Does your insurance provider cover the therapy?
You may be able to get insurance-covered therapy through your employer’s health plan, but you’ll need to do your due diligence to find out what kind of coverage you have through a company plan.
Even if the answer to the question is whether the therapy is covered by insurance is yes, some people still choose not to use it. this may be in part because insurance companies will only pay for medical services that are deemed necessary. to reach that state, an official diagnosis is needed. some people are uncomfortable with having this on record, but it’s a personal choice.
affordable care act (aca)
The Affordable Care Act (ACA) passed in 2010 was established to lower the cost of health insurance for anyone who wanted it. offers tax credits and cost-sharing reductions to make insurance affordable for low-income families.
Among other things, it also created a health insurance marketplace and requires plans to cover specific essential health benefits. any plan purchased through the health insurance marketplace must include mental health and substance use disorder services.
In terms of mental health, health insurance market plans must offer:
- inpatient mental health and behavioral health services
- behavioral health treatments (including counseling and psychotherapy)
- coverage for pre-existing conditions
- parity protections that ensure coinsurance, copayments, and deductibles are the same or similar to the medical and surgical benefits offered
- medication management
- peer support
- social work services
- treatments for substance use disorders
the Mental Health Parity Act of 2008
The Mental Health Parity and Addiction Equity Act (MHPAEA) is a federal law that prevents group plans from offering different (fewer) mental health benefits than medical or surgical benefits.
a primary goal of mhpaea and aca was to create a system that offered equal coverage for addiction treatment and mental health conditions. Before the passage of the mhpaea, 49 million Americans had no insurance, 2% had coverage that did not offer any mental health benefits, and 7% had no substance use benefits.
chip (children’s health insurance program)
Children’s Health Insurance Program (CHIP) provides federal funds to states so they can offer low-cost health insurance to low-income households with children. Although actual coverage varies by state, most plans cover virtually all mental health services, including:
Medicaid plans are administered by the state and must cover everything considered an essential health benefit. this includes both substance use services and mental health services. like chip, medicaid plans differ from state to state, but are also subject to mhpaea requirements.
See also : Abortion – NYC Health
Medicare Part A will cover inpatient behavioral health and substance use services. you may be responsible for deductible and coinsurance costs if you are hospitalized.
In terms of outpatient mental health services, Part B covers many services, including annual screening for depression. Out-of-pocket expenses may be required to cover the cost of therapeutic services and any Part B deductible, copay, or coinsurance.
The medicare advantage (known as part c) will generally cover therapeutic services at least at the level of your original medicare plan or better.
blue cross blue shield
Today, thanks to the Affordable Care Act (ACA), most Blue Cross Blue Shield insurance plans will cover therapy. if you have a plan that started before 2014, when aca was enacted, your plan may not cover mental health services. there are some additional caveats to this as well. blue cross blue shield only covers evidence-based services like psychoanalysis. sessions with a life coach, a career coach, etc. are not covered.
kaiser Permanente offers personalized mental health treatment plans for each member. They will usually cover therapy with a nurse practitioner or a psychiatrist, and will often cover group therapy as well. kaiser goes one step further and offers classes in stress management and mental health and addiction counseling.