Does Health Insurance Cover Mental Health Services?

October 24, 2022

Your mental health is just as important as your physical health, but health insurance companies may not treat it the same. The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act passed in 2008 set out to change that for consumers, to make mental health service coverage equal to physical health coverage, making it easier to get the services you need.

While the law improved things, there’s no guarantee your insurance covers mental health services.

Mental Health Services Coverage and the Law

The parity law puts mental health services on an even playing field with physical health coverages. In other words, an insurance company can’t charge a $100 co-pay for mental health services and a $20 co-pay for physical health coverage. They must be treated equally. This doesn’t mean every co-pay must be the same, but they should be within reason. For example, your mental health services co-pay can’t significantly exceed the co-pay to see other specialists.

The law doesn’t require health insurance companies to cover mental health services. That’s the difference.

The law also allows insurance companies to limit the number of services to those deemed medically necessary. Still, an insurance company can’t put a financial limit on the services if there isn’t one on physical health services.

Can Insurance Companies have Exclusions?

Insurance companies can limit mental health coverage services like physical health coverage as long as they specify the differences. For example, there may be certain diagnoses or issues that insurance companies won’t cover for physical and mental health.

It’s acceptable for insurance companies to have these exclusions, but they must be completely transparent, informing applicants of the exclusions before they accept the policy.

Does Mental Health Services Count Toward your Deductible?

Before the parity law, health insurance companies could have different deductibles for different services. This happens quite often with mental health services. They would have a much higher deductible than physical health service deductibles.

The parity law changed this, though. Your deductible is the same for all health services. For example, if you have a $5,000 deductible, it includes mental health services and any other medical services you have. If you meet your deductible, the health insurance company must cover your mental and physical health services at the stated co-insurance rates.

How to Tell if your Insurance Policy Covers Mental Health Services

The summary of your plan benefits should state whether mental health services are a part of your plan. If it’s unclear, or you don’t understand the deductible and co-insurance, talk to your human resources department to get clarification.

Final Thoughts

Thanks to the parity law, there’s a much larger chance that your health insurance company covers mental health services. Don’t assume, though; always read the fine print, and ask questions if you aren’t sure.

If your insurance doesn’t cover mental health services, consider finding a not-for-profit agency, local social services, or ask your company if they offer employee assistance programs.