Mental Health

The ACA requires marketplace plans to cover mental health and substance use disorder benefits, making them an integral part of healthcare and not an add-on. Health plans are also required to cover preventive services like depression screenings for adults and behavioral assessments for children at no additional cost. And insurance companies cannot deny healthcare coverage to anyone because of a pre-existing mental health condition.

  1. Will I have access to therapists who are experienced treating LGBT individuals, their families, and their children?
    1. To find a list of therapists, counselors, psychologists and other mental health professionals who have self-identified expertise in serving the LGBT community, check out the provider search function at Psychology Today.
  1. How is family defined for the purposes of family therapy?
    1. Is couples therapy covered for same-sex couples?
      • Do I need to be married to access couples therapy?
  2. How many visits are approved by the plan per year?
  3. Is there a copay for mental health services? How much is the copay for mental health services per visit?
  4. Do mental health services include coverage for suicide prevention, bullying, and harassment in schools?
  5. What kinds of mental health professionals are covered on the plan?
    1. Specifically, are psychologists, psychiatrists, and licensed clinical social workers covered on the plan? What other mental health professionals are covered on the plan?
  6. Do mental health services include addiction treatment?
    1. Do I need a referral to receive addiction treatment? From whom do I need a referral to receive addiction treatment?
    2. What kind of in-patient and out-patient treatment services are covered?
    3. Is nicotine replacement therapy covered for tobacco cessation?
    4. Is direct counseling covered?
  7. What are the mental health benefits for children on the plan?
    1. See LGBT Kids/Youth for other specific questions.

    Questions in red are ones that assisters may not be able to answer because this kind of information is not gathered consistently from healthcare providers. However, we included them because we know that these kinds of questions can make a critical difference in creating a trusted relationship with your healthcare provider.