Maximizing your mental health insurance benefits

Navigating insurance plans can feel confusing and overwhelming, especially when it comes to understanding what’s covered for mental healthcare. Historically, mental health services weren’t always covered at the same level as physical healthcare, leaving many people without access to the care they needed. The Mental Health Parity and Addiction Equity Act changed that by requiring insurance plans to provide equal coverage for mental health and substance use services.

As the year wraps up, it’s a great time to make sense of your current insurance benefits, take advantage of any remaining coverage, and plan ahead for next year. By taking a closer look now, you can ensure that you’re prioritizing your mental health while making informed financial decisions.

How do you pick the best insurance for mental health?

The “best” insurance for mental health will depend on many different factors, including your unique mental health needs. For example, what works best for someone who needs a medication-maintenance appointment every few months may be different from what works best for someone who wants to use insurance to see a therapist every week.

With that said, here are some things to look out for when choosing an insurance plan.

Available providers

One of the most important factors is whether therapists you want to work with are in network with the insurance plan you’re considering enrolling in. This varies widely across platforms, locations, and therapists themselves. Some therapists and platforms accept many different insurance plans — for example, Rula’s therapists accept 60+ insurance plans — while others don’t accept any.

Review the therapists in your area or state to see which insurance plans they accept. Your insurance benefits may not cover therapy if there are no providers available who accept them. 

In-network vs. out-of-network benefits

Additionally, look into whether available therapists are in network or out of network with potential insurance plans. When providers are “in network” with an insurance plan, it means that they have an agreement with the insurance company to offer services at a discounted rate, which can significantly lower your out-of-pocket costs. Many people prefer to work with therapists who are in network with their insurance plan.

But out-of-network benefits can help you pay for therapy, too. Out of network means that the provider doesn’t have a contract with your insurance company, but you may still be able to get reimbursed for a portion of the costs depending on your insurance plan’s out-of-network benefits.

Annual visit limits

Fortunately, another benefit of the Mental Health Parity Act is that insurance companies can no longer put firm annual limits on how many mental health and substance use visits you’re covered for (the way they limit other types of outpatient services like physical therapy). This is especially important information to know if you’re looking for insurance to cover your therapy sessions. 

However, keep in mind that your insurance company can still decide whether or not your mental health visits continue to be medically necessary. Some insurance plans have clauses that say that after a certain number of sessions, they will review your case to determine whether you still need mental health services.

Premium, deductible, and out-of-pocket costs

Cost is undoubtedly an important factor when considering the best insurance for mental health. You can estimate how much therapy will cost with insurance by looking at your monthly premium, deductibles, and annual out-of-pocket maximum.

These terms can be confusing. To define them simply:

• Your premium is the amount you pay every month for your insurance coverage, regardless of whether you use health services. Think of it as a subscription fee for keeping your insurance active.
• Your deductible is the amount you must pay out of pocket for healthcare services before your insurance begins covering costs. For example, if your deductible is $1,000, you’ll need to pay that amount before insurance starts contributing.
• Your out-of-pocket maximum is the most you’ll have to pay for covered services in a year. Once you reach this limit, your insurance will cover 100% of the costs for covered services for the rest of the year.

You can determine how much you’re likely to pay out of pocket for mental health services (and all other health services) by considering all three of these factors. Many marketplace platforms also do these calculations for you.

Inpatient vs. outpatient coverage

You might also want to look at different types of services that are covered, including outpatient and inpatient mental health services. While outpatient therapy is the most common treatment setting for mental health, some people require inpatient care in a hospital or residential treatment center. For example, you might need to stay in an inpatient rehab center for substance use disorder.

If you think you might need inpatient services at any point in the year, it’s important to look into inpatient benefits for any insurance plan you’re considering.

Again, however, the Mental Health Parity Act means that all insurance companies must cover mental health and substance use services to the same extent as physical health services. That means that if you’re covered for inpatient hospital stays for physical health reasons, you’re likely covered for mental health stays as well.

Prescription benefits

Lastly, many people also take prescription medication for mental health. Look into your insurance plan’s prescription benefits, including the specific type of medication you need. Some psychiatric medications don’t have a generic version, so it’s worthwhile to look into brand-name vs. generic coverage as well.

Get the most out of your mental health insurance coverage

Maximizing your insurance benefits before the policy period resets can help you save money and get the care you need. Here are some key tips to make the most of your mental health insurance plan:

• Utilize your deductible. If you’ve already met your deductible for the year, the end of the year is a great time to schedule appointments or pursue treatments you’ve been considering. After meeting your deductible, insurance starts covering a greater percentage of your costs (it sometimes may even cover 100% of your costs), so you may pay significantly less for therapy or mental health services.
• Be aware of the out-of-pocket maximum resetting. Once you reach your out-of-pocket maximum, your insurance will typically cover 100% of covered services for the remainder of the year. However, this benefit resets at the start of a new policy year (often Jan. 1). If you’re close to meeting your maximum or have already met it, consider scheduling appointments before the year ends to take full advantage of this coverage.
• Use HSA or FSA funds before they expire. Health savings accounts (HSAs) and flexible spending accounts (FSAs) can be great ways to pay for mental health services. However, unlike HSAs, FSAs often have a “use-it-or-lose-it” policy, meaning any unused funds may not roll over to the next year. Check your plan details and use these funds for eligible expenses, such as therapy, psychiatry visits, or even mental health-related apps and tools, before the year’s end.
• Plan for the next year. If you’ve discovered gaps in your coverage or foresee higher mental health needs next year, use open enrollment periods (typically during November and December) to consider switching to a plan that better suits your needs. Look for plans with better coverage for in-network therapists, inpatient care, or lower deductibles for mental health services.

Find care with Rula

The end of the year is an important time of year when it comes to insurance. Not only is open enrollment a season to make decisions about next year’s plan but also to take steps to maximize the benefits you already have.

Navigating insurance for mental healthcare can be confusing, but it doesn’t have to be. Rula can help you connect with licensed therapists who work with your insurance, so you can get the care you need while making the most of your coverage. Rula is in network with most major insurers, providing 120 million individuals access to therapy covered by their insurance.

Find support with Rula