Finding Mental Health Insurance & Getting the Most From It

Resources for Getting Mental Health Coverage, and Tips for Using It Wisely

Mental Health. image © istockphoto/kondyukandrey

Mental health services can be costly, whether for a short-term crisis or a chronic condition. If you don't have mental health insurance, the out-of-pocket cost might cause you to forgo care you need, or to use fewer services to save money. If you do have mental health insurance, the burden of paying your share of cost can add stress during an already stressful time.

Along with how to identify mental health coverage you might not be aware you have, here are some resources for finding mental health insurance if you don't have it, and tips for getting the most out of mental health insurance once you do.

Employee Assistance Programs

Your employer may offer some mental health benefits within an Employee Assistance Program. EAP benefits are paid for by your employer, accessing benefits are usually free, and the problem you seek help with doesn't have to be work-related. While EAPs aren't designed to provide long-term treatment, a mental health professional will evaluate your needs, initiate crisis intervention and short-term treatment, and provide referrals if the EAP services aren't sufficient to resolve the issue. Check your employee benefits handbook or call your benefits office to see if you have an EAP.

Tips:

  • If you've exhausted your free EAP benefits and need more assistance, ask if your employer has arranged discounted out-of-pocket rates for continuing care from the mental healthcare professional that provided your EAP services. Sticking with the same mental healthcare professional will save you the time required to build rapport with someone new. You'll also save the expense of another initial evaluation.
  • Your free EAP benefits renew each year. If you've exhausted all of your free benefits this year, check with your EAP provider at the beginning of next year. You may find you're eligible for free benefits again.

Behavioral Health Benefits Within Your Existing Group Health Insurance

Even if your existing health insurance doesn't specifically list mental healthcare in the plan summary, it may still provide mental health insurance within the behavioral health section of the benefits package.

Check the behavioral health section of the policy literature for more specifics about any mental health insurance benefits it may provide.

Tips:

  • If your employer offers a choice of insurance plans, check the mental health coverage of each option carefully during your open enrollment period. A more expensive plan that provides mental health coverage may ultimately save you money over a low-cost plan without mental health benefits.
  • If your employer doesn't offer mental health insurance, see if it offers a Flexible Spending Account. An FSA allows you to put aside pre-tax money to pay for eligible out-of-pocket expenses such as psychotherapy, psychiatry visits, and prescription medications. This doesn't decrease the cost of the care itself, but you'll save by not paying income tax on the FSA money you use to pay for the care.

Purchasing Mental Health Insurance

Mental health insurance is generally purchased within the framework of a medical health insurance policy. You can check with your state's health insurance exchange for an Obamacare plan, or use this tool to discover the individual policies available in your area that isn't offered on the exchange.

All individual health insurance policies purchased after January 1, 2014 through the exchanges mandated by the Affordable Care Act are required to provide mental health benefits.

Tip:

  • If your income is moderate, you may be eligible for help paying your monthly health insurance premiums if you choose a health plan on your Affordable Care Act health insurance exchange.

Tip:

  • If you have a standard health insurance plan that doesn't cover mental health services, consider changing to a High-Deductible Health Plan that does cover mental health services. If the deductible amount for the HDHP is less than your current yearly out-of-pocket expenses, you might come out ahead. Many HDHPs can be combined with a Health Savings Account, allowing you to pay the deductible with pre-tax money.

Medicaid

If you meet income and other eligibility criteria, you may be eligible for Medicaid. Medicaid programs are administered by each state, so benefits vary from state to state. However, some states provide at least some mental health insurance coverage within the framework of the medical health insurance.

Medicare

If you're 65 years old or older, you may be eligible for the Medicare. Medicare provides mental health benefits for inpatient treatment, outpatient services, and through Medicare part D for prescription drugs. If you have a Medicare Advantage plan, (Medicare part C), you'll need to check your plan to determine the specifics of your mental health benefits.

Tip:

  • A sub-category of Medicare Advantage plans called Special Needs Plans may benefit you if you have significant mental healthcare needs. In addition to providing basic Medicare Advantage coverage, SNPs provide expanded benefits for specific conditions, including certain types of mental health conditions. For example, a mental health SNP might provide you with expanded mental health treatment options and better coordination of your mental health treatment with your medical treatment.

Disability

If you have a chronic, severe mental illness that makes it impossible to work, you may be eligible for disability benefits. Although disability benefits don't automatically include health insurance, after receiving disability benefits for two years you may become eligible for Medicare, including Medicare's mental health benefits, even if you're not yet 65 years old. If disabled, you might also be eligible for Medicaid, including the mental health benefits provided by your state's Medicaid plan. Applying for disability can be a long, complicated and arduous process, so you should only consider it if your mental health issue is truly debilitating.

Veterans Administration

If you served in the military, you might be eligible for VA health benefits, including mental health benefits. The VA has extensive mental healthcare programs for former members of the Armed Services.

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