Getting Affordable Mental Healthcare
What you need to know about the Affordable Care Act, sliding scales, and more
With the passage of the Affordable Care Act, many insurance providers are now required to offer mental health coverage as comprehensive as the coverage they offer for physical conditions. But even if your insurance plan doesn't fall under the new law or you don't yet have insurance coverage, there are ways to find affordable mental healthcare. Here is our guide to understanding the changes in how mental healthcare is insured – and how you can afford to take care of your mental health and well-being.
How does the Affordable Care Act affect mental healthcare coverage?
Until recently, most insurance companies provided much better coverage for physical illness than for mental health disorders. But in 2010, the Affordable Care Act strengthened the previously passed Mental Health Parity and Addiction Equity Act (MHPAEA). That law now requires that when public insurance companies offer mental healthcare, it must be of the same quality and accessibility as the equivalent medical care in the same package.
This means that if your insurance offers mental health benefits, seeing a therapist must be no more expensive or restrictive than seeing your general practitioner. Copays for your mental healthcare visits must be no costlier than those for your medical visits, and treatment limitations for mental health visits cannot be more restrictive than your medical copayments.
Who is covered by the MHPAEA?
• Works for a company that employs more than 50 people
• Purchased individual insurance through the healthcare exchange marketplace
• Is eligible for Medicaid (or is pregnant) in a state with expanded Medicaid coverage
Who is not covered under the law?
• Is insured through a workplace with 50 or fewer employees
• Is insured by Medicare
• Is insured by Medicaid in a state without expanded Medicaid coverage
It is important to note that individual companies, workplaces, and programs not required to comply with the MHPAEA may choose to offer ACA-compliant benefits anyway.
How do I find out what my plan covers?
Under the ACA, insurance plans are obligated to provide a uniform summary of benefits and coverageclearly outlining what services are included and on what terms. The summary must be reasonably short, written in plain language, and available to anyone. If your plan offers mental health benefits, they must be listed in this summary.
Call your insurance company and ask:
• Is my plan "ACA-compliant?"
• Does my plan offer mental healthcare, and if so, what is the coverage?
• Can you email me a copy of the summary of coverage?
You can also find answers to questions about workplace-issued insurance plans and mental health coverage on the Department of Labor's Employee Benefits Security Administration website.
Under the MHPAEA, the rules about your network of coverage (and whether and how you can seek help outside of it) will be the same for your physical and mental health benefits. While in-network therapy will be less expensive, any special rates or policies for out-of-network physical care must also apply to mental healthcare.
What are the differences between PPOs, POS plans, and HMOs?
Preferred Provider Organizations (PPO) usually cover a combination of doctors (inside and outside your network), and you are able to select the doctors you would like to see with a different level of coverage outside your network. Point of Service (POS) insurance plans offer less expensive medical costs in exchange for more limited choices and with the requirement that your primary care practitioner refer you to doctors outside the network. Under POS and PPO plans, therapy outside your network will be more expensive than services within your network, but your insurance is likely to provide some level of out-of-network coverage.
Insurance plans with health maintenance organizations (HMOs) offer much lower monthly premiums but usually do not cover any costs out of network (with the exception of emergencies). Like POS plans, HMOs generally require a referral from your primary care practitioner before you may see a specialist. Exclusive Provider Networks (EPOs) similarly offer lower prices but do not cover the cost of care outside your network. However, you choose the type of provider you see within the network without necessarily having to be referred by your doctor.
Does the MHPAEA apply to all types of therapy?
The parity requirements apply to all types of service covered by a health plan. When deciding what type of therapy to seek, it will be helpful to have your insurance plan's coverage summary to guide you through your choices.
How can I find a therapist who will accept my insurance?
Therapist databases that factor in your insurance are featured on such websites as HelpPRO, NetworkTherapy, and ZocDoc. These databases also often list therapists' credentials and specialties as well as other practical information.
If you have a good relationship with your general practitioner, you may want to ask for a direct referral to a therapist who fits your needs. There are many different types of therapy to choose from.
How can I afford therapy if I only have partial (or no) insurance coverage?
If you are employed, check whether your employer offers an Employee Assistance Program (EAP). Many large employers offer free counseling to employees who are going through short- or long-term interpersonal issues such as anxiety, depression, grief, trauma, and other challenges.
Flexible spending accounts (FSAs), which many employers offer, allow you to save pre-tax income for healthcare costs not covered by your insurance plan. Money in FSA accounts can usually be put toward therapy or counseling. Health Savings Accounts (HSAs) are another option for seeking therapy under a high deductible insurance plan. Money in HSAs is not subject to federal income tax.
Other options include private mental health clinics that have a sliding scale for fees, and mental health centers, such as Seleni, that offer financial assistance programs. Some centers simply ask you to pay what you are able. Others require you to submit tax forms, tuition statements, insurance forms, statements of government aid, or other documentation of your financial situation to qualify for assistance. Some clinics may also take your mental health diagnoses into account and offer financial assistance to patients facing particular issues. Ask potential mental healthcare providers whether they have financial assistance programs.
Community mental health centers operate on a sliding scale and can be found through the center locator on the website of the Substance Abuse and Mental Health Services Administration. Health centers under the Health Resources and Services Administration, a federal agency for improving access to healthcare, offer free and reduced-cost mental healthcare to pregnant women and mothers. In addition, colleges and universities often have graduate training programs that offer sessions to the community at lower costs. Finally, group therapy sessions usually have lower rates than individual sessions and can be a great way to find affordable support that is nonetheless specific to the issues you are facing.