Does Health Insurance Cover Mental Health the Same Way It Covers Physical Health?

Skipping mental health care because of cost concerns is more common than it should be. When policyholders are unclear about what their health insurance covers, they may postpone or avoid treatment, potentially worsening their conditions and increasing long-term costs. Understanding your mental health benefits is a critical first step toward accessing the care you need.

What the Law Requires

Federal law requires plans that include mental health and substance use disorder services to do so at the same level as medical and surgical benefits. This is known as mental health parity. In practice, that means your plan typically cannot charge you higher copays for a therapist visit than for a primary care visit, or impose stricter limits on mental health treatment days.

Where Gaps Still Exist

It’s important to note that mental health parity does not require all plans to offer mental health or substance use disorder benefits. It requires parity only in plans that already include those benefits.

Additionally, parity rules apply to every plan type. Short-term health plans, retiree-only plans and self-funded plans sponsored by employers with 50 or fewer employees are often exempt from these requirements. Some self-funded non-federal government plans have also elected to opt out of parity requirements.

Get the Right Coverage for Your Needs

The clearest way to know what your plan covers is to review your summary of benefits and coverage. You can reach out to Florida Coast Insurance Agency to compare plans and identify coverage gaps before you need care. Contact us today to find a plan that supports both your physical and mental health needs.

This blog is intended for informational and educational use only. It is not exhaustive and should not be construed as legal advice. Please contact your insurance professional for further information.