Will Your Medical Insurance Cover Your Treatment For Mental Health Concerns? Here Are 7 Things To Know

Will Your Medical Insurance Cover Your Treatment For Mental Health Concerns? Here Are 7 Things To Know

Daniel Hall 21/09/2022
 Will Your Medical Insurance Cover Your Treatment For Mental Health Concerns? Here Are 7 Things To Know

Medical insurance is designed to cover expenses pertaining to your physical health.

Can it also do the same for your mental health? We will answer this question in our guide along with seven things you’ll want to know.

If you are dealing with mental health issues, New Waters Recovery is committed to helping you. You can learn more information by going to this link. Now, let’s talk about the following facts regarding mental health and whether medical insurance can cover any issues that may arise.

1. Yes, Medical Insurance Can Cover Mental Health Concerns


To begin, we can confirm that medical insurance can cover mental health concerns. This includes plans that you can purchase under the Affordable Care Act’s marketplace, Medicare, Medicaid, and the Children’s Health Insurance Program (or CHIP). 

All plans have coverage for mental health. This can include healthcare plans that cover individuals and family members. People who are covered under an insurance plan provided by their employer will be able to use it for mental health treatment.

2. Marketplace Plans Include Excellent Coverage

Under a marketplace insurance plan, it will cover mental health issues that are pre-existing. So you won’t have to worry about being denied coverage. It also has no annual or lifetime dollar limit.

The plan will cover behavioral health treatments and also inpatient services for behavioral and mental health. For CHIP, this can cover mental health services such as therapy, counseling, social work services, medication, and more. The coverage will vary from one state to another.

3. Employed-Sponsored Insurance is Required If a Company Has 50+ Employees

By law, an employer with 50 or more full-time employees must provide health insurance. As mentioned, the insurance policies offered will include mental health services as well as services for treating substance abuse disorders.

None of these are excluded in any plan. So if the plan is a basic level, mental health and substance abuse care will be included. This is due to the fact that they are two of the most serious issues that need to be treated (albeit on an immediate basis).

Regardless of how the plan was purchased or the type they have, individuals and their family members will be able to access such care with the help of health insurance.

4. Marketplace Insurance Covers Essential Health Benefits

In accordance with the ACA, insurance policies sold on the marketplace need to cover ten essential health benefits. Two of those being mental health and substance abuse treatment. If you have yet to purchase health insurance, there is a 100 percent chance that you will find a policy that will have you covered, even if the condition existed beforehand.

Even though the availability of plans and coverage are on a state by state basis, you won’t have to worry about having a lack of coverage. However, you will need to find an insurance plan that will be affordable based on your income.

5. Medicare and Medicaid Will Cover You If Needed

If you do not meet the income requirements for marketplace insurance, no need to worry. You still have alternative options to consider. Medicare and Medicaid are your other options.

Keep in mind, you will need to meet specific requirements in order to get coverage for either program. Medicare Part B will provide you mental health coverage (mostly outpatient services). These include but are not limited to the following:

  • Diagnostic tests for mental disorders

  • Wellness visits (annually)

  • Medication

  • Mental health evaluation

  • Testing to ensure you are getting adequate services

  • Family counseling

  • Psychotherapy (Individual or group)

  • Depression screening (annually)

  • Hospitalization (partial)

  • Prescription drugs that are not self-administered

Part B can also provide you with coverage for substance abuse treatment. Medicare is ensured to cover the ten health benefits the same way Marketplace plans do.

Medicaid can also cover mental health and substance abuse treatment. They will need to meet requirements based on the state they live in. However, they are subject to what is known as the Mental Health Parity and Addiction Equity Act or MHPAEA.

Because of MHPAE, this allows all insurance plans whether it’s purchased or through a program like Medicaid to include mental health and substance abuse treatment. It’s important that you check out what your state’s requirements are for qualification.

Medicaid can cover both inpatient, outpatient, and residential care. However, it may not cover everything. For example, family and marriage counseling is not covered by Medicaid in some states.

The same can be said about other treatments and counseling such as holistic treatment or career counseling. As it is, most of these are not health related to begin with.

6. You Don’t Need to Pay Everything Out of Pocket

Insurance is designed to cover as much of the care as possible without paying anything out of pocket. You may need to pay for some expenses, if need be. For example, you may need to pay for a therapist on a sliding scale basis. 

Also, negotiating with your health care provider will be possible to ensure that you don’t spiral farther into medical debt. The good news is, medical debt will be removed from your credit report. Thus, it won’t hurt you in regards to anything related to credit such as buying a home or even borrowing money as a loan for something you may need such as a vehicle or starting a business.

7. Your Mental Health Should Always be a Priority


Your mental health should always be taken care of no matter what. Insurance policies know this and they will do whatever they can to help take care of it, especially when you need help. There aren't a whole lot of limitations that are in place.

Be sure to take advantage of your health insurance plan if you are dealing with potential mental health issues. Even though it may not cover everything, you can soften the burden of paying out of pocket should such expenses arise. Don’t worry about expenses, but worry more about taking care of yourself mentally.

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Daniel Hall

Business Expert

Daniel Hall is an experienced digital marketer, author and world traveller. He spends a lot of his free time flipping through books and learning about a plethora of topics.

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