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5 Tips for Choosing a Mental Health Insurance Plan That Fits Your Needs

Posted: January 31, 2024


In California, nearly one in seven people experience a mental illness. This makes it one of the most common health conditions in the state. If you’re experiencing mental health or substance abuse issues, the costs for care and treatment can rack up pretty fast. This is why it’s beneficial to have mental health insurance.

Thanks to the Affordable Care Act (ACA), all insurance plans cover mental health and substance use disorders in California. It’s important to note that an insurer can’t deny you coverage for an existing condition, and they can’t limit you or charge more than they would for other health services. There are multiple insurance options to choose from, no matter your financial circumstances. We’ve compiled a list of tips to help you select the one that best supports your mental health needs.

1. Determine Your Mental Health Needs

If you’re searching for a new insurance provider or are looking to switch, consider your mental health needs so that you can choose the right plan to cover your treatments.

California health insurance covers the following:

  • Eating disorders
  • Anxiety disorders
  • Bipolar disorder
  • Depression
  • Post-traumatic stress disorder (PTSD)
  • Substance use disorders

Insurance plans will cover therapy sessions, the medicine you need and certain out-patient and in-patient treatments.

If you have an existing mental health condition, some plans may offer specialized programs that you can take advantage of, including for depression and substance abuse. Some plans offer more mental health services than others. Compare each plan’s offerings and the cost to find the best one for you.

2. Compare Health Insurance Plans

Everyone in the state of California must be enrolled in a health plan or they will have to pay a tax penalty. While you can choose private insurance, there are multiple health care options in California, including free or subsidized options for low-income families.

The following health care plans are available in California:

  • Medi-Cal is a government insurance plan for low-income families and disabled, pregnant or older people.
  • Medicare is a government insurance plan specifically for people over the age of 65.
  • Covered California plans are found in health care marketplaces where families, individuals and small businesses can compare and purchase insurance. These plans are for those who don’t have insurance from their employer or don’t qualify for free government insurance.
  • Short-term medical plans can cover you while you are in between plans. This is important if you miss the insurance enrollment period that most plans have.
  • Off-exchange plans are also available for those who wish to purchase insurance directly from insurance companies.

If you qualify for government insurance, you can receive mental health care even if you can’t afford it. If you need to pay for your insurance, it’s essential to consider all your options to make the most cost-effective choice based on your needs. A health insurance marketplace will let you compare the plans and get a quote.

3. Understand Network Type and Size

There are four types of insurance plans that have specific network and referral policies, including:

  • Health Maintenance Organization (HMO): You must use health care providers (HCPs) in their network and live within their network area. For referrals, you’ll need to see your primary care physician (PCP).
  • Preferred Provider Organization (PPO): You pay less when you use an HCP in their network and more for an HCP outside their network. You typically don’t need referrals to see a specialist.
  • Point of Service (POS): You pay less if you use an HCP in their network and you need a referral to see a specialist.
  • Exclusive Provider Organization (EPO): You need to see HCPs in their network — except for emergencies — and referrals aren’t required.

These types are essential to consider if you currently have a mental health or substance use condition, as you may already have a preferred health care provider that you see. To continue seeing the same doctor, check the plan’s network policy and ensure they are included in the network. If they aren’t, you’ll want to find a plan that does or consider seeing a new doctor.

If you wish to manage your own mental health care, consider a plan that requires no referrals to see a specialist. A PPO is a type of plan that doesn’t require referrals, but you may pay more to see a doctor outside of their network.

4. Look Out for Telehealth

Telehealth or virtual appointments are a new type of care that lets your health care provider diagnose and treat you over the phone or by video chat. While HCPs can’t treat everything virtually, multiple conditions are suited to telehealth, including mental health conditions such as depression or anxiety.

Virtual appointments are beneficial and sometimes necessary for people who are unable to take time off work to go to the doctor or are at risk when visiting hospitals and doctors’ rooms. People may also prefer to speak to therapists by message or video calls. If this is the case for you, look for telehealth options when comparing insurance plans.

5. Consider the Costs

It is crucial that you choose an insurance plan that supports your mental health care needs and fits within your budget. When you are reviewing the costs involved in insurance plans, you may come across the following terms:

  • Premium: This is the amount you will pay monthly for your health insurance coverage.
  • Deductible: This is the total amount you need to pay for services in a year before your insurance will cover you.
  • Copay: This is a set amount you might need to pay at the time of receiving a service.
  • Coinsurance: This is the percentage you will pay for services once you’ve paid the deductible amount.

It would be best to consider all of these costs when comparing insurance plans. The premium is how much you pay monthly, but the deductible, copay and coinsurance amounts can all add up if you require a lot of care. Consider your mental health needs — if you don’t need too much care, you can opt to pay a lower premium, but you’ll be paying more out of pocket. If you need frequent care, a higher premium with more coverage and a lower deductible can save you money.

Find the Best Mental Health Insurance Plan With Health for California

Health for California is a health insurance exchange certified by Covered California. We know it can be difficult and time-consuming to look through all the health care options and pick the one that works for you. That’s where we come in — our team can help you find the best insurance for your mental health needs while considering your budget. Getting a quote from us is easy, fast and free!

Just fill in our online form to get your free quote or contact us if you have any questions. Our agents are happy to assist you!