The Affordable Care Act (ACA) requires that all individual and family plans sold through the Health Insurance Marketplace include mental healthcare. When exploring mental health benefits, remember that your monthly premium and out-of-pocket costs will vary depending on the coverage level of the plan you choose. Understanding how your health plan options can support your care needs and budget will help you make informed decisions regarding your mental health.
In recent years, many people have experienced mental health challenges, with over 30% of adults in the United States reporting symptoms of anxiety and/or depression. 1 Negative mental health outcomes have also impacted youth and young adults.
Mental health insurance coverage is a vital component of whole-person care, ensuring that individuals managing ongoing conditions or experiencing temporary mental health challenges can access help from licensed professionals.
Recognizing that mental health is crucial to overall well-being, Anthem is partnering with care providers to ensure that mental health is given the same priority as physical health.
To help members prioritize their mental health, insurers often offer virtual mental healthcare visits. By connecting with a mental healthcare provider through virtual sessions, you can conveniently seek the help or treatment you need from the comfort of your own home. This ease of access helps to remove barriers to seeking mental healthcare and offers an additional level of privacy.
Anthem offers its members virtual mental healthcare visits through the Sydney Health mobile app on their smart phone, tablet, or computer. 2 The Sydney Health app allows you to schedule a virtual care visit with a licensed mental health professional for stress, anxiety, depression, family issues, and other health concerns. Psychiatrists are also available by appointment when needed.
ACA-compliant insurance plans cover various mental health benefits, including:
The above is not a comprehensive list and your specific mental health benefits will depend on your state and the health plan you choose.
While all Marketplace health plans include mental health benefits, the cost of coverage varies. In addition to your plan’s monthly premium, you may also encounter other out-of-pocket costs when accessing mental health services, including your deductible, copays, or coinsurance. The amount you pay for mental healthcare services and treatments depends on whether you seek care from network providers, virtual or in-person treatment, and any out-of-pocket costs for prescription drugs to help manage your condition. Review the details of any insurance plan—including its mental health benefits and associated out-of-pocket costs for care—before you decide.
The ACA also established health insurance subsidies to help lower healthcare costs for individuals and families. Subsidies are based on income and household size. There are two types of ACA subsidies: Advanced Premium Tax Credits to lower your monthly plan premium, and Cost-Sharing Reductions to reduce costs for care, including your deductible, copay, and out-of-pocket maximum.
When choosing an insurance plan with mental health benefits, be sure to consider:
By assessing these factors, you can choose ACA mental health coverage that meets your care needs, aligns with your budget, and ensures access to essential mental health benefits.
You can purchase ACA Marketplace insurance through the Health Insurance Marketplace. Anthem insurance plans available on the Marketplace include mental health benefits and offer a range of coverage levels for individuals and families, allowing you to compare and choose the best plan for you.
Enrollment in Marketplace insurance occurs during the annual Open Enrollment Period, which typically runs from November 1 to January 15. You may also qualify for a Special Enrollment Period if you experience a life event, such as losing other health coverage, moving, getting married, or having a baby.
