Health Insurance For Mental Illness

Nearly one-fourth of hospitalizations in 2005 and 2006 involved mental health or substance abuse disorders, according to the National Alliance on Mental Illness. Yet, 80 percent of people who did not receive needed treatment for mental health issues listed cost as a reason in the 2005 and 2006 National Survey on Drug Use and Health. Mental health benefits in private insurance plans lag behind coverage for physical ailments, but the 2010 federal health reform legislation will help to narrow this gap.

Private

Private health care insurance plans, usually provided by an employer, differ greatly. Some states require medical insurance companies to provide a minimal range of mental health services and others do not. The 1996 Mental Health Parity Act, MHPA, requires that a plan's dollar limits on mental health services, if offered, be the same as for medical benefits, but the law does not require insurers to include mental health in their coverage. The MHPA also provides an exemption if the additional mental health coverage would increase the cost of the plan by 1 percent or more. Businesses with fewer than 50 employees are exempt from the regulation.

Employee Programs

Some companies offer an Employee Assistance Program, or EAP, as a supplemental resource to assist employees with mental health issues, such as stress and depression. This service is separate from insurance coverage and usually is free to the employee, but often there are limits on the number of sessions you may have with a mental health professional and EAPs normally offer only a limited range of services. Information discussed in sessions with EAP care providers is confidential and should not be shared with the employer.

Federal Assistance

The federal government provides mental health insurance through Social Security, Medicare and Medicaid. People who have worked and paid Social Security taxes may be eligible for mental health benefits under the Social Security Disability Insurance program. For those without a work history, the Supplemental Security Income program may provide assistance, depending on income. Medicare provides some mental health coverage for persons over 65 and in some cases to people under 65 with disabilities. Medicaid provides benefits for the poorest in all age groups. Children may be eligible for State Children's Health Insurance Program--SCHIP-- even if they are not eligible for SSI. SCHIP provides gap coverage for children from families whose income is too high to qualify for Medicaid but who cannot afford private insurance.

State/Local Services

If you are unable to get mental health insurance, contact your state mental health agency, which can help you identify services in your area, including those run by county and city governments. These programs frequently base the cost of their services on your income and you can receive services even if you have no income. In addition, community mental health centers--CMHCs--offer counseling and mental health services at low rates for people with low incomes; however, you may have to qualify for public assistance to use CMHC services. Some faith-based organizations also offer counseling for free or on a sliding-scale basis.

2010 Reform

The 2010 Patient Protection and Affordable Care Act includes important changes for mental health patients. For example, insurers will be required to cover people with pre-existing conditions and the law sets minimum standards for the policies offered through state-level exchanges. It also expands the number of individuals who qualify for mental health services under Medicaid. Mental health issues will be covered on a level equivalent to medical and surgical services, and those who cannot afford insurance will receive subsidies to help pay for it.