How To Choose The Best Insurance Plan For Mental Health Care

Finding the right insurance plan for you can depend on a range of factors, including the types of care you need, the total cost of the plan, and the network of covered providers. 

For many Americans, finding mental health support covered by insurance can be top of mind, as it can reduce the financial burden of care. But choosing a plan that fits your unique mental health needs can often be another challenge entirely. 

Does health insurance cover mental health conditions?

In the United States, most health insurance plans cover mental health services, due to rules established by the Affordable Care Act (ACA) and the Mental Health Parity and Addiction Equity Act (MHPAEA):

Together, these rules typically eliminate the need for separate mental health plans. However, not all insurance plans must follow ACA rules, such as “grandfathered” employer-sponsored plans and self-funded health plans. Some states may also have stricter mental health parity requirements. So, it is paramount to review the specific coverage details of each plan. 

How to choose the best insurance for mental health

Trying to choose the best insurance for mental health can be like trying to find the right pair of gloves: while many different options will provide some measure of coverage, some will fit you better than others. 

The right fit for you can depend on a range of individual and plan-specific factors, namely:

• Your unique mental health care needs
• The total costs involved in the plan 
• The plan’s network of providers
• The plan’s coverage for online therapy
• Any rules and restrictions the plan has for services to be covered

Identify your mental health care needs

To determine what you are looking for in an insurance plan, consider the exact services you need to support your mental health. While one person may need talk therapy appointments, another may need psychiatry services and medications, in addition to therapy. 

Therapy and counseling

Therapy is often a vital component of treatment, either on its own or alongside other approaches. For concerns such as stress, anxiety, depression, major life transitions, and relationship concerns, therapy and counseling can be essential avenues of support, so reviewing a plan’s therapy coverage for mental health can be crucial.  

Psychiatry and medication management

Some people may benefit from other forms of care beyond therapy, such as medication. For serious mental health conditions or those in severe distress, psychiatry services and medication management can be an important part of a treatment plan. 

Prescriptions

When medication is part of a person’s treatment plan, it is important to ensure the plan covers necessary prescriptions. Many insurance plans have an official list of covered prescription medications you can review. 

Higher levels of care

Some individuals may need higher levels of care beyond standard outpatient programs, such as: 

• Intensive outpatient programs
• Partial hospitalization programs
• Residential treatment programs
• Inpatient psychiatric hospitalization

If you or someone in your household may require these types of care, reviewing an insurance plan’s coverage can be vital for ensuring access to necessary support.

Compare total costs, not just monthly premiums

Cost can be a major consideration when comparing insurance plans. However, accurately comparing the costs involved in a plan is not as simple as just comparing a monthly price tag. 

Premiums

A health insurance premium is the amount you pay each month for your health insurance. While a plan’s monthly premium is one part of the equation, it is not the whole picture: the total cost you pay for health care with that plan can depend on other costs, including your deductible, copays, and out-of-pocket maximums. 

Deductibles

A deductible refers to the amount you have to spend on certain covered health services and prescriptions before your plan begins to pay. However, many plans pay for certain services before you have met your deductible.

Copays and coinsurance

A copayment or copay refers to a fixed amount you pay for a covered service, and coinsurance refers to the percentage of the cost you pay for a covered service. Oftentimes, plans with lower monthly premiums may have higher copays.

Out-of-pocket maximums

The out-of-pocket maximum is the most you have to pay for covered services in a plan year. Once you reach this amount through deductibles, copays, and coinsurance, a plan pays 100% of the costs of covered services. 

Check the mental health provider network

Beyond the cost of mental health care, the quality of that care is also of major importance. In therapy, the relationship between a client and their therapist can significantly impact outcomes, so finding the right therapist whose services are covered by your plan can be essential. 

In-network therapists

In-network therapists refer to therapists who have contracted with your insurance company. As such, they provide care at a pre-negotiated rate, they bill the insurance company directly, and you often pay just a copay for covered therapy sessions. 

Out-of-network therapy

Out-of-network therapists are therapists who do not accept your health insurance plan. As such, you often pay the full fee for the session upfront. Some health plans may offer full or partial reimbursement for these services. In some cases, some therapists may also offer sliding-scale fees, in which rates are adjusted based on your income. 

Provider availability

It is also important to check the availability of providers in your network. Some providers may not be accepting new clients or have long waitlists, so ensuring there are therapists with availability can be key.

Review online therapy coverage

Research shows that online therapy can be just as effective as in-person therapy, so for those who prefer seeking support virtually, checking an insurance plan’s coverage for online therapy can be an important consideration. With a platform like BetterHelp, you can also check to see which insurance plans are covered, which may be helpful as you compare plans. 

Understand plan rules and restrictions

Another key element to understand when navigating mental health care is the specific set of rules and restrictions a plan may have regarding covered services. These can dictate how exactly you can access care and might include the following: 

• Referrals: Some health insurance plans may require you to receive a referral from your primary care physician in order for visits to other providers to be covered. 
• Prior authorization: Some healthcare providers may require you to get approval from the health plan first before providing  certain treatments. 
• Visit limits or medical necessity reviews: Due to mental health parity laws, insurers generally cannot impose annual limits stricter than those for physical medical care. However, some insurers may require providers to prove that sessions beyond a certain threshold are “medically necessary.”