How to Maximize Mental Health Coverage

As Congress seeks to reach consensus on mental health reform, critics say deficits in insurance coverage often leave individuals and families struggling to afford therapy and medications to treat psychological issues, or worse: forgoing care altogether.
No overarching remedy exists to alleviate widespread impediments to access, rooted in everything from health plans that don’t cover many mental health providers to higher out-of-pocket costs for some drugs that treat mental health conditions. Still, there are situation-specific strategies that may maximize coverage and make mental health services and medications more affordable.



Do Your Homework Before Enrolling in a Plan

With the next open enrollment period under Obamacare set to begin Nov. 1, it’s a good time to get an early start researching health insurance plans. That's a solid idea whether you're getting a plan through a health insurance exchange or looking at several options an employer offers.
Large employer plans are not required to cover mental health services, but if they do offer mental health benefits, they must be on par or equivalent to benefits for general medical care, says Sita Diehl, director of state policy and advocacy for NAMI. “So the first thing to do if you’re shopping for a plan through your employer is to make sure that mental health benefits are covered. Most are – most plans do cover mental health – but you’ve got to check it out,” Diehl says. Those who work for a company that offers a plan that doesn't cover mental health may choose to purchase insurance outside their company. You may end up spending more of your own money on monthly premiums as a result, however.

Crunch Dollars and Cents Upfront

Take into account plan deductibles – including out-of-network versus in-network for preferred provider organization, or PPO, plans – and out-of-pocket limits, says Nicholas Moriello, a health insurance broker and president of Health Insurance Associates in Newark, Delaware.

Then go a step further in your cost assessment. Plans commonly use a tiered coverage system, in which drugs – including some for mental and behavioral health – falling into higher tiers receive less-robust coverage, resulting in higher out-of-pocket costs for consumers, says Moriello, who is also a member of the national legislative council for the National Association of Health Underwriters, an industry trade group. Check to see not only whether your medications are covered, but to what degree.