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Mental Health Guide: Health Insurance

A guide of mental health resources in the Quad Cities.

Insurance

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Types of Health Insurance

Types Of Health Insurance

Understanding the differences in health insurance plans can help a person make an informed decision about what plan is appropriate and what options are available. The level of coverage and availability of services and mental health professionals depends on the type of plan chosen.

Common types of health insurance include:

Private Health Insurance
Medicaid
Medicare
CHIP
TRICARE and VA Health Care

If insurance is provided through a job or government program, there may be fewer health plans that are available to choose from. If insurance is not offered by an employer or you are not enrolled in a government program, additional insurance options are available through the Health Insurance Marketplace.

Marketplace

The Health Insurance Marketplace is designed to make buying health coverage easier and more affordable. The Marketplace allows individuals to compare health plans, get answers to questions, find out if they are eligible for tax credits to help pay for private insurance or health programs like the Children’s Health Insurance Program (CHIP), and enroll in a health plan that meets their needs. The Marketplace Can Help You:

Look for and compare private health plans.
Get answers to questions about your health coverage options.
Get reduced costs, if you’re eligible.
Enroll in a health plan that meets your needs.

Learn more at HealthCare.gov

Insurance

Medicaid

Medicaid is a public state and federal combined health insurance program, which provides health insurance coverage to low-income children and adults who meet certain eligibility criteria. Medicaid plans have low costs, but the choice of mental health professionals may be more limited than in private health insurance plans.

Who's Eligible?

Benefits for the Medicaid Expansion population vary by state. Medicaid.gov has a list of state Medicaid profiles that details eligibility requirements. Medicaid.gov has a complete listing of what benefits Medicaid can cover.

Medicare

Medicare is a federal health insurance program that provides coverage similar to private health insurance. Medicare does not cover a broad range of community-based services for people with mental illness.

Who's Eligible?

  • People aged 65 or older
  • Adults with disabilities who have received Social Security Disability Insurance benefits (SSDI) for at least 24 months

Learn more at medicare.gov

CHIP

Children’s Health Insurance Program (CHIP) is a state and federal combined health insurance program for children in families who earn too much to qualify for Medicaid but not enough to buy private health insurance. 

Who's Eligible?

Usually, a child will qualify for CHIP if he is under age 19 and his family meets certain income requirements. In some states, a family can have a higher income and children may still qualify.

Learn more about CHIP

TRICARE And VA Health Care

TRICARE and VA Health Care are federally-run health insurance plans for people who have served in the military.

Who's Eligible?

A person may be eligible for TRICARE if he is a:

Uniformed Service member or family member
National Guard/Reserve member or family member
Survivor
Former spouse
Medal of Honor recipient or family member
Registered in the Defense Enrollment Eligibility Reporting System (DEERS)

 A person may be eligible for VA Health Benefits if he:

Served in the active military service and left under any condition other than dishonorable
Is a current or former member of the Reserves or National Guard and was called to active duty by a federal order

Learn more about eligibility requirements for TRICARE or the U.S. Department of Veterans Affairs.

If someone served in the military, she may also qualify for enhanced eligibility for VA Health Benefits. Veterans who qualify under this special eligibility do not have to pay copays for conditions potentially related to their combat service.

Learn more about TRICARE

Learn more about VA Health

 

Coverage for Mental Health Treatment

As of 2014, most individual and small group health insurance plans, including plans sold on the Marketplace are required to cover mental health and substance use disorder services. Medicaid Alternative Benefit Plans also must cover mental health and substance use disorder services. These plans must have coverage of essential health benefits, which include 10 categories of benefits as defined under the health care law. One of those categories is mental health and substance use disorder services. Another is rehabilitative and habilitative services. Additionally, these plans must comply with mental health and substance use parity requirements, as set forth in MHPAEA, meaning coverage for mental health and substance abuse services generally cannot be more restrictive than coverage for medical and surgical services.

Denied Coverage & Payments

Do you have Insurance Questions about Mental Health or Addiction Services?

Help is available if you have:

-Been denied coverage
-Reached a limit on your plan (such as copayments, deductibles, yearly visits, etc.)
-Have an overly large copay or deductible

You may be protected by Mental Health and Substance Use Disorder Coverage Parity laws require most health plans to apply similar rules to mental health benefits as they do for medical/surgical benefits. Select your insurance type below for more about the protections that apply for you, and to get assistance information. There are Federal and State Agencies that can provide assistance.