What Your Health Insurance Covers for Mental Health—and What It Doesn’t

If your mental health claim is denied, you have the right to appeal and contact your state insurance regulator or CMS if necessary.

Federal law requires mental health benefits to be treated similarly to medical coverage. Ei Ywet/Shutterstock

In 2022, mental illness in the United States was estimated to affect more than one in five adults, according to the National Institute of Mental Health (NIMH). That means 23.1 percent of adults 18 and older have a mental illness.

Mental health is just as important as physical health. But although most health insurance companies have some coverage for mental illness, not all treatments are covered. Let’s take a look at what’s covered and what’s considered an out-of-pocket cost.

Mental and Behavioral Health Services Considered Essential Benefits

The Affordable Care Act (ACA) mandated that mental health and behavioral services be considered essential health benefits.