Does Insurance Cover Therapy? What Affordable Options Are Available?

Are you one of the millions of people struggling with behavioral health issues? Now more than ever, people are struggling with mental health issues and substance use disorders. The isolation and fear of Covid have increased the need for an online psychiatrist. 

But, does your insurance cover therapy? Luckily most insurance plans offer some coverage for behavioral health issues. And, what if you don’t have insurance for therapy? There are resources to help find affordable coverage.

Employee Assistance Programs

Your employer may offer an Employee Assistance Program that offers some behavioral health benefits. Your employer pays for your EAP benefits. So, accessing your benefits are generally free and doesn’t have to be work-related. 

Even though EAP’s are a short-term solution, they help with the following:

  • Evaluation by a mental health professional
  • Initiate crisis intervention
  • Start short-term therapy
  • Provide referrals for further care

Although your EAP benefits can run out, they do renew each year. But, if your benefits have been exhausted and you still need treatment, there are options. For one, you can ask your employer if they offer discounted out-of-pocket rates for continuing behavioral health treatment. 

Existing Group Health Insurance Behavioral Health Benefits

Some health insurance policies don’t specifically list mental health coverage in the benefit summary. But, does health insurance cover psychologists? Often, you can look in the behavioral health section of your policy for coverage answers. 

Your employer may offer a choice of health insurance plans. If so, compare behavioral health coverage during enrollment periods. Although a plan may cost more, it may save you money vs. paying out-of-pocket. 

A Flexible Spending Account may be an option through your employer. This allows you to set aside pre-tax money for an online psychiatrist, psychotherapy, and prescription medication. Although it doesn’t lower the cost of treatment, it saves you money by not paying taxes on the money.

Marketplace Insurance for Therapy

When you purchase an insurance policy, the framework typically includes behavioral health insurance. In fact, health insurance purchased through the marketplace is mandated by the Affordable Care Act (ACA) to provide mental health and addiction benefits. 

Without the Affordable Care Act, insurance companies would sell plans without behavioral health coverage. If you qualify, the ACA may help you pay the premiums. The ACA helps individuals and families obtain health insurance who can’t afford it but make too much for state insurance.

If you have a mental health or substance use disorder, the ACA provides the following benefits.

  • Insurance companies can neither deny nor charge you more for coverage if you struggle with behavioral health disorders. Additionally, they can’t cancel your coverage when you are sick or using more services.
  • If you are 26 or under, you can be on your parent’s insurance policy. This applies even if you work and live elsewhere.
  • Insurance companies can no longer apply lifetime dollar or yearly limits on essential benefits. These benefits include mental health and substance use disorder treatment. 
  • Most health insurance plans must cover preventative services at no cost. These services include a depression screening for adults and behavioral health assessments for children.

Medicaid: Does Health Insurance Cover Psychologists?

If you meet specific criteria, you may qualify for Medicaid. Since Medicaid is state insurance, benefits will vary from state to state. However, some states do offer some insurance for therapy.

Medicaid covers more than just low-income people. The following groups may be eligible for Medicaid.

  • Pregnant women
  • Women with children under 6
  • Children ages 6-19
  • Supplemental Security Income recipients
  • Young adults up to age 21 who live alone
  • People over 65
  • People who are blind or deaf

Medicare: Does Insurance Cover Therapy?

If you are 65 and older, you may qualify for Medicare. Behavioral health benefits for inpatient treatment and outpatient services are provided through Medicare. Medicare Part D also includes coverage for prescription medication. 

However, if you have Medicare Advantage Plans check your plans for coverage details. These plans also have a Special Needs Plan if you have a significant mental health disorder. SNP’s offer expanded benefits for specific conditions, including mental health and substance use disorders. 

Disability Insurance for Therapy

Some mental illnesses can make it impossible to work. In this case, you may be eligible for disability benefits. For starters, disability benefits don’t automatically come with health insurance for therapy. However, after 2 years, you may qualify for Medicare and its services. For this reason, while waiting for Medicare benefits, you may be eligible for Medicaid. 

Does Health Insurance Cover Psychologists and Behavioral Health Treatment? 

Although insurance for therapy may only cover medically necessary treatments, the following services may be covered.

  • Emergency psychiatric services
  • Co-occurring mental health and substance use disorders
  • Psychotherapy and behavioral therapies
  • Unlimited outpatient therapy sessions with a therapist and online psychiatrist
  • Telemedicine and therapy with an online psychiatrist
  • Inpatient behavioral health treatment in a hospital or rehab setting
  • Addiction treatment
  • Medical detox programs including medications

Can Intensive Outpatient Programs Save You Money?

Generally, intensive outpatient programs (IOP) are more cost-effective than inpatient treatment. IOPs allow you to continue working and living at home while in treatment. If your insurance for therapy has high out-of-pocket expenses, this can be very beneficial.

Another benefit is some IOPs allow you to pay week to week. This is a better option for some as they don’t have extra money for treatment. If you are struggling to pay for or avoiding treatment because of money, it’s vital to speak to your doctor. There may be an alternative, more affordable options such as online psychiatrist.  

Why Is Telehealth and an Online Psychiatrist More Affordable?

Telehealth has been around for many years. However, once Covid struck, the need for telehealth services rose. If you were seeing a therapist for behavioral health issues, you may now see an online psychiatrist. One benefit to telehealth is the safety of social distancing and protecting yourself from Covid. 

Another benefit to talking with an online psychiatrist is the affordability. If you have insurance and use telemedicine to speak to your online psychiatrist, you may not have a co-pay for your visit. That can save a lot of money over time. 

If you are uninsured, the cost of telemedicine and an online psychiatrist is significantly reduced. A study in 2015 by the Boston Globe shows that waiting for s doctor’s visit costs a person $43. Telemedicine not only costs less per visit, but the money you save in travel time and time off work also saves even more. 

Does Insurance Cover Therapy and Medications?

Most insurance companies have a form of prescription coverage. However, there may still be high out-of-pocket expenses. If you can’t afford your medication, there are a variety of options to help. 

Some drug companies offer prescription assistance programs. They may require your doctor’s consent and proof of financial hardships. They may also require you not to have health or prescription coverage. 

Your doctor may also have free samples to give you. So, don’t be embarrassed and be honest with your doctor. You may be able to switch to a more affordable generic medicine. Or, your doctor may know how to get it cheaper. 

How Is the Covid Crisis Affecting Mental Health?

Because of Covid, more than 2 in 5 Americans are struggling with mental and behavioral health issues, according to the CDC. These issues include anxiety, depression, suicidal thoughts, and substance use disorder. 

“Markedly elevated prevalences of reported adverse mental and behavioral health conditions associated with the COVID-19 pandemic highlight the broad impact of the pandemic and the need to prevent and treat these conditions,” the report noted.

The stressors revolving around Covid can lead to Covid Stress Syndrome. 5 related aspects characterize this syndrome:

  • Danger and contamination fears
  • Socioeconomic concerns
  • Xenophobia
  • Traumatic stress
  • Compulsive checking and reassurance seeking

About 16 percent of adults struggle with severe Covid Stress Syndrome. The symptoms include:

  • Anxiety and depression
  • Panic buying/stockpiling
  • Self-isolation distress
  • Avoidance behaviors

What if You Need Help Understanding Insurance for Therapy?

If you’re like many others, understanding your insurance for therapy is like reading Greek. It makes no sense. But, there is help available to get your questions answered. 

If your insurance for therapy is through your employer, they may be able to answer the following questions:

  • Does insurance cover therapy?
  • Can I see an online psychiatrist?
  • Does health insurance cover psychologists?
  • How do I use my insurance for therapy?

If you have private insurance, contacting them can answer all your questions about insurance for therapy. Or, you can contact your state’s insurance department with questions. They can tell you if your insurance is following mandated benefits and help if you are having issues. 

Let Sana Lake Behavioral Wellness Center Help

Covid has many people feeling alone and struggling with mental and addiction issues. If you or someone you love needs help, we can help. Our compassionate representatives are waiting to answer all your insurance and treatment questions. Contact us today to find out how you can live Recovery for Life. 

References:

https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage/

https://www.psychiatry.org/patients-families/what-is-telepsychiatry

https://www.bostonglobe.com/metro/2015/10/05/study-puts-dollar-value-time-spent-waiting-for-doctor/If7KB4aU9mkY5qK8CqDYUO/story.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7361582/

https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html

https://www.cdc.gov/mmwr/volumes/69/wr/mm6932a1.htm