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Mental health programs

Mental health care is health care.

What federal parity rules require, what plans typically cover, and how to find a therapist or psychiatrist who is actually in your network. If you need help right now, call or text 988.

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Get help now

If you are in crisis, help is free and available 24 hours a day.

You do not need insurance, a diagnosis, or a plan of what to say. These lines are staffed around the clock.

  • 988 Suicide and Crisis Lifeline: call 988 or text 988 from any phone, any time, for free and confidential support in English and Spanish. Chat is available at 988lifeline.org.
  • Veterans and service members: call 988 and press 1, or text 838255.
  • Spanish-language support: call 988 and press 2.
  • Crisis Text Line: text HOME to 741741 to reach a trained crisis counselor by text message.
  • SAMHSA National Helpline: call 1-800-662-4357 for free, confidential, 24/7 referrals to treatment for mental health or substance use.
  • If someone is in immediate physical danger, call 911 or go to the nearest emergency room.

Parity

Your plan cannot treat mental health as a lesser benefit.

The Mental Health Parity and Addiction Equity Act, extended by the Affordable Care Act, sets the ground rules for how plans that cover mental health and substance use care have to administer that coverage.

  • Financial requirements such as copays, coinsurance, and deductibles cannot be more restrictive for mental health and substance use care than for comparable medical and surgical care
  • Treatment limits such as visit caps or day limits cannot be stricter than the limits on medical and surgical benefits
  • Rules like prior authorization and step therapy must be applied comparably across both types of benefits
  • Plans must disclose the criteria they use for medical necessity decisions, and the specific reason for any denial, when you ask
  • Marketplace and small group plans must cover mental health and substance use services as one of the 10 essential health benefits

What is covered

Services most plans include.

Exact benefits, networks, and authorization rules vary by plan and by state. This is the shape of the benefit on a typical ACA-compliant or employer plan.

  • Outpatient therapy with a psychologist, licensed counselor, clinical social worker, or marriage and family therapist
  • Psychiatric evaluation and ongoing medication management
  • Prescription medications for mental health conditions, subject to the plan drug list
  • Inpatient hospital care during an acute psychiatric or substance use crisis
  • Partial hospitalization and intensive outpatient programs, which sit between weekly therapy and inpatient care
  • Substance use disorder treatment, including counseling, detoxification, and medication for opioid or alcohol use disorder
  • Virtual therapy and telepsychiatry visits, offered by most plans on the same terms as in-person care
  • Screening for depression, alcohol use, and anxiety as preventive care, often with no cost sharing in network
See how essential health benefits work

Finding a clinician

Four steps that shorten the search.

Waitlists are the most common obstacle, and the way around them is usually breadth: call several clinicians, and use more than one door into care.

01Start with the directory

Search your plan directory, then filter

Use the behavioral health directory for your specific plan and filter by specialty, language, telehealth availability, and whether the clinician is accepting new patients. A clinician listed under a different plan from the same insurer may not be in your network.

Look up a provider
02Call and confirm

Ask three questions on the first call

Are you in network for this exact plan, what is the wait for a first appointment, and do you treat what I am dealing with. Directories go stale, so confirming directly saves you from a surprise out-of-network bill.

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03Use every door

Employer, school, and community options

Many employers offer an employee assistance program with a set number of free confidential sessions. Colleges have counseling centers, and community mental health centers and federally qualified health centers offer care on a sliding scale based on income.

Find care near you
04If the network falls short

Ask about a network adequacy exception

If no in-network clinician can see you in a reasonable time or distance, ask your plan about a network exception, sometimes called a single case agreement, so out-of-network care is covered at in-network rates. Put the request in writing and keep a record of the clinicians you called.

How appeals work

What you pay

Cost sharing works the same way it does for any other care.

A therapy session usually runs through your deductible first, then a copay or coinsurance, just like an office visit with any other clinician. Screening for depression or alcohol use is often covered as preventive care with no cost sharing when you see an in-network provider. Higher levels of care, such as inpatient or intensive outpatient treatment, are typically subject to prior authorization and to the same deductible and out-of-pocket maximum as the rest of your medical benefits. If cost is the barrier, ask about sliding-scale fees at a community mental health center and check whether your employer offers an employee assistance program.
Compare plans in my areaHow deductibles and copays work
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Worth knowing

Numbers to keep in mind.

Call or text for crisis support, 24/7
988
Crisis lines are staffed around the clock
24/7
Essential health benefits, including mental health
10
Cost sharing for in-network preventive screening
0

Good to know

Common questions about mental health coverage.

Does every health plan cover therapy?
Most do, but the requirement depends on the type of coverage. Individual and small group plans that follow the Affordable Care Act must cover mental health and substance use services as an essential health benefit. Large employer plans almost always include the benefit and, when they do, federal parity rules apply to how it is administered. Short-term plans and health care sharing arrangements are not required to cover it at all, which is one reason to read what a plan actually includes before you buy.
What does mental health parity actually mean?
Parity means a plan cannot treat mental health and substance use benefits worse than medical and surgical benefits. It does not mean the care is free. Your normal deductible, copay, or coinsurance still applies, and the clinician still has to be in network. Parity governs the comparison between the two categories of benefits, not the absolute level of cost sharing.
Do I need a referral to see a therapist?
It depends on the plan type. HMO and POS plans often require a referral from your primary care doctor, while PPO and EPO plans usually let you book directly. Prior authorization is more common for higher levels of care such as inpatient, residential, partial hospitalization, and intensive outpatient programs. Check your plan documents or call the number on your member ID card before the first appointment.
Is virtual therapy covered the same as an office visit?
Most plans now cover telehealth for mental health, and many apply the same copay as an in-person visit. Coverage details, licensing rules that require the clinician to be licensed in your state, and which platforms are in network all vary by plan, so confirm before you schedule.
What if my claim for mental health care is denied?
You have the right to an explanation and to appeal. Start with an internal appeal to the plan, and ask in writing for the medical necessity criteria used in the decision. If the internal appeal is denied, most plans must offer an independent external review by a reviewer who is not part of the plan. Keep copies of everything and note the deadlines in your denial letter, since they are strict.
How do I get help paying for care?
If you buy your own coverage, a premium tax credit may lower your monthly cost, and cost-sharing reductions can lower your deductible and copays if your income qualifies. Community mental health centers and federally qualified health centers offer sliding-scale fees based on income. Many therapists in private practice keep a small number of reduced-fee slots, and it is reasonable to ask.
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Coverage that includes behavioral health

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