Insurance Coverage
Health insurance can help cover the cost for mental health care needs including therapy, appointments with providers, emergency department visits, and hospital stays or residential treatment programs.
The level of coverage for mental health services varies depending on your plan. There is often a cap on how many days are covered for services like day programs, hospital stays, or substance use recovery centers.
If you or your spouse has health insurance through your employer, you’ll want to find out which mental health providers and services are covered before your child starts treatment (see Questions to ask about mental health coverage).
Types of health insurance
If you aren’t eligible for health insurance through an employer and don’t yet have coverage, look into getting health insurance through one of the following options. Healthcare.gov can help you explore the different options and offers specific advice about Opens in a new tabhealth insurance options for young adults. There are also special pages explaining insurance options for Opens in a new tabstudents. Some states have their own marketplaces. If your state has one, Healthcare.gov will direct you to it.
If you are no longer eligible for health insurance from an employer due to leaving a job, reducing work hours, divorce, or certain other reasons, you can ask the employer if you are eligible for Opens in a new tabConsolidated Omnibus Budget Reconciliation Act (COBRA) coverage.
COBRA allows you to continue getting health insurance through a former employer for 18 months. You must sign up within 60 days of the date on which you would otherwise lose group coverage through your employer. You may be required to pay the cost of COBRA coverage.
You can enroll in a private health insurance plan through the Opens in a new tabHealth Insurance Marketplace, which lists various plans available in your state. Plans have different costs based on the coverage they offer. You can enroll in whichever plan works best for you. Depending on your circumstances, part of the cost may be subsidized.
The federal Open Enrollment period is from November 1st to January 15th. State marketplace enrollment dates can vary. If you need to apply for a health insurance plan outside of enrollment dates, you can see if you qualify for a Special Enrollment Period.
Mental health benefits vary by private health insurance plan. All are required to cover "Opens in a new tabEssential Health Benefits," which include mental, behavioral health, and substance use care. They typically offer some level of coverage for residential treatment, partial hospitalization, medications, and outpatient mental health treatment.
Opens in a new tabMedicaid is a health insurance program for low-income adults, children, pregnant women, older adults, and people with disabilities. It is funded by both state and federal governments. You can see if you qualify and apply online through your state’s Medicaid agency, or through the Health Insurance Marketplace (see Private health insurance). You can apply for Medicaid anytime.
Medicaid may have less in-network (covered) mental health providers than private health insurance plans. Medicaid covers medically necessary treatments and services through age 21 (there is advocacy nationwide to remove that age cap). Each state has its own Medicaid plan, so coverage varies per state. The Opens in a new tabMedicaid director in your state can help you understand your state’s plan.
Opens in a new tabMedicare is a federal health insurance program for people 65 or older or for younger people with disabilities. Medicare coverage is the same nationwide. Medicare does not cover all mental health services but does cover inpatient hospitalization, partial hospitalization, outpatient therapy and services, and emergency care. Prescriptions are covered under Opens in a new tabMedicare Part D.
Opens in a new tabLearn more about the difference between Medicaid and Medicare.Opens in a new tabChildren’s Health Insurance Program (CHIP) is a combined state and federal health insurance program, overseen by Medicaid, for children in families who don’t earn enough to buy private health insurance but earn too much to qualify for Medicaid. CHIP is free or low cost. Its coverage varies by state. States are allowed to set premiums and cost sharing on a sliding scale. The Opens in a new tabMedicaid director in your state can help you learn more about CHIP.
Opens in a new tabTRICARE is a federally run health insurance plan for people who serve in the military and their families. Opens in a new tabVA Health Care is a federally run health insurance plan for veterans and their dependents. TRICARE and VA Health Care mental health benefits cover inpatient hospitalization, partial hospitalization, outpatient services, psychiatric residential treatment for children and adolescents, emergency care, and prescriptions. Not all services are available at all locations. Check with your local VA to find out what is available in your area.
Opens in a new tabIndian Health Service (IHS) is the federal health program for American Indians and Alaska natives. To receive Indian Health Service health care benefits, you can visit your local Opens in a new tabIHS office to fill out an application.
- The Opens in a new tabIHS Division of Behavioral Health offers various mental health services and resources.
- The Opens in a new tabIHS Mental Health Program provides access to outpatient mental counseling, dual diagnosis services, mental health crisis response, and other services.
Visit or call your local IHS office for more information.
What is mental health parity?
Most health insurance plans are required to follow Opens in a new tabThe Mental Health Parity and Addiction Equity Act (MHPAEA). This means they must provide the same coverage for a mental health condition as they would for a physical condition. For example, if your insurance plan covers unlimited visits for asthma, it also needs to cover unlimited mental health care visits.
Ask your health insurance plan if they follow mental health parity guidelines. Note: despite positive changes to Medicare made in 2024, Medicare is still NOT subject to parity and has limited or no coverage for many mental and behavioral health conditions.
Questions to ask about mental health coverage
It’s important to find out what services are covered when you research health insurance plans and before consenting to treatment with a mental health provider. Some questions to ask insurance providers:
- Are referrals needed for mental health care? If so, who can provide them?
- How many visits are covered per year for each type of mental health provider? (A young person may see more than one, such as a therapist and a psychiatrist.)
- Are your child’s providers in-network or out-of-network? Note that you will have less out-of-pocket costs for in-network providers. Some plans will not reimburse for out-of-network provider costs.
- Are telehealth visits covered?
- What types of mental health services are covered? Be sure to ask about check-ins with medication providers, therapy, residential programs, partial hospitalization, substance use counseling, and prescription medications, as applicable for your child.
- What will the copay or co-insurance cost (that’s the amount you’ll owe out-of-pocket) be for each service, including appointments, residential programs, and prescriptions medications?
- What length of stay is covered for residential or partial hospitalization programs?
- Are only certain diagnoses covered for residential or partial hospitalization programs?
Not all mental health providers take health insurance
Some mental health providers do not participate in any health insurance plans. This means that you’ll need to pay their fees out-of-pocket.
Find out from your insurance company if you are eligible for partial reimbursement for out-of-network mental health providers. If the answer is yes, you can ask each provider for a monthly “superbill” and submit it to your insurance company. (A superbill is the form that a provider would otherwise submit to insurance for coverage.) Note: Medicaid does not offer reimbursement for out-of-network providers.
Call your insurance company or check their website to find out how to submit a superbill, and what the appeal process is if coverage is denied.
What to do if your health insurance company denies coverage
If your child is entitled to a specific mental health service (such as a therapy appointment or prescription medication) and your health insurance company denies coverage, you can appeal the decision.
Call your insurance company or check their website to find out what the appeal process is if coverage is denied.
What to do if your health insurance company covers treatment but you can’t find a provider who accepts the insurance
If you can’t find a provider who accepts your insurance, call your insurance company and ask for help finding a provider. Some insurance companies may assign a case manager to help you. If none of the providers are available or accessible, you can seek out-of-network coverage.
For additional assistance
For additional assistance and information, you can:
- Visit the National Alliance on Mental Illness ( NAMI ) Opens in a new tabUnderstanding Health Insurance page.
- Contact your state’s insurance commissioner.
- Enlist a patient advocate who can help you navigate health insurance. Your local hospital may have in-house patient advocates, or you can find one through Opens in a new tabGreater National Advocates or Opens in a new tabNational Association of Healthcare Advocacy. Some non-profits like the Opens in a new tabPatient Advocate Foundation lend their services for free. Private patient advocates are paid out-of-pocket and fees range from $75 to $450 per hour.
National Alliance on Mental Illness (NAMI)
The National Alliance on Mental Illness (NAMI) is the nation’s largest grassroots mental health organization dedicated to improving the lives of individuals and families affected by mental illness.
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