Know what mental health services your insurance covers

By The Health News Team | May 25, 2023
Therapy session between patient and doctor

The experience of living through the COVID-19 pandemic had 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 affected far more than our physical health. The Centers for Disease Control and Prevention (CDC) reports that communities across the U.S. continue to face mental health challenges related to the pandemic. From the sickness and death the disease caused, to the loss of work and need for social distancing and distance learning, COVID-19 and its related consequences lead to isolation, depression and anxiety for many.

In fact, according to the CDC:

  • More than 20% of adults in the U.S. live with a mental illness.

  • Over 20% of young people ages 13 to 18 have had, or currently have, a seriously debilitating mental illness.

  • About 1 in 25 adults in the U.S. lives with a serious mental illness, such as schizophrenia, bipolar disorder or major depression.

"These mental health concerns are not only pervasive during unprecedented times,” 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 all health plans cover mental health and substance use services as essential health benefits. Plans 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 age 65 or older and certain younger people with disabilities, also covers some mental health and substance use care. 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 taking 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.

Talk with your primary care provider about any mental health or substance use concerns. Together, you can develop a plan to ensure you get the care you need.

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

Get the best of Sharp Health News in your inbox

Our weekly email brings you the latest health tips, recipes and stories.