Types of Health Insurance
Understanding the differences about health insurance plans can help a person make an informed decision about what plan is appropriate and what options are available. The level of coverage and availability of services and mental health professionals depends on the type of plan chosen.
Common types of health insurance include:
- Private Health Insurance
- Medicaid
- Medicare
- CHIP
- TRICARE and VA Health Care
If insurance is provided through a job or government programs, there may be fewer health plans that are available to choose. If insurance is not offered by an employer or you are not enrolled in a government program, additional insurance options are available through the Health Insurance Marketplace.
Read more about these insurance options that may be available on types of health insurance.
Which Plans Cover Therapy
Visit Healthcare.gov to learn about your options to get health insurance coverage, check if you qualify for savings, and compare plans. Whether you have insurance or are looking for insurance, below are the types of health insurance that are affected by the parity law.
Employer-sponsored health coverage. If you have insurance from your company, and there are more than 50 employees, your health insurance is required to provide equal mental health services to you.
Health insurance purchased under the Affordable Care Act. By purchasing health insurance through an exchange under the health care reform law, you have greater access to mental health services.
The Affordable Care Act helped more than 21 million Americans get access to health coverage. This included classifying mental health services as an essential health benefit.
Children’s Health Insurance Program (CHIP). This insurance program is designed specifically for families with children who don’t qualify for Medicaid.
Medicaid programs. Most Medicaid programs are required to give you equal access to mental health care. These requirements could change depending on your program.
Understanding Health Insurance
Insurance is a crucial tool that can grant access to needed treatment to get well. Health insurance helps pay for mental health care needs including checkups, visits to specialists, emergency care and hospital stays. In most cases insurance will keep a person from paying the full cost of medical services.
Getting insured or reviewing your current insurance plan may seem complicated, but knowing the basics can help you navigate the system successfully.
How Much Insurance Does Someone Need?
Each person is different and not everyone needs the same amount of insurance. The limiting factor for many people is the cost of the plan. But a person should make sure to get the most coverage for the money he or she spends.
Whether choosing insurance for the first time or evaluating a current plan here are some things to keep in mind:
- Affordability. Compare monthly premiums, deductibles, co-pays and/or co-insurance to make sure you are getting the best deal for your health insurance needs. Consider not just about how much you pay per month, but also how much money is needed to pay co-pays and co-insurance.
- Availability of mental health professionals. Make sure there is a broad range of mental health professionals included in the health plan’s network of providers. Some mental health professionals do not take insurance, so check to see what the insurance plan will pay for out of network providers.
- Coverage of prescription medications. If a person has found the right medication to treat their illness, she should find a plan that covers that medication to maintain wellness.
- Limits on the number of mental health-related office visits. Some health plans place limits on the number of office visits for things like therapy. Choose a plan that allows the number of visits needed. Depending on a person’s need, he may need to consider differences in inpatient and outpatient coverage.
Common Terms Related to Health Insurance
Part of what adds to the frustrating process of obtaining mental health services is the confusing terminology that insurance companies use. Here are some of the most common terms used when health services are denied:
- Medical necessity criteria are standards used by health plans to decide whether treatments or health care supplies recommended by your mental health provider are reasonable, necessary and appropriate. If the health plan decides the treatment meets these standards, then the requested care is considered medically necessary.
- Utilization review, also known as utilization management, is the process used by insurers to decide whether the requested mental health care is medically necessary, efficient and in line with accepted medical practice. In line with accepted medical practice means that the mental health treatment or service is proven to be effective based on scientific evidence.
- Prior authorization, also known as pre-approval, preauthorization, prior approval or precertification, is a type of utilization review. It is when you or your service provider must ask for approval before your health plan will agree to pay for a service, treatment plan or prescription drug.
- Step therapy is a type of prior authorization in which you must try a less expensive prescription drug or service before you can move to a more expensive prescription or service.
How to Get the Help You Need
If you need mental health help but are worried about the cost, there are options. First, if you don’t have health coverage you can look into Medicaid. If you’re not insured, you could find one with reasonable rates by looking around for mental health professionals.
If you have health insurance, you should check with your provider before your first therapy session. If your insurance plan isn’t covering your therapy costs, you can appeal their decision. The way you'd appeal depends on what type of insurance you have. However, you can always appeal your case to the Federal Center for Medicaid and Medicare Services or to the U.S. Department of Labor. They can enforce the parity law and help you get your therapy costs covered.
If you need help paying for medication related to your mental illness, there are county, state, and national programs available to you. These programs are designed to help you afford your medication through discounts based on financial need.