Understanding Mental Health Coverage

Posted: October 23, 2021

About one in five adults struggle with mental health disorders throughout America, and 14.4% have received treatment for their condition in the last year. However, it’s estimated that more than half of all Americans with mental health conditions are living without treatment. No matter your economic circumstances, you can always take the initiative to find coverage and start on the path to wellness.

Mental health care is considered one of America’s 10 essential health benefits, meaning all Californians qualify for mental health coverage through the Affordable Care Act (ACA) and Covered California. Health for California is committed to teaching Californians about accessible mental health care no matter their price point. Learn more about starting your journey to better mental health and find affordable care options with Health for California.

Does Insurance Cover Mental Health Services?

Although not every insurance provider is required to provide mental health coverage, many of them do. If a plan is part of a state- or federally-managed marketplace — like Healthcare.gov or Covered California — it must cover mental health services, including substance abuse and behavioral health treatment. Other benefits for mental health insurance might include follow-up case management services, consultations and referrals to community resources.

Mental health insurance coverage can vary widely by your insurance company, state and health care provider, but, generally speaking, you can receive coverage for a wide range of services, like counseling, inpatient treatment and substance use treatment. You might use these services to talk to a therapist, see a psychiatrist for behavioral health medication or be admitted to a rehabilitation facility.

Depending on the service you’re receiving, you may still be charged a copay or coinsurance. For example, you might pay a flat fee of $25 for a talk therapy session or a percentage of 25% of the costs for inpatient treatment. Your plan’s deductible may also apply, but you cannot be charged a separate deductible from the one that applies to your other medical care.

Fortunately, most health insurance plans now need to cover these services similarly to how they would cover other medical services. This requirement comes from the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA), which was passed in 2008. Before MHPAEA, mental health coverage was harder to come by.

Other strides in mental health coverage come from the ACA. Thanks to this legislation, plans generally cannot deny you coverage for a pre-existing condition or limit your coverage for mental and behavioral health services. They also can’t put dollar limits on your essential health benefits, which include mental health and substance use disorder services.

The Benefits of Mental Health Insurance

Mental health benefits in an insurance plan can be an extraordinary resource. Mental and behavioral health services can be life-saving treatments, or they could significantly improve the quality of your life. Research has shown that expanded mental health insurance benefits, including coverage itself, have benefited people in many different ways, such as:

• Increasing access: Mental health insurance decreased unmet mental health needs due to cost and improved access to care for lower-income adult populations in some states. It also reduces out-of-pocket spending for young adults with mental health or substance use conditions.
• Improving outcomes: Mental health insurance has improved mental health access for young adults, and outcome studies tell us that Medicaid expansion has reduced the number of poor mental health days for low-income, childless adults. It may also reduce severe psychological stress and improve mental health for young adults.

Mental health insurance affects individuals and society as a whole. Below are some of the benefits mental health insurance offers.

1. Affordable Care

When you have access to mental health benefits through insurance, you can visit the doctor without worrying about unaffordable costs — that applies to acute events like hospitalization or ongoing care, such as talk therapy or rehabilitation. Many people delay care due to cost, but mental health benefits can make it easier to get help. Instead of an $80-$120 fee for a therapy session, you might get a more manageable copay like $20 or $40.

Affordability is one of the most prevalent barriers to healthcare access. Since mental health problems can affect things like how likely you are to have a job or stay in school, making care more affordable is essential for helping you say healthy and financially secure.

2. Accessible Care

In many cases, your insurance coverage dictates who you can see and how you can see them. Your mental health benefits might only cover in-network providers, and many areas of the United States are facing shortages of providers. Better coverage can help expand the number of providers available to you to ease the process of getting care.

Another way that insurance for mental health can improve access is by offering resources for people living in rural areas. For example, many insurance companies expanded benefits for telehealth services during the pandemic. Many rural Americans live far away from providers, making it harder to get to appointments. Other Americans may not have access to reliable transportation. If you’re in a similar situation, coverage for telehealth services might help you more easily see a doctor.

3. Reduced Risk for Other Health Conditions

Mental health issues are often associated with other health conditions. People with depression, for instance, have a 40% higher risk of metabolic and cardiovascular diseases than the general population. Mental illness is also associated with substance use disorder. Receiving mental health services may help you reduce your risk for other conditions. Say you’re trying to lose weight or quit smoking for your health. Mental health providers could help you create healthy strategies to better reach your goals and avoid setbacks from mental illness.

Controlling mental health issues may also offer benefits like reducing stress, improving your relationships or handling emotions in healthier ways. These small changes can offer significant benefits for your quality of life and overall happiness.

4. Less Unemployment, Hospitalization, Homelessness and Incarceration

Mental health conditions are associated with higher unemployment rates, more hospitalizations, homelessness and trouble with the law. In fact, 37% of adults in the state and federal prison system have a mental illness. That number jumps to 70% for youth in the juvenile justice system with a diagnosable mental health condition. Mood disorders are the most common cause of hospitalization for Americans under the age of 45, excluding those related to pregnancy and birth.

If you’re facing any of these issues or worry about them, mental health treatment could help, and insurance can make it easier to get. At a larger scale, minimizing these mental health problems could play a big role in creating a more stable, successful society with fewer incarcerations, better housing and more employment.

5. Reduced Risk of Suicide

Suicide and mental illness often go hand in hand. According to interviews with family, friends and medical professionals, 90% of people who committed suicide might have experienced symptoms of a mental health condition. Almost half of them had a diagnosed condition. The risk of suicide is especially high for young people, men, transgender adults and LGBTQ youth.

Good mental health treatment can be particularly valuable in reducing suicide rates, especially for someone who is part of a vulnerable population.

6. Lower Healthcare Costs for Everyone

On a broader level, mental health insurance is good for society, too. Expanded legislation has helped to reduce the number of mental health treatment visits required and is associated with reducing treatment needs and disparities for at-risk subgroups. Researchers suggest that prolonged exposure to these mental health laws and benefits during childhood and adolescence could reduce the need for further treatment in adulthood, minimizing costs across the system.

In other words, better mental health insurance coverage can reduce costs for all parties, including patients, insurance companies and healthcare systems.

The Roadmap to Better Mental Health

It’s essential to remember that behavioral health conditions are common and can affect people of all ages, races and genders. The first step to treating mental issues is to remember they aren’t your fault and are an illness just like any other. By understanding your options and reaching out to a provider, you can start on the path to improving your mental health.

If you don’t know where to begin, use the following steps as a roadmap to better behavioral health:

1. Understand and Document Your Mental Health

The first step to obtaining the right mental health coverage is understanding your mental health. Before approaching a behavioral health provider, be sure to document the symptoms you’re experiencing. Behavioral health conditions are broken down into the following categories:

• Mental health disorders: Mental health issues may involve changes in mood and thinking and can be treated with a combination of therapy and medication. Mental health issues may manifest in changes in eating, sleeping, mood or thought patterns.
• Substance use disorders: Substance use disorders refer to the recurrent use of drugs or alcohol despite the negative consequences it causes in a patient’s life. Substance use disorders are treated just like any other mental health disorder and are covered under America’s 10 essential health benefits.
• Co-occurring or co-existing disorders: Co-occurring disorders refer to the presence of mental health conditions alongside substance use disorders. A patient may have a co-existing disorder if they experience mental health issues alongside physical health conditions.

2. Investigate Your Mental Health Insurance Options

All Americans are required to have health insurance, and Californians who do not have health insurance through their employers can get insurance through the Affordable Care Act or Covered California. All health insurance options available in the Marketplace must include:

• Mental health and substance use disorders
• Emergency services
• Hospitalizations, surgery and overnight stays
• Ambulatory patient services (outpatient care)
• Rehabilitation and rehabilitative services
• Pregnancy, maternity and newborn care
• Pediatric physical, oral and vision care
• Laboratory services
• Prescription drugs
• Preventative wellness services

3. Research Which Treatment Providers Are Available to You

There are multiple types of mental health providers who offer different mental health treatments in their practices. While primary care providers can quickly address some mental health problems, others are better suited for professionals like psychiatrists or behavioral health providers. Your health care plan may cover appointments with the following professionals for your mental health:

• Primary care providers: Primary care providers can screen for behavioral health problems and ensure they don’t have a physical root. Your primary care provider may treat your behavioral health problems or refer you to a behavioral health provider.
• Behavioral health providers: Behavioral health providers have the experience and background necessary to diagnose and treat mental health disorders. Behavioral health providers may include therapists, psychologists, psychiatrists, licensed mental health counselors and licensed independent clinical social workers.
• Psychiatrists: Psychiatrists specialize in diagnosing mental and substance use disorders and prescribing and monitoring the administration of medication. They may also provide therapy or counseling depending on their training or specialty.
• Mental health nurse practitioners: Psychiatric or mental health nurse practitioners are trained in providing assessments, diagnoses and therapy for those struggling with mental health disorders or substance use. Depending on the institution, they may be able to prescribe medication.
• Clinical psychologists: Clinical psychologists provide counseling, therapy and prescriptions.
• Clinical social workers: Clinical social workers provide counseling alongside case management.

4. Find the Right Mental Health Treatment Provider

Depending on your insurance coverage, you’ll have different in-network options available. When you find a behavioral health provider, make a preliminary appointment and see whether this treatment provider is right for you. When making an appointment, be sure to ask the following questions:

• Does the practice accept your insurance, or is it out of network?
• Are there limits on coverage due to specific diagnoses?
• How many sessions does the practice allow per year?
• Is the practice currently accepting new patients?
• Do the mental health care providers specialize in the help you need?
• Do the practice hours work with your schedule?
• Do you feel like your needs are being addressed and you are receiving a therapeutic outcome?
• Is your provider respectful of your experiences and cultures?
• Does the provider pay attention to you and speak in accessible terms you can understand?
• Do they lay out treatment options clearly and listen to your input?
• Does your provider give you in-depth information and expectations about your prescriptions?
• Does your provider give you a concrete follow-up plan?

5. Stay on the Path to Mental Health Recovery

After meeting with your health service providers, be sure to schedule follow-up appointments before you leave and follow the treatment plan you’ve agreed on. After receiving mental health care, you’ll be sent an Explanation of Benefits (EOB), which lists a record of the services you’ve received from your providers and how much you’ll be charged by your insurance company. If you find your current insurance plan doesn’t meet your present mental health care needs, consider shopping around for more comprehensive plans during open enrollment.

Finding Health Insurance for Mental Health Treatment

Out of more than 47 million Americans, 26 million of that population live with an untreated mental health condition. Fortunately, mental health care is considered essential in America and is available to all citizens under the Affordable Care Act. The first step to receiving care for mental health in California is either signing up for health insurance or understanding your in-network options and starting the journey to finding the right provider.

After the passing of the Affordable Care Act in 2010, all states had to create an online marketplace that allows patients to shop around for health coverage. In California, this marketplace is called the Covered California Health Exchange. The California Health Exchange allows you to view different health care plans in an apples-to-apples comparison format and compare plans by coverage and price.

The state of California works with 11 different health insurance companies to help individuals and families find the best insurance for mental health that fits their needs. Californians can choose between the following health insurance providers:

• Anthem Blue Cross
• Blue Shield of California
• Health Net
• Chinese Community Health Plan
• Kaiser Permanente
• A. Care Health Plan
• Western Health Advantage
• Molina Healthcare
• Oscar Health
• Sharp Health Plan
• Valley Health Plan

Along with traditional healthcare plans, you may find mental health coverage through supplemental insurance options like short-term health insurance or travel insurance. These coverage options are not as comprehensive as traditional plans, but they may be able to help you fill a gap in coverage.

Mental Health Coverage in California

Since 2010, mental health coverage has been considered essential, and all California and federal health care plans cover mental health and substance use disorders. Thanks to the ACA, you can’t be denied insurance coverage due to pre-existing mental health conditions or be charged a higher rate than those without. Under the ACA mandate, you must:

• Be enrolled in a qualified health plan.
• File an exemption mandate when filing taxes.
• Pay a penalty for being uninsured (if uninsured for more than three consecutive months).

Each health care coverage plan has a different open enrollment period for new patients. Plans under the Affordable Care Act have Open Enrollment Periods from November 1 through January 15 annually. To have coverage for the beginning of the year, you must enroll in a plan before December 15th. Medicare enrollment has its Open Enrollment Period every year from October 15 to December 7.

The Covered California Marketplace

California is proud to be the first state to create a health insurance marketplace in accordance with the Affordable Care Act. California has a partnership with 11 different health insurance companies in the “Obamacare” California plan and offers coverage to individuals and families, plus small business and group health insurance. The entire state is sectioned into 19 different pricing regions that offer unique plans and prices by area. No matter where you’re living in California, you will have at least two carrier options.

What Is Covered California?

The Covered California Health Exchange offers subsidized “Obamacare” plans throughout California. At the core of Covered California plans is an emphasis on easy enrollment and affordable prices. The Covered California program creates plans for families looking for minimum coverage and people searching for more comprehensive health care policies. You’ll need the following information to apply for coverage:

• You and your family’s Social Security or document numbers
• Your previous year’s tax information
• Your household size and everyone included on your federal tax return

If your household is within the 0%-400% Federal Poverty Level (FPL) range and does not receive full coverage health care through an employer, you may be eligible to receive financial assistance and subsidies to reduce your premium. Families that make below $97,200 annually or individuals who make less than $47,520 a year are eligible for government assistance through the state of California.

Covered California Metallic Benefit Plans

When the ACA came into play in California, health insurance plans were repackaged into several tiers: Bronze, Silver, Gold and Platinum. Covered California takes these distinctions one step further to show patient-centered benefit designs and medical costs shares. As designated by the ACA, all Metallic Benefit Plans cover the 10 Essential Health Benefits, including mental health and substance use disorder services.

Covered California Metallic Benefit Plans are each named according to the total percentage of costs the health insurance provider pays. For example, a Bronze 60 plan covers 60% of expenses, while a Platinum 90 plan pays for 90% of expenses. The Metallic Benefit plans split into the following categories:

• Bronze 60 Plan: If you and your family are healthy and looking for an affordable option that will protect you in case of emergencies, consider the Bronze 60 Plan. The Bronze 60 Plan comes with free preventative care, fixed copays for the first three office visits, a high deductible and an out-of-pocket maximum of $7,800 per individual or $15,600 per family. There is also a Bronze High Deductible Health Plan (HDHP) that allows families to put money in a Health Savings Account (HSA) to cover medical expenses from year to year.
• Silver 70 Plan: The Silver 70 is a middle-of-the-road plan that mixes affordability and reasonable copays. This plan offers set copays for lab work, office visits and generic drugs without the prerequisite that you meet your deductible first. Like the Bronze 60 Plan, the Silver 70 Plan includes free preventative care and an out-of-pocket maximum limit within a calendar year that protects your wallet in the worst-case scenario. With the Silver 70 Plan, you’ll pay $7,800 per individual or $15,600 per family out of pocket.
• Gold 80 Plan: If you or your family frequently require medical services and need a plan without a deductible, the Gold 80 Plan is perfect for you. When you choose the Gold 80 Plan, you can pick between copays or coinsurance. The Gold 80 Plan has an out-of-pocket maximum of $7,800 per person or $15,600 per family.
• Platinum 90 Plan: The Platinum 90 Plan comes with no deductible and the least overall out-of-pocket costs of any Covered California Metallic Benefit Plan. This plan is highly recommended for individuals and families who frequently use medical services and need affordable access to doctor visits and prescriptions.

In addition to the four plans above, Covered California also offers a minimum coverage plan for those 30 years old or under who do not qualify for premium assistance. The minimum coverage plan still offers free preventative care, three free office visits and an out-of-pocket maximum.

Medi-Cal

Medi-Cal is California’s Medicaid program, which serves about one in three Californians. It is available for many low-income individuals, including some legal immigrants and undocumented children. Depending on what kind of coverage you qualify for, you may get full-scope Medi-Cal or partial Medi-Cal, which only covers some services. You may even qualify for some dental or vision benefits. If you qualify, Medi-Cal can be an excellent way to obtain affordable mental and behavioral health treatment.

Get Mental Health Coverage From Health for California

Health for California is a health insurance exchange staffed by individuals who are dedicated to getting you the mental health coverage you deserve at a price point you can afford. Healthcare is our livelihood, and we want to ensure you have the coverage you need to succeed. We make searching for mental health coverage in CA simple by giving you a quick quote and helping you get through the application process. We can even help you calculate your government subsidy and see if you qualify for cost-sharing options.

We provide quotes for the following:

• Individual health insurance
• Family health insurance
• Child-only health insurance
• Senior plans
• Small business plans
• Vision insurance
• Dental insurance
• Short-term health insurance
• Travel health insurance

Getting a quote from Health for California is always easy, instant and free. All you have to do is tell us a few things about yourself and we’ll give you the best quotes from health insurance companies around California. Get a free individual or family quote from us online, or contact us today for more information.