What Does Mental Health Insurance Cover and How Do You Use Your Benefits?

Most health insurance plans include some form of mental health coverage, largely because the Affordable Care Act (ACA) requires marketplace plans to treat behavioral health services as an essential health benefit. What your plan actually covers depends on your specific policy, your state, and the providers in your network. Understanding the basics may help you feel more confident as you look for support that fits your needs.

What does mental health insurance typically cover?

Under the ACA, mental health and substance use disorder services are one of the 10 essential health benefits. This means plans sold through the Health Insurance Marketplace are generally required to include some level of coverage for these services. Covered services may include outpatient therapy sessions, psychiatric evaluations, and certain behavioral health treatment programs.

Many insurers also base coverage on medical necessity. This means a service must be clinically appropriate for treating a diagnosed condition, as documented by a licensed provider. If a service doesn't meet your plan's medical necessity criteria, it may not be covered, even if your insurer covers it in other situations.

Some plans also include session limits or exclude certain types of treatment. Because coverage varies from plan to plan, reading through your plan documents may help you know what to expect.

How is behavioral health coverage different from general health coverage?

Federal parity laws generally require that mental health and substance use disorder coverage be comparable to physical health coverage. In practice, your insurer typically can't place stricter limits on behavioral health services than it does on medical or surgical care. For example, if your plan doesn't cap medically necessary visits to a cardiologist, it generally can't cap your therapy visits at an arbitrary number.

Parity protections don't guarantee identical coverage across all plans, though. The details depend on your insurer, your plan type, and how your policy defines medical necessity. Knowing this may help you advocate for yourself if your mental health coverage seems to be treated differently than your physical health coverage.

How do you use your mental health insurance benefits? 

Knowing that coverage exists is one part of the picture. Using your benefits takes a few practical steps, and your plan documents are usually the best place to begin.

Your summary of benefits is a standardized document that outlines your copays, deductibles, and covered services. It may show you what you might owe per therapy session, whether you need a referral, and what your out-of-pocket maximum is. Your insurer's online member portal is often the quickest place to find it.

It also helps to understand the difference between in-network and out-of-network providers. In-network therapists have contracts with your insurance company, which may mean lower out-of-pocket costs depending on your plan. Out-of-network therapists don't have contracts with your insurance provider. Depending on your benefits, you may be able to seek reimbursement after paying for services, so it's worth confirming the details with your plan directly. If you're starting your search, you’ll want to learn more about how to find a therapist that takes your insurance.

If you have questions about your coverage, calling the member services number on the back of your insurance card is often the most direct route. You may ask about covered services, in-network providers, and how to submit a claim.

Many employers also offer an employee assistance program (EAP), which may include a set number of therapy sessions at no cost to you. Your HR department may usually tell you whether you have access to one.

Knowing your benefits may also help you see more options for how you receive care, including online therapy. BetterHelp accepts insurance and is an affordable option for seeking online therapy. Eligible members' average copay is $15 per session. You may also connect with a licensed therapist from the comfort of your home, which may make it easier to fit therapy into a busy week.

BetterHelp insurance availability, coverage, and cost may vary by state, plan, provider network, therapist availability, and deductible status.

What if your insurance does not cover the care you need?

If your plan doesn't cover a particular service, or the out-of-pocket costs feel out of reach, there are still paths forward.

Many people may use health savings accounts (HSAs) or flexible spending accounts (FSAs) to help pay for therapy services, because therapy is generally considered a qualified medical expense. That means you may be able to use pre-tax dollars toward your sessions. Eligibility may vary, so check with your plan administrator for details.

Some therapists also offer sliding-scale fees based on income. Community mental health centers and university training clinics may offer lower-cost care as well, and you may search for options near you through SAMHSA's treatment locator. If cost is a concern, you may ask a provider about payment options directly. Many people ask this question.