How to Pay for Mental Health Care

Despite an uptick in awareness campaigns in recent years, mental illness still feels like a hush-hush topic for many people. But if you’re dealing with a mental health issue, know you’re not alone. In fact, mental illness affects about 19% of American adults each year. That’s nearly 1 out of every 5 adults in the U.S. But the problem doesn’t just affect people over 18. About 1 in 6 kids ages 6 to 17 experiences a mental illness disorder every year, too. Chief among the mental health problems facing U.S. adults? Anxiety. Approximately 48 million adults in the country deal with an anxiety disorder. Major depressive episodes are number two, at 17.7 million people.

Mental health care matters.

With nearly a fifth of American adults and a significant number of U.S. kids facing mental health challenges every year, getting help is critical. Mental health goes hand in hand with physical health. And there’s data to prove it. According to the National Alliance on Mental Illness (NAMI):

• Depression could increase your risk of heart and metabolic diseases by 40%.

• Depression is also the leading cause of disability — worldwide.

• Just over 19% of adults with a mental illness also suffer from a substance use disorder.

• People with a mental illness are more likely to be unemployed. The unemployment rate in 2018 was 5.8% for adults with a mental illness but just 3.6% for those without one.

But even given these stats, most people with a mental illness don’t get the help they need. Per NAMI, only 43% of adults with a mental illness will get the help they need in a given year. That number jumps to 64% for people with a serious mental illness. But only about half (51%) of kids ages 6 to 17 with a mental health condition will get the right help in a year. It takes about 11 years from symptom onset for people to get help with a mental illness. And that’s 11 years too long. Apart from the stigma that mental health still carries, cost may be a big factor in keeping those who need help from reaching out. Mental health care, like healthcare in general in the U.S., is expensive. And if you don’t have health insurance, you might not even realize there are ways to pay for mental health care. But you’ll need to do some legwork. This post highlights some of those ways, including health insurance.

But first, let’s talk about the law for a sec.

The Affordable Care Act mandates mental health care as an essential benefit. More on that in the next section. But even before the ACA took effect, Congress passed a mental health parity law in 2008 to ensure equal coverage for mental and physical health. “Parity” in this context means that whatever your health plan covers for physical health, it must also cover the same for mental health. For example, if your health plan covers doctor visits with a $20 copay, then it also has to cover mental health visits for the same copay. Now, there are limits to this. A health plan doesn’t have to have low copays or unlimited visits to a therapist (or a doctor, for that matter). There are good and bad health insurance plans, with varying levels of coverage along the spectrum. Parity just ensures that health plans treat mental and physical health the same in terms of coverage. Whether that coverage is good — for both categories — is up to the plan. (And you, as a consumer, should shop carefully.) The parity law applies to most major medical health insurance plans created on or after March 23, 2010. But there are some exceptions. These plans don’t have to treat mental and physical health coverage the same:

• Grandfathered health plans that existed & were bought before March 23, 2010
• Medicare (except for cost sharing for outpatient care)
• Medicaid fee-for-service plans
• Plans that get an exemption for “increase of costs related to parity”

By law and assuming it doesn’t fall under the exemption category, your major medical plan should treat mental and physical health the same. That said, mental health care can still be costly, even if you have health insurance. Here are some ways to pay for mental health care if you need it.

Health Insurance

Mental health care is an essential health benefit under the Affordable Care Act (ACA). That means that major medical plans have to cover it, by law. “Major medical” plans are the full, comprehensive health plans you find on federal, state and private marketplaces; through private insurers; and via brokers and agents. These plans:

• Cover 10 essential health benefits
• Guarantee coverage to people with pre-existing conditions
• Offer a host of consumer protections
• Meet all the requirements of the ACA

Major medical insurance sold on or after March 23, 2010 — when the ACA got signed into law — all meet a set of standards. Exceptions for grandfathered plans exist, but by and large, major medical plans today cover a broad range of benefits. They also cost more because of it. In 2020, the average cost of a plan on the Obamacare marketplace was $606 a month for an individual. And that’s just the premium. Health insurance also comes with deductibles and other cost sharing amounts that make it hard to pay for healthcare — mental or otherwise. Still, most people get subsidies for Obamacare health plans. That $606 average doesn’t account for tax credits that lower premiums for most shoppers. This year, about 87% of people who bought a marketplace plan got a tax credit to lower the premium. You qualify if you earn between 100% and 400% of the federal poverty limit. This year’s tax credit brought the average down to just $89 a month for individual health plans.

Bottom line? Health insurance is expensive. But it covers a lot.

And by law, your health plan has to cover mental health like it covers physical health. At less than $100 a month for most consumers, major medical plans make sense. You get comprehensive benefits, including mental health care, and a lot of consumer protections. But if you’re not part of the 87% of consumers who get a tax subsidy to lower your premiums, where does that leave you? Health insurance is a great option if you can afford it. If you can’t or you’re not eligible to enroll right now, here are some other ways to pay for mental health care.

Cash Discounts

If you have to pay for mental health services yourself, you’ll probably spend $100 to $200 per session or more. The actual rate depends on your therapist’s level of certification, where you live and other factors. But as a self-paying client — i.e., someone without insurance — you may have options for reduced pricing. That’s because some mental health providers offer sliding scale payments for lower-income clients. If you meet the income requirements, you might get a reduced rate on your sessions. It’s not the best or most reliable plan. After all, mental health can still be pricey even with a sliding scale payment. But don’t be afraid to ask a provider up front about costs and whether they offer discounts for self-pay and low-income clients.

Online Apps & Telehealth

The great thing about getting help in the digital age is that there are lots of digital options for mental health care. Telemedicine gives you access to a broader range of providers, since you don’t need to leave home to talk to someone. And if you have health insurance, your telehealth visit might even be covered. The Anxiety and Depression Association of America offers a list of ADAA member providers who offer telehealth, if you’re looking for a place to get started. But there are other ways to get help online, sometimes for much less than you’d spend otherwise. The ADAA keeps a list of reviewed mental health apps. You’ll find info on effectiveness, personalization and research evidence, among other things. Popular mental health apps include:

• What’s Up
• MindShift
• Talkspace Online Therapy
• nOCD
• PTSD Coach

Psycom.net lists these and other top mental health apps on a list with pricing info and a brief summary. Many of the apps on this list are free or inexpensive — but not all. Talkspace, for instance, costs $65 a week. But it covers as many texts as you need and a daily response from a trained professional. Given that in-person therapy sessions can easily cost twice this much for a single hour, Talkspace could be a good option if you’ve got a bigger budget for mental health care.

Programs for Limited Income

Don’t assume that a low income means you can’t afford mental health care. Programs exist to help people with limited resources access services. In fact, Medicaid is the largest payer for mental health services in the country. This program typically covers people with limited income, though states have different requirements on who’s eligible. If you have Medicaid already, then check with your plan to see what kind of options exist for mental health care. Beyond Medicaid, there are other resources for mental health care if you don’t have much — or anything — to spend on it. Start with one of these:

• The National Suicide Prevention Lifeline (or 1-800-273-8255)
• The Substance Abuse and Mental Health Services Administration helpline
• Your local NAMI affiliate
• The U.S. Department of Veterans Affairs mental health services

Each of these caters to slightly different audiences. But all of these resources offer 24/7 confidential help that’s free in many cases. At the very least, you can reach out to a crisis worker anytime you need for support. From there, you may be able to find local resources or providers to continue treatment. And if you’re looking for something more local, try checking your area for free clinics, community mental health centers, or local colleges and universities that may offer lower-cost care. Mental health care is expensive, an unfortunate side effect of the high cost of healthcare in general. But there are resources to help you afford it, with or without health insurance. Getting help can seem overwhelming in and of itself. Don’t let the cost deter you. If you need support, reach out. You’re not alone. And getting the support you need now may help you build a healthier path going forward.