Does Insurance Cover Mental Hospital Stays and How to Access Care

Insurance coverage for mental hospital stays varies greatly depending on the type of insurance you have.

Most health insurance plans, including those offered through the Affordable Care Act, typically cover inpatient mental health services, including hospital stays, as an essential health benefit.

If you're struggling to pay for mental health treatment, you may be eligible for financial assistance or sliding scale fees at certain hospitals or treatment centers.

Many hospitals and treatment centers also offer free or low-cost mental health services, especially for those who are uninsured or underinsured.

Insurance coverage for mental hospital stays varies depending on the type of insurance plan you have. Private health plans, for example, may cover some level of mental health services, including inpatient hospitalization, partial hospitalization, and outpatient mental health treatment.

If you have a private plan through your job, it may cover emergency care and prescription drugs. However, these plans typically offer fewer mental health services than Medicaid or public mental health programs.

All health plans offered in the Marketplace are required to cover 10 types of services, including mental, behavioral health, and substance use care.

Some insurance plans require prior authorization for certain behavioral health services, particularly for inpatient treatment or specialized therapies. This means that your healthcare provider must obtain approval from the insurance company before providing the service.

The Affordable Care Act (ACA) and the Mental Health Parity and Addiction Equity Act (MHPAEA) require most insurance plans to cover mental health services. This means that therapy, counseling, and other mental health treatments are typically included in your plan.

Here are some common mental health insurance benefits:

Additionally, mental health insurance may cover substance use disorders and provide benefits such as inpatient and outpatient treatment, coaching and support programs, and referral services and online resources.

Insurance companies are required to cover mental health services, including inpatient hospitalization, partial hospitalization, and outpatient mental health treatment. This is due to federal laws like the Mental Health Parity and Addiction Equity Act (MHPAEA) and the Affordable Care Act (ACA).

In fact, the ACA requires health insurance plans to cover 10 essential health benefits, including mental health and substance use care. This means that therapy, counseling, and other mental health treatments are typically included in your plan. However, the specifics of coverage may change depending on the state you live in or the health plan you choose.

Some of the services a mental health insurance plan may cover include therapy, partial hospitalization, inpatient hospitalization, substance use treatment, and emergency treatment. It's a good idea to call your insurance provider directly to clarify your coverage and ask specific questions, such as your copay amount for in-network vs. out-of-network therapy, and if there's a limit to how many therapy sessions are covered annually.

Here are some key questions to ask your insurance provider:

Medicare is a federal health insurance program that provides coverage similar to private health insurance. It's available to people aged 65 or older, adults with disabilities who have received Social Security Disability Insurance benefits for at least 24 months, and people with low incomes and limited assets who are enrolled in Medicare and Medicaid.

Medicare covers a range of services, including inpatient hospitalization, partial hospitalization, outpatient services with licensed mental health professionals, emergency care, and prescription drugs under Medicare Part D.

Here are the specific groups of people who are eligible for Medicare:

Medicare also has a 190-day lifetime limit on psychiatric hospital care, which means that if you need longer-term hospitalization, you may need to explore other options.

Mental health services are typically covered by private health plans, but the level of coverage can vary. Private plans usually cover inpatient hospitalization, partial hospitalization, outpatient mental health treatment, emergency care, and prescription drugs.

Most private insurance plans cover some level of mental health services, but public mental health programs often offer more comprehensive coverage. In the federal Health Insurance Marketplace, all plans must cover 10 essential health benefits, including mental health and substance use care.

Insurance companies are required by law to cover mental health services, including therapy, counseling, and other treatments. The Mental Health Parity and Addiction Equity Act (MHPAEA) ensures that mental health and substance use disorder treatments are covered at the same level as physical health care.

Here are some services that are typically covered by mental health insurance plans:

Some services may not be covered by mental health insurance, including:

As you progress with your therapy, it's essential to keep track of your progress and stay on top of your insurance coverage. You can call your insurance provider directly to clarify your coverage and understand any specific requirements.

Ask the right questions to get a clear understanding of what's covered. For example, you can ask about your copay amount for in-network vs. out-of-network therapy.

To ensure you're making the most of your therapy sessions, it's crucial to know the limits of your coverage. Ask your insurance provider about the number of therapy sessions covered annually.

Here are some key questions to ask your insurance provider to stay on track with your therapy progress:

By asking these questions and staying informed about your coverage, you can confidently continue with your therapy and make progress towards your mental health goals.

Private health plans typically cover some level of mental health services, including inpatient hospitalization, partial hospitalization, outpatient mental health treatment, emergency care, and prescription drugs.

These services may vary depending on the type of plan you have, but employer-sponsored health plans, individual market plans, Medicaid, and Medicare often have different coverage levels and requirements.

In the Marketplace, every health plan is required to cover 10 types of services, including mental, behavioral health, and substance use care. This ensures that mental health services are included in your plan, making mental health care more accessible and affordable.

Here are some common types of mental health services that are typically covered by insurance plans:

CHIP is a state and federal combined health insurance program for children in families who earn too much to qualify for Medicaid but not enough to buy private health insurance. It provides free or low-cost health coverage and goes by different names in every state.

In general, a child will qualify for CHIP if they are under age 19 and their family meets certain income requirements. Some states allow families with higher incomes to still qualify.

CHIP plans with mental health benefits must cover the following services equally if they are covered for other medical conditions:

Some CHIP plans may include additional mental health services or the full range of the state Medicaid plan’s mental health services. States are allowed to set premiums and cost sharing on a sliding scale.

Your insurance plan type can significantly impact your behavioral health coverage. Employer-sponsored health plans may have different coverage levels and requirements.

Employer-sponsored health plans are a common type of insurance plan. They are often provided by your employer as a benefit of working for the company.

Individual market plans are another type of insurance plan. These plans are purchased directly by individuals, often through the health insurance marketplace.

Medicaid and Medicare are government-sponsored health insurance programs. They may have different coverage levels and requirements compared to employer-sponsored plans.

Medicaid is a joint federal-state program that provides health coverage to low-income individuals and families. It may have different coverage levels and requirements compared to other insurance plans.

Accessing care is a crucial step in getting the mental health treatment you need. You can start by visiting your primary care physician, who can help you find a qualified mental health provider.

To find a provider, you can also look for licensed mental health care professionals, such as therapists, counselors, psychologists, psychiatrists, clinicians, addiction counselors, social workers, and mental health nurse practitioners.

Using an in-network provider is usually better because insurance companies have negotiated lower rates with these providers, reducing your out-of-pocket costs. In-network services are more likely to be fully or partially covered by your insurance.

Before starting treatment, you may need to take additional steps, such as pre-authorizations or diagnostic assessments to ensure that the recommended care is necessary and appropriate. This is especially true for specialized care, such as residential treatment, inpatient services, or intensive therapy.

Here are some common requirements to keep in mind:

By understanding your insurance options and following these steps, you can make mental health treatment more accessible and stress-free.

Inpatient treatment is a serious commitment, requiring patients to admit themselves to a center for residential treatment. This level of care is designed for those with severe disorders or addictions.

Patients receive around-the-clock care and support, making it a great option for those who need intense treatment.

Outpatient care, on the other hand, provides programs and treatments that are less restrictive, allowing patients to work or attend school. Outpatient programs can include partial hospitalization programs (PHPs) and intensive outpatient programs (IOPs).

PHP programs usually involve five to six hours of treatment a day, while IOPs are less restrictive, usually involving three hours of treatment several times a week.

Some insurance plans may not cover all aspects of outpatient care, so it's essential to understand what's covered and what's not. For example, a patient in a PHP may need to contribute financially for sober living services, even if their insurance plan pays for the PHP portion of treatment.

Most insurance plans cover a range of mental health and addiction treatments, including emergency psychiatric services, dual-diagnosis treatment, and comprehensive addiction treatment programs. These essential treatments offer support for both mental health and addiction recovery, helping individuals access the care they need on their path to wellness.

Here are some commonly covered treatments: