For the media

Know what mental health services your insurance covers

By The Health News Team | May 20, 2024
Therapy session between patient and doctor

Your mental health can change at any time. Whether you’re looking for help when experiencing challenges or checking in with a provider to maintain your mental health, it’s more important than ever to know how to get care when you need it.

"Our mental health is just as important as our physical health, and there are many ways to get support," says Dr. Lisa Arian, senior medical director at Sharp Health Plan. "Approximately 1 in 5 American adults experience mental illness. For these individuals, and many others, mental health coverage is paramount."

Health plans are meeting this demand by making it easier to get the care you need, whether that entails an in-person or a telehealth appointment with a provider. Here’s what you need to know about mental health care coverage when shopping for a health plan.


The Affordable Care Act requires health plans to cover certain treatments and services.

“The Affordable Care Act, also known as the ACA or ‘Obamacare,’ ensured that most individual, family and employer group plans cover mental health and substance use services as essential health benefits,” says Don Truong, director of sales at Sharp Health Plan.

Additionally, health plans in California are required by law to cover certain treatments, such as psychotherapy and counseling; mental and behavioral health inpatient services; substance use disorder treatment; and more.

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


Medicare offers mental health coverage.

Medicare, the federal health insurance program for people who are age 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.


Medi-Cal and your employer offer coverage too.

If you have Medi-Cal, California’s Medicaid program, contact your County Mental Health Department to find services. Employer-sponsored coverage, in which your employer offers health insurance to you and your dependents, also offers benefits. Reach out to your employer's human resources or benefits department for more information.


Health plans' offerings vary.

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 plans provide.

"It’s 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 makes it easy to get care, with thousands of behavioral health providers for our members to choose from."

Dr. Arian adds that many health plans, including Sharp Health Plan, offer telehealth services. “Video visits offer a convenient way for you to access care confidentially from the privacy and comfort of your own home,” Dr. Arian says. “What’s more, with Sharp Health Plan, 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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