Understanding how your insurance covers mental health care
Insurance coverage for mental health care varies from plan to plan. It also depends on where you get your health insurance from. Here’s a general overview:
- If you have a Marketplace Plan: Under the Affordable Care Act (ACA), all plans must cover mental health and substance abuse services. In fact, those services are among the ACA’s 10 essential health benefits, along with things like preventive care and prescription drug coverage.
- If you have an individual or small employer group plan: Individual and small employers (those at organizations with 50 or fewer employees) are not required to offer health insurance to employees. If they choose to offer insurance through the Small Business Health Options Program (SHOP) Marketplace, those plans cover the ACA’s 10 essential health benefits, including mental health and substance use disorder services.
- If you have large group coverage through an employer: The ACA requires employers with more than 50 employees to offer health insurance coverage that meets minimum standards (including the 10 essential health benefits) to its full-time employees and their dependents.
- If you have Medicare: Medicare Part B covers visits with a mental health professional. And Part D covers prescription drugs.
All offered plans, under the Mental Health Parity and Addiction Equity Act (MHPAEA), must treat mental health benefits the same way they treat medical benefits. You’ll want to check with your plan’s summary of benefits to figure out exactly what your plan covers. You can also call your insurance company for help.
Enter your zip code to find the virtual mental health care option available in your area.
Virtual care during 2020 and beyond
In March 2020, the Centers for Medicare & Medicaid Services began to broaden the coverage of telehealth visits for new and established patients.
This coverage (and funding) was expanded and allowed to continue through December 31, 2024, by the Consolidated Appropriations Act, 2023. But once the expiration date passes, patients will have to have at least 1 in-person visit first, with periodic in-person requirements remaining in effect afterward, unless Congress extends or repeals that provision, explains Zebley.
As for other health plans, Zebley expects less restrictive access to continue. “They have far more flexibility and there’s pretty robust coverage in those plans,” he says.
Sir agrees. “Virtual mental health care is not merely having a moment,” he says. “The need for care and the value in convenience and improved access won’t disappear. Many practitioners, as well as patients, have gotten more comfortable with online and virtual mental health care and will continue to provide and use it in the future.”
A mental health professional can help treat anxiety and depression, relationship conflicts and more. Explore Mental Health Complete Plus for your virtual care options, or call 1-844-211-7730.
This article contains information that is compiled by UnitedHealthcare or its subsidiaries. UnitedHealthcare does not represent all the information provided are statements of fact. Please consult directly with your primary care physician if you need medical advice.
Sources:
Centers for Disease Control and Prevention. “Mental health.” November 6, 2023. Retrieved from https://www.cdc.gov/nchs/fastats/mental-health.htm
Centers for Medicare & Medicaid Services. “Medicare and your mental health benefits.” August 2023. Retrieved from https://www.medicare.gov/Pubs/pdf/10184-Medicare-and-Your-Mental-Health-Benefits.pdf
Centers for Medicare & Medicaid Services. “The Mental Health Parity and Addiction Equity Act (MHPAEA).” September 6, 2023. Retrieved from https://www.cms.gov/marketplace/private-health-insurance/mental-health-parity-addiction-equity
HealthCare.gov. “Employer shared responsibility payment (ESRP).” Retrieved from https://www.healthcare.gov/glossary/employer-shared-responsibility-payment/ Accessed April 5, 2024
HealthCare.gov. “Mental health and substance abuse coverage.” Retrieved from https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage/ Accessed April 5, 2024
HealthCare.gov. “Minimum essential coverage.” Retrieved from https://www.healthcare.gov/glossary/minimum-essential-coverage/ Accessed April 5, 2024
HealthCare.gov. “Overview of SHOP: Health insurance for small businesses.” Retrieved from https://www.healthcare.gov/small-businesses/choose-and-enroll/shop-marketplace-overview/ Accessed April 5, 2024
HealthCare.gov. “What Marketplace health insurance plans cover.” Retrieved from https://www.healthcare.gov/coverage/what-marketplace-plans-cover/ Accessed April 5, 2024
National Institute of Mental Health. “What is telemental health?” Retrieved from https://www.nimh.nih.gov/health/publications/what-is-telemental-health Accessed April 5, 2024
Telehealth.HHS.gov. “Telehealth policy changes after the COVID-19 public health emergency.” December 19, 2023. Retrieved from https://telehealth.hhs.gov/providers/telehealth-policy/policy-changes-after-the-covid-19-public-health-emergency
U.S. Department of Health and Human Services. “As a small business owner, am I required to offer health insurance to my employees?” April 20, 2023. Retrieved from https://www.hhs.gov/answers/health-insurance-reform/am-i-required-to-offer-health-insurance-to-employees/index.html
U.S. Department of Health and Human Services. “HHS fact sheet: Telehealth flexibilities and resources and the COVID-19 public health emergency.” May 10, 2023. Retrieved from https://www.hhs.gov/about/news/2023/05/10/hhs-fact-sheet-telehealth-flexibilities-resources-covid-19-public-health-emergency.html
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