How well does your insurance cover mental health care?

By The Health News Team | May 5, 2022
Therapy session between patient and doctor

The COVID-19 pandemic has many of us thinking about what we would do if we required medical care. Where would we go for treatment? Would our insurance cover it? How much would we have to pay out of pocket?

However, it has been proven that COVID-19 affects more than our physical health. The Centers for Disease Control and Prevention (CDC) reports that communities across the U.S. face mental health challenges related to the coronavirus pandemic. From the sickness and death the disease causes, to the loss of work and need for social distancing and distance learning, COVID-19 and its related consequences can lead to isolation, depression and anxiety.

In fact, in September 2020, researchers found that adults in the U.S. reported struggling with mental health concerns or substance use:

  • 33% reported anxiety or depression symptoms

  • 15% reported increased substance use

  • 12% seriously considered suicide

  • 30% reported COVID-19-related trauma symptoms

"These mental health concerns are not only pervasive during unprecedented times, such as the one we're now experiencing," says Dr. Lisa Arian, senior medical director at Sharp Health Plan. "Even without a looming pandemic, approximately 1 in 5 American adults experience mental illness. For these individuals, and many others, mental health coverage is paramount."

The ACA and mental health care coverage
According to Don Truong, director of sales at Sharp Health Plan, the Affordable Care Act, also known as the ACA or “Obamacare,” ensured that individual and family plans and small employer group plans cover mental health and substance use services as essential health benefits. There are also California laws that require coverage of treament for mental health and substance use disorders for all individual and employer group plans (both large and small). Therefore, health plans in California must cover behavioral treatment, such as psychotherapy and counseling, mental health inpatient services, and substance use disorder treatment.

“Additionally, preexisting mental health and substance use conditions are covered,” Truong says. “And plans cannot put limits on coverage of these essential health benefits."

Medicare, the federal health insurance program for people who are 65 or older and certain younger people with disabilities, also covers counseling, inpatient services and substance use disorder treatment. Medicare Advantage Plans, which are "bundled" plans offered by Medicare-approved private companies, vary in the mental health services they cover. You can compare the quality of Medicare health and drug plans using Medicare's Star Ratings system, which rates plans on a one-to-five scale.

Dr. Arian and Truong recommend that you take the time to review a plan's network of doctors and the medications covered before enrolling. You also want to familiarize yourself with the level of customer service that support plans provide.

"It is important to do your research about the doctors and therapists within a plan's network, as well as the services and medications covered," Truong says. "For example, Sharp Health Plan offers over 250 behavioral health providers for our members to choose from."

Dr. Arian says that Sharp also makes getting care convenient with video visits. What’s more, no referral is needed for outpatient therapy with a provider in your network.

Sharp HealthCare accepts almost all health insurance plans, including Sharp Health Plan. Learn more about purchasing individual insurance.

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