Health and well-being include physical and mental health. However, many people do not seek mental healthcare when they need it. Most people assume that mental healthcare is expensive and not covered by their insurance. While this has been true in the past, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) has changed this.
The Mental Health Parity and Addiction Equity Act passed in 2008 and ensures that mental healthcare is now covered by most insurance plans.
Insurance can be used for therapy sessions, including talk therapy, cognitive behavioral therapy, and online therapy in certain cases.
Medicare, Medicaid, and CHIP programs all provide coverage for mental healthcare.
It is essential to check with your insurance company to determine the coverage available to you.
Deductibles, copays and/or co-insurance costs may apply.
The act, passed in 2008, requires that insurance companies provide mental health coverage equal to physical health coverage. Although the amount of coverage varies from plan to plan, some level of therapeutic coverage is available through commercial insurance companies and Medicare, Medicaid, and CHIP programs.
Types of therapy covered by insurance
Mental health benefits include seeing a therapist. Therapy includes talk therapy, cognitive behavioral therapy, or online therapy. The type of therapy you may need is based on your personality and situation.
Talk therapy, also known as psychodynamic therapy, is what most people think of when they consider seeing a therapist. Talk therapy involves discussing feelings and emotions with your therapist to determine the issues that cause emotional stress and how to best cope with those issues.
Cognitive behavioral therapy (CBT) focuses on the link between our thoughts and behavior. However, CBT is typically short-term and goal-oriented. Its goal is to help you change thought patterns that result in undesirable behaviors. Cognitive behavioral therapy is often used to help treat anxiety, depression, and specific phobias.
Online therapy is a convenient way to access a therapist when in-person visits are inconvenient or not an option due to location or availability. Online therapists may use various types of therapy, including talk therapy or CBT, to best serve their clients. However, it is important to note that not all insurance companies provide the same benefits for online therapy as they do for in-person treatment.
What type of treatment does insurance cover?
Various types of treatment are necessary for different situations. Types of treatment covered by most insurance companies include:
- Outpatient treatment, including therapy;
- Emergency psychiatric treatment;
- Inpatient treatment at a psychiatric facility or hospital;
- Addiction and substance use disorder treatment;
- Medical detox;
- Online therapy.
If treatment is considered medically necessary, it is likely covered under the insurance policy. However, coverage amounts and length of time covered may differ for every plan, so it is essential to check with your insurance company to see what coverage is available.
Plans covered by health insurance
There are many types of insurance plans currently available that cover both physical and mental health. As long as the treatment or therapy sought is deemed medically necessary, most programs provide some coverage.
Employer-sponsored health coverage
Employer-sponsored health insurance is required for companies with 50 or more employees. Companies such as Blue Cross Blue Shield, Cigna, Aetna, and United Healthcare are commonly used for employer-sponsored plans. Though employers with 50 or fewer employees are not legally required to offer health insurance, mental healthcare coverage must also be provided if physical health coverage is offered.
Affordable Care Act (ACA)
Under the Affordable Care Act (ACA), health plans purchased through the Health Insurance Marketplace must cover ten essential health benefits, including mental health and substance use disorder treatment. In addition, while plans and coverage vary from state to state, all plans must include the following:
- Psychotherapy and counseling services;
- Inpatient behavioral and mental health services;
- Co-pays, coinsurance, and deductibles for mental and behavioral health that are similar to those provided for physical health;
- No dollar limits on mental health coverage.
Children’s Health Insurance Program (CHIP)
The Children’s Health Insurance Program (CHIP) provides states with federal funding to help provide low-cost insurance for children who are not eligible for Medicaid. Each state has various coverage for physical and mental health, but most include coverage for inpatient and outpatient treatment, therapy, and even online or teletherapy options.
Other coverage may include social work services, medication management, and substance use disorder treatment. The Parity Act requires that CHIP programs provide coverage for mental health that is the same or similar to physical health coverage.
Medicaid plans in all states are subject to the Mental Health Parity and Addiction Equity Act (MHPAE). They are required to provide mental health coverage on par with the physical health coverage provided by the state. All mental health treatments considered medically necessary are covered under the act.
Outpatient mental health care, including treatment by a psychologist, psychiatrist, social worker, clinical nurse specialist, or nurse practitioner, is covered under Medicare Part B. Partial hospitalization may also be covered by Medicare Part B if certain conditions are met.
Inpatient mental health care is covered by Medicare Part A (Hospital Insurance). Benefit period regulations determine out-of-pocket costs. Medicare Advantage Plans (Part C) provides coverage equal to or greater than Original Medicare.
What health insurance providers cover therapy?
All health insurance companies offer a large variety of plans, so it is impossible to cover the specifics of each. However, here are a few examples of major health insurance companies and what they cover.
Does Aetna cover therapy?
Aetna offers employer-sponsored, individual, family ACA, student, and international plans. Each plan has specifications on what is covered, but all programs abide by the MHPAE, and each provides mental health coverage consistent with the coverage provided for physical health.
Aetna also has coverage for behavioral and medication therapy and offers treatment through telehealth as well.
Does Cigna cover therapy?
Cigna offers a wide variety of coverage for mental health treatment. Depending on your employer’s chosen plan, Cigna coverage may also include coverage for personalized coaching and support programs in addition to traditional therapy and psychiatric treatment. Furthermore, community support groups, behavioral coaches, and online therapy may also be covered.
Does Kaiser cover therapy?
Kaiser Permanente covers many mental health services, most without requiring a referral from your primary care provider. All mental health and substance use disorders are covered under Affordable Care Act plans, including Kaiser Permanente.
What other therapy does health insurance cover?
In addition to traditional psychotherapy, many insurance companies cover other types of therapy like group session therapy or couples therapy. In addition, music and art therapy are increasingly covered under most insurance plans as well.
Physical therapy and occupational therapy may also be covered, especially in cases where it is considered to be medically necessary. In some instances, even massage therapy can be covered. However, coverage for these alternative therapies is more likely to be available when your primary care provider or specialists refers you specifically for a medically necessary procedure or treatment.
How do I know if my insurance covers therapy?
Coverage levels for therapy will vary from plan to plan. Before seeking treatment, it is essential to determine what coverage is available to you. Check your insurance company’s website or call their toll-free number to find out the specifics of your plan. Be sure to have your member ID available so that you can be sure to find information regarding your specific plan coverage.
Does insurance cover couples therapy?
Many insurance plans do cover couples therapy. It is important to check with your insurance company to ask if couples therapy is covered and to verify that your therapist accepts your insurance plan before scheduling an appointment.
Will I have to pay out of pocket for therapy if I have health insurance?
Most insurance companies require you to meet a certain deductible dollar amount before coverage begins. Depending on your specific plan, you may also be required to pay a co-pay or co-insurance for each therapy visit. Ensure that the therapist you choose accepts your insurance plan before making an appointment.
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