March 12, 2024

Mental health is just as important as physical health, yet it is often undiagnosed and untreated. With the conversation around mental health coverage changing, more people are beginning to explore therapy and prescription medication to manage the symptoms of disorders like depression, anxiety, bipolar I and II, and schizophrenia.

Treatment can make the difference between living a healthy life and being unable to function, so understanding your options for mental health insurance coverage is crucial.

In this guide, we explore what your options are for mental health coverage in Florida.

Understanding Mental Health Coverage

Under the Affordable Care Act, mental and behavioral health services are considered essential health benefits, so every policy must provide them. The exact level of coverage varies from insurer, and many therapists do not take insurance, so you may have to search to find one that does.

If you need prescription medication to manage your mental health symptoms, both public and private health insurance options are available, as well as government-funded programs.

Medicaid

For individuals who earn a lower than average income, Medicaid is a potential option. This free health insurance offers low and no-cost services, as well as reimbursement for community mental health services such as therapy and substance abuse treatment.

Reimbursements require you to pay out of pocket, then submit a claim to have the money given back to you. Medicaid Florida will reimburse:

  • Mental health assessments
  • Medical and psychiatric care
  • Individual, group, and family therapy
  • Rehabilitative services for substance use disorders

Visit the official Florida Agency for Health Care Administration website to learn more about fees, rules, and eligibility requirements.

Medicare

Starting January 1, 2024, Medicare Parts A and B covers all mental health care services provided by licensed therapists. Part A will cover hospital costs if you receive inpatient treatment, and Medicare Part B will cover up to eight therapy sessions.

After paying your yearly Part B deductible, you must pay 20% of the Medicare-approved amount for office visits and services if your healthcare provider accepts the assignment. Medicare will cover one annual depression screening, alcohol misuse screening, and counseling.

Opioid addiction treatment is free for Medicare beneficiaries after you pay the Part B deductible, so long as you receive services from a provider who is enrolled in Medicare.

Key Components of Mental Health Coverage

There are important terms and types of mental health services to know about when exploring coverage options. Be sure to explore these further before committing to a plan or undergoing treatment.

Inpatient and Outpatient Services

Inpatient and outpatient mental health care can address conditions like anxiety, depression, PTSD, schizophrenia, schizoaffective disorder, bipolar I or II, and psychosis. Substance abuse disorders can also be treated in a hospital setting, rehabilitation facility, or outpatient.

Inpatient treatment may not always be desirable, but some patients need it to stabilize and receive the level of intensive care they need. Outpatient treatment can include individual counseling, group therapy, and family sessions led by a licensed mental health therapist, psychologist, or psychiatrist.

Prescription Medications for Mental Health

Only physicians and psychiatrists can prescribe medication for mental health symptoms. The coverage for these medications will fall under your policy’s prescription drug coverage formulary.

Telehealth for Mental Health Services

Not everyone has access to transportation or a schedule that permits them to receive routine counseling or even urgent mental health services when they need it. Screenings and therapy can both be performed virtually through telehealth services.

Telehealth mental health counseling is done from the comfort of your own home on a confidential platform. Insurance coverage varies by provider, so check with the platform you are considering and your own insurance company before booking treatment of any kind.

Coverage for Different Mental Health Professionals

Mental health professionals range from social workers and therapists to behavioral health specialists, addictions counselors, and psychiatrists. The coverage may vary depending on the type of mental health professional you see and the services you receive.

Coverage for Crisis Situations

During a mental health crisis, you may need access to emergency medical care. This could include ambulatory services, emergency room care, and inpatient hospital care. Each plan has its own terms regarding urgent mental health services.

Copayments and Deductibles

Copayments and deductibles are a standard part of health insurance. You pay a monthly or annual amount of money called a premium to reach a certain figure. Once you’ve paid your deductible, your provider starts paying for covered services and prescription drugs.

A copayment is the amount of money you pay for healthcare after you’ve paid your deductible. Many people still have lower rates for service if they are insured, so health insurance may still help offset the cost of mental health treatment and medications even if you haven’t met your deductible yet.

Choosing the Right Mental Health Coverage

Everyone deserves good mental health. At Live Health, we take every aspect of your wellness into account. Contact us today to discover the top Florida health insurance plans with the best mental health coverage options for your needs.

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