Do You Have Mental Health and Substance Abuse Coverage?

mental health and substance abuse coverage

The National Alliance on Mental Illnesstells us that In the U.S., mental illness affects 1 in 5 adults, and many never seek medical care. Part of the issue has been the lack of health insurance coverage. The Affordable Care Act addressed this by requiring Marketplace insurance providers to offer mental health and substance abuse coverage.

But it gets complicated from there. Insurance companies outside the ACA system aren’t beholden to the exact same requirements, and for those who do have coverage, inside or outside the Marketplace, many mental health professionals don’t accept insurance.

Should You Use Mental and Substance Abuse Health Coverage?

The Pros of Using Insurance Coverage

1. Coverage for prescribed medicines

While most individual and small group health insurance plans cover mental health and addiction, not all coverage is equal. But, one often-common denominator is reduced cost of prescribed medications. If your policy doesn’t have the mental health coverage components you want and you decide to pay out-of-pocket for “talk therapy”, coverage for related medicinal treatments for things like depression or anxiety can bring your costs down considerably.

2. It is illegal for Marketplace plans to deny coverage or charge more for people with pre-existing conditions.

If you enrolled in health insurance through the ACA, you have health and substance abuse coverage, even if you have pre-existing mental health conditions.

3. Certain kinds of health insurance are required to provide mental health, substance abuse and behavioral health coverage at least equal to medical coverage.

The Mental Health Parity Act, or federal parity law, was enacted in 2008 to ensure particular types of health insurance don’t charge more in terms of copays for mental health and substance abuse coverage and can’t limit the number of visits annually you can have with a mental health professional. The federal parity law applies to:

  • Employer-sponsored health coverage for companies that have 50 or more employees.
  • Insurance coverage provided through the ACA Marketplace.
  • Children’s Health Insurance Program (CHIP).
  • Most, but not all, Medicaid programs.

Roadblocks to Get Mental Health and Substance Abuse Coverage

Unfortunately, even if you have insurance coverage, you may have a hard time finding a therapist or mental health clinics who accepts insurance. Many people find it easier to pay out-of-pocket. An HMO plan, for instance, may require you to use a specific network for mental health therapists, but wait times to get an initial consult can be as long as four months.

Most mental health therapists and clinics who don’t accept insurance do so for some practical reasons:

  • Therapists can make a lot less money when they take insurance, considering the enormous amount of paperwork required for which they aren’t compensated.
  • Therapists may object to the fact that treatment records submitted to insurance becomes part of your permanent record and accessible by the insurance company, creating a lack of privacy.
  • Typically, insurance will only cover medically necessary services. Before you can get treated you have to be diagnosed with a mental illness first. If you don’t have certain diagnosable disorders, for you to even qualify for coverage can be a challenge.

With a little research involved, you can still find mental health and substance abuse coverage that is right for you, at a price you can afford. Learn more, get quotes from different health insurance companies and ask about their coverage for mental health issues. Get started here.


EINSURANCE is a one stop shop for insurance quotes comparison. Our writers, researchers, and industry experts all work together to inform consumers about online insurance marketplace. Whether you’re buying your first car insurance policy or finding health insurance for your families, EINSURANCE always provides latest relevant information to your choices.