medication to target symptoms you are having, then a psychiatrist or psychiatric nurse practitioner would be appropriate. Keep in mind, even if you start with one type of treatment, that professional might recommend and refer you to another if you possibly could benefit from both types of treatment.

Your insurance provider can help you find a therapist. Many have online search tools, or you can call them directly. There are also search engines like OnlineTherapy , Network Therapy, American Psychological Association’s Psychologist Locator and Psychology Today’s therapist finder.

What You Can Do if the Insurance Won’t Pay

There are many reasons that an insurance company may not cover a mental health service, such as missing information, a billing error or an uncovered service. They may deny the full amount of a claim or most of it. The good news: You don't have to accept their refusal. The Affordable Care Act (ACA) ensures your right to appeal claim denials. Here's what you can do:

1
Determine if it is a violation of the mental health parity law
There are certain considerations to appeal a decision by your health plan under parity law, as outlined by the National Alliance on Mental Illness. These include paying more for mental health services or services not covered for mental health that are covered for other kinds of health care.
2
Contact the insurance company to ask for a thorough explanation of the denial
You can also ask your HR benefits representative or insurance agent for help understanding claims, appeals and benefits, as well as contacting the insurance company for you.
3
Contact your state’s insurance division
If you complete the insurance company’s internal appeals process and are not satisfied, your state’s insurance division can help.
4
Do you have a self-insured plan?
You can enlist the help of a benefits advisor in a regional office of the U.S. Department of Labor (DOL) who can enforce parity.

An illustration of two women hugging each other.

Getting Affordable Mental Health Care Without Insurance

Concern about paying for mental health care is not uncommon. Many people need help and worry that they can’t afford it. A 2019 National Survey on Drug Use and Health revealed that 51.5 million American adults had a mental health illness in the past year, and of those, 26% felt there was an unmet need for mental health services. Though some insurance companies don’t provide much mental health coverage and often have expensive copays and deductibles, there’s still affordable — and even free — mental health care or support.

Government Support for Mental Health

The federal government has options and various resources for those seeking mental health support. It regulates systems and providers, protects consumers’ rights, provides major funding for services and supports research. It also establishes and sets standards the states can build on.

Medicare: Covers various treatment services for those with mental illness and substance abuse disorders, including psychological counseling, preventive screenings and outpatient treatment programs; special rules limit coverage. Get started by letting your doctor’s office know you want to schedule your “Welcome to Medicare” preventive visit.
Medicaid: Care under Medicaid can vary from state and county. But it provides support for both adults and children, and it generally covers counseling services, therapy, medication management, social work services and substance abuse treatment. Contact your state to determine if you qualify.
Social Security Disability Insurance Benefits (SSDI) and Supplemental Security Income (SSI): Certain mental disorders can qualify you to receive monthly benefits from SSI or SSDI. Each requires that your impairment prevents you from working. Children with an impairment can also receive SSI benefits. Regardless of the type of mental disorder, you have to show that you are receiving and complying with treatment.
Substance Abuse and Mental Health Services Administration (SAMHSA): This agency works to improve substance abuse and mental health treatment services. SAMHSA offers a directory of numerous ways for people to find reputable sources for assistance, including The Behavioral Health Treatment Services Locator, The National Helpline for mental or substance use disorders and The National Suicide Prevention Lifeline.
U.S. Department of Veterans Affairs Mental Health Resources: This agency provides an array of information about mental health and support services — locally and nationally — specifically for veterans, including Treatment Works For Vets and the National Center for PTSD.

Employee Assistance Programs

Employee Assistance Programs (EAPs) are work-based programs that offer confidential, free support to employees struggling with mental health issues, substance abuse and grief, to name a few. While most EAPs do not offer long-term counseling, they can refer an employee to services for long-term solutions. Check your employee benefits to find out if you have one or ask your HR benefits department.

Free Clinics and Nonprofit Options

It’s hard to know where to start with mental health care, especially if cost is a concern. Luckily, there are options, like free clinics and nonprofits, that can provide support.

Contact any local facility to find out if they offer the free mental health service that you seek.
The National Association of Free and Charitable Clinics has a search tool for finding health services clinics.
Contact a university training clinic near you as they often have free or low-cost options for therapy. The Association of Psychology Training Clinics has listings.
The National Suicide Prevention Lifeline can provide recommendations for nearby mental health services.

Virtual Therapy

The American Psychology Association reports a growing wave of people utilizing online therapy. The affordable options, convenience and accessibility make it easier for people to get the mental health support they're seeking. A VeryWell Mind study found that 90% were satisfied with the quality of online therapy. Studies show that online therapy is as effective as in-person therapy.

Keep in mind that coverage by insurance depends, but here are a few options to consider:

MDLive: Doctors are on call and able to provide care via both phone and video chat options.
Teladoc: Health-care providers are available for virtual care appointments. Scheduling is flexible, and appointments are available seven days a week.
TalkSpace: TalkSpace offers therapy options for individuals, couples and teens.
BetterHelp: BetterHelp draws from a large network of therapists to serve their patients.
Pride Counseling: Therapists who use their expertise to help those in the LGBTQ+ community.

An illustration of a young woman meditating.

Ways to Practice Self-Care at Home

Taking care of yourself is essential to your mental health and quality of life, and self-care can play a role in supporting your treatment if you’re dealing with mental health issues. It’s not a replacement for professional care, but even small acts of self-care incorporated into your daily life can help manage stress, lower your risk of illness and boost your mood.

Exercise regularly. It naturally produces stress-relieving hormones in your body and improves your overall health.
Eat well. Whole grains, vegetables and fresh fruit can help lower your risk for chronic diseases and boost your energy and mood.
Get enough sleep. Experts recommend seven to nine hours of sleep. Practice good “sleep hygiene,” like avoiding using computers and digital devices before bed.
Practice deep breathing and meditation. This is a quick way to reduce stress and gives you space to seek clarity about conflicts and problems. Apps like Simple Habit and Headspace provide easy-to-follow meditations.
Set aside time for yourself. Just five minutes a day can be a meaningful reminder of who you are and that you matter.
Recognize the positive. Try writing down one thing each day or week that was positive — it will start to change how you experience life. Try apps that help promote optimistic perspectives and activities like Happify or Moodfit, which include several therapeutic tools such as a gratitude journal.

Resources for Mental Health Care

Most people face mental health issues at some point in life. And it’s OK to get help by seeking professional care. There are resources, groups and programs available to assist you, whether you need a short-term or long-term solution.

Here are some organizations to get you started:

FindTreatment.gov: Find a provider treating substance use disorders, addiction and mental illness.
National Council on Alcoholism and Drug Dependence: This advocacy group provides information on local resources for getting help for substance abuse, along with support for friends and family members.
The Trevor Project: This nonprofit provides support to LGBTQ+ young people. You can call, chat or text with a crisis counselor 24/7 for anyone struggling with issues such as coming out, LGBTQ identity, depression or suicide.
American Psychiatric Association Foundation: This organization promotes high-quality care for individuals with mental illness, including substance use disorders. They provide a search tool for finding psychiatrists too.
American Academy of Child and Adolescent Psychiatry: This organization’s online research tool helps adults find psychiatric care for their children.
Make the connection: This campaign raises awareness on mental health symptoms, conditions and treatment for veterans. It also has a search tool to find local support.
National Empowerment Center: The center provides information and advocacy resources for those diagnosed with a mental illness.
National Alliance on Mental Illness: This nonprofit provides resources on mental disorders that are helpful for people who have experienced mental illness and their families, including support groups, education and training.
Freedom From Fear: This nonprofit provides information, screening tools and other resources on many types of anxiety disorders.
Mental Health America: This organization promotes prevention, diagnosis and treatment for people at risk of mental illness.
Soaring Spirits International: This group offers peer-based support programs to people coping with grief.
Dual Recovery Anonymous: This group conducts meetings for people who have both substance addiction and a mental illness.

About Erin C. Perkins

Erin C. Perkins is a finance writer at MoneyGeek, with 15 years of experience in the media industry. She has covered topics about money, including banking, insurance and budgeting for several publications over the years.

Perkins has a master's degree in magazine journalism from Kent State University and a bachelor's degree in mass communications from Winston-Salem State University.

Read Full Bio »

sources

Cognitive Behaviour Therapy. "Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: an updated systematic review and meta-analysis." Accessed November 6, 2024.
GoodRx, Inc.. "Prozac (Fluoxetine)." Accessed November 6, 2024.
Kaiser Health News. "It's Not Just You: Picking Health Insurance Is Hard. Here's How To Be Smart About It." Accessed November 6, 2024.
Mental Health America. "Access to Care Ranking 2020." Accessed November 6, 2024.
National Alliance of Mental Illness. "Mental Health By the Numbers." Accessed November 6, 2024.
Substance Abuse and Mental Health Services Administration. "The National Survey on Drug Use and Health: 2019." Accessed November 6, 2024.
VeryWell Health. "A Verywell Report: Americans Find Strength in Online Therapy." Accessed November 6, 2024.

A Guide to Obtaining Insurance for Mental Health Care

A Closer Look at the Impact of Mental Illness

Finding the Right Mental Health Care

Choosing the Right Mental Health Professionals

Determine what you need

Talk to your health insurance provider

No insurance? Get recommendations

Make an appointment

Ask plenty of questions

Treatments Health Insurance Can Cover

Paying for Mental Health Care Using Insurance

Navigating Insurance for Mental Health Care

Understand the common insurance terms

Get a clear understanding of your coverage

Nail down the cost

File a claim correctly