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Does Health Insurance Cover Mental Health Care

    Your mental health is as essential to you as your physical well-being. When you require mental health care, you want to know the services are covered by your health insurance.


    Health insurance can seem like a maze of confusion. Deductibles, co-pays, in-network, out-of-network, all of these terms can make your head spin. Then there is the issue of what exactly is covered under your plan. Routine medical and surgical care is included in various degrees by all health plans. In the past, a gray area for medical coverage was mental health services. With new laws enacted, health insurance plans are now required to cover at least a portion of mental health care.


    Types of Health Insurance

    There are five main private health insurance plans typically provided by employers and sold through state marketplaces. These include:

    • Health Maintenance Organizations (HMO)  
    • Preferred Provider Organizations (PPO)
    • Exclusive Provider Organizations (EPO)
    • Point-of-Service Plans (POS)
    • High-Deductible Health Plans (HDHP)


    Each plan has a different level of cost for premiums and medical coverage. Most of the programs only cover services for in-network provider care. This means the health insurance plan includes more of, or only, services given by physicians, hospitals, and other medical professionals that have contracted with the health insurance provider. The health plan may cover some of the expenses for out-of-network providers. The health insurance plans that have in-network provider coverage requirements include HMOs, PPOs, EPOs, and POS.


    High-deductible health plans (HDHP) have a lower monthly premium and a higher deductible than other traditional medical insurance coverage. This plan is an option for healthy individuals that rarely go to a doctor, but need health insurance. The monthly cost is much lower than other medical coverage.


    An HDHP can be combined with a Health Savings Account (HSA). This is a financial account you can deposit money into on a pre-tax basis to help pay for qualified medical expenses. To be able to use a Health Savings Account you must have medical coverage through an HDHP. There is a yearly limit to the amount that you are allowed to contribute to the account.


    Other health insurance plan choices include Medicaid, Medicare, CHIP, Tricare, and VA care. Medicaid is both a state and federally funded program for qualified low-income adults and children. For families that don’t qualify for Medicaid but need health insurance for their children, there is the Children’s Health Insurance Program (CHIP). The program is generally known by a different title in each state and offers free or low-cost insurance coverage for low to moderate- income families.  


    Medicare is a federal insurance program for individuals that are 65 and older, those with specific disabilities, and individuals with end-stage renal disease.


    TRICARE and VA health care are federally funded health insurance programs for those who served in the military, their spouses and families.


    What is Mental Health Care?

    Your mental health is the state of your emotional, and psychological well-being. It affects how you function daily. When you are experiencing mental health issues it can cause you to have difficulties in how you think, feel, and act. This can create life disrupting-problems with your family, friends, and employment. Getting the help you need is essential.

    There is a wide range of causes of mental health injuries including catastrophic injuries, traumatic and non-traumatic brain injuries, etc. It is very common that physical traumas can become extremely stressful for the patient and develop psychological disorders. Thus, the recovery in these cases works on two fronts. The rehabilitation center should also provide strong psychiatric treatment.


    Mental health care consists of primary care services and specialists that are involved in diagnosing and treating individuals with mental health disorders and substance use disorders. Mental health professionals include psychologists, counselors, primary care physicians, hospitals, rehabilitation centers, and other mental health care providers and facilities.


    Health Insurance Coverage Percentage of Mental Health Care

    In 2014 the Mental Health and Substance Use Disorder Coverage Parity Law was enacted with the Affordable Care Act (ACA). This law requires most health plans to apply similar coverage for mental health services as they do for medical and surgical benefits.


    In the state of Nevada, all Qualified Health Plans (QHP) that are sold through the Marketplace and are part of the Affordable Care Act (ACA) have ten Essential Health Benefits they must cover. One of these benefits is mental health and substance use disorder services, including behavioral health treatment. Counseling and psychotherapy are two of these forms of treatment.


    If you have a mental disorder, when purchasing a health insurance plan you want to look for certain coverage benefits, including the number of qualified mental health professionals in the plan’s network, if the policy covers mental health providers outside of their network, and the number of covered visits. If you are taking any medications, make sure the plan includes your prescription drugs.


    When you have been diagnosed with a mental health or substance use disorder, you want the best care possible. With the Affordable Care Act regulations, health insurance plans are now required to cover mental health care.  With the right plan, you can get the care you need.