Supporting Your Mental Health Year-Round
At The Insurance People, we are passionate about supporting your mental health year-round. We specialize in serving mental health practices throughout Illinois, working directly with hundreds of practices and therapists to ensure they and their clients have the coverage they need.
One of the most common discussions we have with folks is about how their mental health treatment is covered by their insurance. The answer depends on your plan, but understanding a few key details can help you make the most of your benefits. Thanks to the Affordable Care Act (ACA), Marketplace individual health plans are required to include mental health and substance use disorder services as an essential health benefit. Many employer-sponsored plans are ACA and include robust mental health coverage too. This means you can expect mental health services such as talk therapy, family counseling, inpatient and outpatient behavioral health treatment, and substance use disorder treatment to be covered. However, your out-of-pocket costs and provider options will vary depending on your plan.
Many people begin by talking with their primary care provider about concerns like anxiety, depression, stress, or sleep issues. Primary care physicians can often screen for common mental health conditions, prescribe certain medications, and refer you to a therapist or psychiatrist if additional care is needed. Mental health specialists, such as licensed therapists, psychologists, counselors, and psychiatrists, provide specialized treatment through counseling, therapy, psychological testing, and medication management.
Some preventive services performed by your primary care provider, such as routine depression screenings, may be covered at no cost when provided as part of your preventive care benefits. If you're unsure how preventive care works under your plan, we've covered it in more detail in our blog about preventive mental health benefits and travel coverage here.
Your plan type also plays a major role in how you access mental health services. If you have an HMO, you'll generally need to receive care from providers within your plan's network. Depending on your carrier, you may also need a referral from your primary care physician before seeing certain specialists. Seeing an out-of-network therapist with an HMO usually means you'll be responsible for the full cost of care. Since an HMO's network is more limited than a PPO, often there is a waiting list for therapists who accept HMO plans. You may end up needing to spend months or even years on a waiting list for a therapist, and as such, we generally do not recommend HMO’s to those looking for immediate and frequent therapy sessions.
PPO plans offer more flexibility when seeking out a therapist or other mental health specialist. You can schedule appointments directly with in-network specialists without a referral, and many PPO plans also provide some level of coverage for out-of-network providers. While you'll pay less by staying in-network, having out-of-network benefits can make it easier to continue seeing a provider you already know or access care when local options are limited. If your plan does not have out-of-network coverage, taking a few minutes to verify your provider beforehand can help prevent unexpected bills later. If you ever need assistance confirming if your provider is in-network with your plan, get in touch with us!
Your health insurance may not be the only resource available to you. Many employers offer Employee Assistance Programs (EAPs), which often include confidential counseling sessions at no additional cost, along with referrals and other mental health resources. If you're covered through your employer, it's worth checking whether an EAP is available as part of your benefits package. We cover EAPs in-depth in our blog post here. Another place to check for robust mental health resources is your plan carrier's wellness programs. Many insurance companies offer wellness programs that include stress-management resources, mindfulness apps, fitness discounts, virtual wellness programs, and other tools at discounted rates. Not sure if your carrier offers a wellness program? We’ve got you covered with those details in a recent blog here!
Mental health care is an important part of your overall health, and understanding your insurance benefits shouldn't be another source of stress. Whether you're looking for a therapist, trying to understand your network, or have questions about what your plan covers, The Insurance People are here to help. If you’re trying to make the most of your mental health benefits, get in touch! We are happy to walk through all the resources available to you.
