Insurance Coverage for Mental Health Care Changing for Better

WebMD: Insurance coverage for mental health problems is changing – for the better.

In the past, your insurance might have paid 80% of the cost of seeing your primary care doctor but only 50% of the cost for seeing a psychologist, for example.

But a new law that began taking effect in 2010 changed the rules. Under the new law, if a private insurance plan provides coverage for mental health and substance use services, the plan's coverage must be equal to physical health services.

For example, benefits must have equal treatment limits, such as:

  • Number of days you can stay in the hospital
  • How often you get treatment

Also, limits on the amount you pay on your own need to be similar for both physical and mental health services, such as:

  • Lifetime and annual dollar limits (the total amount an insurance company will pay)
  • Out-of-pocket maximums (the total amount you have to pay)
  • Co-payments (a fixed amount you pay for a health care service)
  • Co-insurance (your share of payment for a health care service)
  • Deductibles (the amount you have to spend before your insurance company starts to pay)

If your health insurance covers some or all of the cost of going out of network for a physical health problem, it has to do the same for a mental health problem.

There are some exceptions. For instance, the law doesn't apply to companies with 50 or fewer workers. So insurance plans available to those employees are not required to provide equal services for mental and physical health problems.

Changes on the Way

More changes are coming in 2014.

Right now, health insurance plans that provide mental health services must provide equal physical health services. But there is no requirement, presently, that health insurance companies include coverage for mental health conditions.

Starting in 2014, though, mental health and substance abuse must be covered by certain plans, including all the ones offered through the new insurance exchanges. Exchanges, also called marketplaces, are places where people who don't get insurance through their job — or don't have insurance for any other reason — can buy a plan.

Also starting in 2014, mental health or substance abuse can no longer be considered a "preexisting" condition. That means insurance companies can't deny you coverage because you had a mental health condition before you enrolled in a health plan.

WebMD Medical Reference

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Kaiser Health News: "After Newtown Shootings, Questions About Mental Health Insurance Coverage."

Kaiser Family Foundation: "Mental Health Financing in the United States: A Primer."

American Psychological Association: "Mental health insurance under the federal parity law" and "How Does the New Mental Health Parity Law Affect My Insurance Coverage?"

Reviewed by Charlene Frizzera on April 19, 2013