Mental Health & Therapy: What Health Insurance Covers by Law

If you or someone you know is struggling with a mental health or substance use disorder, you are not alone. In California, one in six adults experiences a mental illness of some kind, and 8 percent meet the criteria for substance abuse disorders. The good news: if you have health insurance, there are both federal and state laws that ensure you receive the necessary care you need.

Mental Health Coverage & The Law

Struggling with a mental health condition can be extremely difficult, but help is available and you can find the treatment you need. Both state and federal laws apply to health coverage for mental health and substance use disorders in California.

Under the Affordable Care Act

Your mental health is just as important as your physical health. That’s why federal law, under the Affordable Care Act (ACA), says that mental and behavioral health services are essential health benefits that must be covered. These include behavioral health treatment, like counseling and psychotherapy; inpatient mental and behavioral health services; and substance use disorder treatment. All ACA-compliant health plans cover nearly all mental disorders, as well as substance use disorders and treatment for alcohol and chemical dependency.

In addition, federal law requires certain protections for mental health and substance use disorder benefits to ensure they are covered in the same way as most medical and surgical services. This means that things like deductibles, limits to days or visits covered, or the way care is managed must be the same for mental health and substance use as they are for other medical benefits.

More Coverage from California

California law provides added security by requiring every health plan in the state to cover certain mental health conditions, including the following:

• Major depressive disorders

• Autism or pervasive developmental disorder

• Bipolar disorder

• Panic disorder

• Schizophrenia

• Schizoaffective disorder

• Obsessive-compulsive disorder

• Anorexia nervosa

• Bulimia nervosa

• Serious emotional disturbances in children under age 18

These are all serious conditions that deserve immediate treatment. A health plan must cover outpatient diagnosis and treatment, inpatient hospital services, partial hospitalization, diagnosis, outpatient services, and prescription drugs (if your health plan covers prescriptions), with the same terms as any other medical condition.

A California law signed in 2021, requires that when you see a mental health or substance abuse health professional, you’re offered a return appointment within 10 business days. This new law also applies to your health care provider referring you — that referral appointment must be scheduled within 10 business days. The new law went into effect in July 2022.

Your Path to Treatment & Help

If you are in need of care, you can start your path to treatment today. The sooner you have support, the sooner you can begin to heal. For some health plans, you can make an appointment directly with a mental health care provider, but for others, you may need a referral from your primary care physician or your health plan. Check your insurance company’s website or call the number on your membership card to find out more. Some plans have a behavioral health phone number that you can call directly. Remember, it’s important to ask for help — and help is available for you and your loved ones.

Not sure where to start? Try the Behavioral Health Treatment Services Locator. It’s a completely anonymous and confidential resource for anyone seeking treatment for substance use disorders or mental health issues in the United States. If you feel you are at risk of harming yourself, please call or text the National Suicide Prevention Lifeline at 988, available 24 hours a day, 7 days a week. The three-digit national suicide hotline number – 988 – operates like 911 but for mental health related emergencies.

If you aren’t currently covered, Covered California’s Shop and Compare tool can help you find out which health plan options are available to you.