9 Questions to Compare Health Insurance for Mental Health

How to Evaluate Mental Health Coverage

Choosing the right health insurance for mental health can feel overwhelming, especially when every plan claims to offer “comprehensive” benefits. In reality, therapist networks, teletherapy access, medication tiers, and authorization rules vary widely. 

According to KFF, a growing number of Americans rely on weekly therapy, virtual counseling, or psychiatric medication. So, comparing plans carefully matters more than ever.

The good news? Your Summary of Benefits and Coverage (SBC) and drug formulary reveal most of what you’ll actually pay for mental health care. These nine questions turn that information into a simple pre-enrollment checklist so you can compare plans confidently before you pick one.

9 Mental Health Questions to Ask Before You Pick a Health Plan

1. Are your preferred therapists or psychiatrists in-network?

Therapist and psychiatrist networks differ significantly, even among plans with similar premiums. SBCs list costs under “Mental/Behavioral Health Outpatient Services,” and you’ll see separate rows for:

• In-network therapy
• Out-of-network therapy

This distinction can drastically affect how your health insurance for mental health functions.

Example SBC language:

• $30 copay in-network
• 50% coinsurance out-of-network, after deductible

Always search provider directories or confirm directly with your therapist’s office. If you’re still unsure what’s covered after checking your SBC, read more about how health insurance covers therapy and counseling so you know what to expect before you book a session.

2. Does the plan include teletherapy or virtual care?

Teletherapy is now a core part of health insurance for mental health, but coverage varies:

• Some plans offer $0 telehealth copays.
• Others require you to use a specific vendor.
• A few only cover video visits—not phone or text-based therapy.

Check the SBC and the insurer’s telehealth page for details.

3. Are there limits on therapy visits?

Thanks to the Mental Health Parity and Addiction Equity Act (MHPAEA), most ACA-compliant plans cannot impose stricter limits on therapy than on medical visits.

However:

• Some employer plans may cap out-of-network visits.
• Short-term medical and fixed-indemnity plans often exclude or limit mental health care. 

Look for “Limitations & Exceptions” on your SBC.

4. Will you need prior authorization for therapy, psychiatry, or testing?

Prior authorization rules can affect when treatment begins. Plans may require prior authorization for:

• Psychological testing
• ADHD or autism evaluations
• Intensive outpatient or inpatient programs
• Certain psychiatric medications

See the SBC section labeled “Preauthorization Required?”; unclear items should be verified with the insurer.

If you’re not familiar with how insurers approve services, this quick explainer on what prior authorization is and how it works breaks down the process and helps you understand when you may need insurer approval before starting treatment.

5. What costs apply before you meet your deductible?

Different plans structure mental health cost-sharing differently:

• Some waive the deductible for therapy.
• Others require full payment until you meet the deductible.

This can make a major difference in your health insurance for mental health cost prediction.

Example:

• Plan A: $0 copay, deductible waived
• Plan B: 20% coinsurance after deductible

Coinsurance-based plans may mean paying $80–$120 per visit early in the year.

6. Which psychiatric medications are covered—and on what tier?

Every formulary categorizes medications into pricing tiers:

• Tier 1: Low-cost generics
• Tier 2: Preferred brands
• Tier 3: Non-preferred
• Specialty tiers: High-cost meds

To evaluate a plan’s medication coverage:

• Search for antidepressants, anti-anxiety meds, ADHD medications, or mood stabilizers.
• Confirm whether prior authorization or step therapy applies.
• Check copay vs. coinsurance pricing.

Because medications drive ongoing costs, this is essential when comparing health insurance for mental health.

If you’re not sure how to read the list, start with this explainer on what a drug formulary is and how tiers work so you can quickly find your medications.

7. What is the out-of-pocket maximum for mental health care?

Your out-of-pocket maximum (OOPM) limits what you’ll pay for the year, according to Healthcare.gov. Parity rules ensure that mental health and medical care share the same OOPM.

Lower OOPMs may make sense if you expect weekly therapy, specialty medications, or testing.

8. How does the plan cover emergency or crisis mental health care?

Review two areas of your SBC:

• Emergency Services
• Mental/Behavioral Health Inpatient Services

Important questions:

• Are out-of-network ERs covered at the in-network rate?
• What are the coinsurance costs after admission?
• Is stabilization covered before transfer?

Reliable health insurance for mental health should offer predictable crisis coverage.

9. Does the plan demonstrate compliance with mental health parity protections?

Signs of MHPAEA compliance include:

• No separate mental health deductibles
• No stricter therapy visit caps
• Comparable authorization rules
• Reasonable network access

Plans sold on Healthcare.gov must follow parity protections, while short-term or supplemental plans may not.

Comparison Table: What to Look for in Your Plan Documents

Bottom Line

Choosing health insurance for mental health is easier when you break coverage into clear, comparable elements using your SBC and drug formulary. 

• Ask about networks, teletherapy, medication tiers, visit limits, and authorizations to avoid unexpected costs or barriers to care. 
• If you rely on weekly therapy or ongoing prescriptions, take a close look at deductibles, OOPMs, and medication requirements. 

To see how access and coverage vary across the country, check out this data-driven ranking of the best states for mental healthcare.

Comparing plans with this checklist helps you enroll confidently in coverage that supports your mental wellness and your budget.