How to Access and Afford Mental Health Treatment During the Coronavirus

If you are feeling heightened anxiety or depression, do not ignore your mental health. Signs you may need professional help include symptoms such as:

• Feeling depressed, sad, or tearful — often, not just occasionally.
• Trouble sleeping or sleeping more than usual.
• Loss of appetite or eating more than normal.
• Inability to concentrate.
• Loss of interest in activities you used to enjoy or participate in.
• Ruminating or feeling guilty — often, not just occasionally.
• Having trouble sitting still or feeling slowed down.
• Panic attacks, which are sudden feelings of fear, racing heart, shortness of breath, sweating, and shaking.
• Feeling so anxious that it interferes with your day.

If these symptoms persist for more than a few days, it’s time to seek help.

Depending on the nature and severity of the problem, a different level of mental health care may be appropriate.

Out of necessity, social distancing has sped up the adoption of telemedicine, including in mental health, where it may help reduce social stigma. The relaxing of federal regulations has made it possible to have visits over Zoom, FaceTime or Skype.

“We think about human connection as something that is done in person, and that's just not possible right now,” Plater-Zyberk of Supportiv says. “But authentic human connection doesn't depend on being face-to-face with someone. It depends on being honest and vulnerable and willing to share our feelings and thoughts and emotions with people. So it's just as possible today as it ever was. We just have to be willing to explore new channels of expression.”

Luckily, new channels exist to fit many different needs and budgets.

Free helplines staffed with trained responders are available if you or someone close to you is in crisis or needs help finding services.

• The National Suicide Prevention Lifeline is available 24/7 at 800-272-8255 or by chat.
• Samaritans also offers 24/7 crisis support via phone or text at 877-870-4673.
• Text HOME to the Crisis Text Line to text with a crisis counselor 24/7.
• NAMI offers a free, national peer-support helpline at 800-950-NAMI (6264). This is not a crisis line.
• The National Domestic Violence Hotline at 800-799-SAFE (7233) offers free and confidential support to anyone experiencing domestic violence, available 24/7.
• The National Sexual Assault Hotline at 800-656-HOPE (4673) provides free support for people who have experienced sexual assault and connects them with free services, 24/7, and offers an online crisis chat, also available 24/7.
• The federal Substance Abuse and Mental Health Services Administration (SAMHSA) offers a free, confidential national helpline at 800-662-HELP (4357), 24/7 and provides referrals and resources.

Some telemedicine platforms for primary or urgent care include mental health, while others are built specifically to address mental health needs and provide relatively cheap mental health services. Some platforms work with insurers, so you pay your regular copayment; most also offer per visit or monthly membership fees.

• Teladoc offers remote visits with a licensed therapist or psychiatrist. The first consultation cost varies, then users pay up to $99 per visit. Teladoc works with insurance, so your costs may be less.
• AmWell helps doctors offer telemedicine and provides direct online urgent care and teletherapy and psychiatry. Therapy visits can cost $85 to 99 per visit with a therapist, or $199 for a psychiatry evaluation and $95 for follow-up visits.
• MDLive offers access to trained mental health professionals and psychiatrists. Visits to treat addiction, bipolar disorder, depression, eating disorders, grief and loss, panic disorders, stress, trauma, PTSD and other conditions can cost $99 with a counselor or $259 with a psychiatrist. If your insurance works with the company, you may pay less.
• DoctorsOnDemand offers remote access to therapists and psychiatrists for $129 and $299, respectively, if you pay out of pocket. If you have insurance that participates, you may pay less.
• Plushcare includes treatment for anxiety and depression in their $14.99 monthly membership fee. Per visit, you pay either your insurance copayment or a flat fee of $99 for the first visit. You can access non-mental health services in their membership, but even if all you need is therapy, it may be a cost-effective option.
• LemonAidHealth is a telehealth platform that prescribes medications, including for depression and anxiety, under physician supervision. They do not work with insurers and charge a $25 consultation fee plus the cost of medications.

Peer support is when individuals who have made progress with their own mental health problems support others going through similar challenges.

• NAMI and Mental Health America provide free peer counselor training.
• Supportiv is a peer-support network that matches people into groups in real-time, based on the type of struggles they’re facing. Trained facilitators moderate each group to ensure users’ safety and make referrals if necessary.
• 7 Cups of Tea offers free peer support via chatrooms and an online forum, as well as paid access to therapists five days a week.

Mental health services can be costly, and even people with health insurance can struggle to find affordable options. Parity laws requiring mental health benefits to be equivalent to medical benefits do not always work.

“It’s very much just a function of the market,” explains Dr. Rosenquist, a Ph.D. in applied economics from the University of Pennsylvania’s Wharton School. “If you look at reimbursement rates for mental health care, even with the advent of parity laws, the relative reimbursement rates for a unit of service pales in comparison even to other primary care specialties.” That makes it hard for practitioners to maintain a viable practice if they accept insurance. In turn, mental health services cost consumers more out of pocket if they can afford it at all.

Still, there are options to make mental health services more affordable, depending on your health insurance status.

Publicly funded programs offer a safety net for people without private insurance.

MEDICARE Medicare — the federal insurance program for Americans 65 years and older and some younger people with disabilities — is not a single, free program but a patchwork with different costs.

• Medicare Part A includes coverage for psychiatric hospitals or mental health-related hospital admissions. Services are subject to a more than $1,400 deductible for hospitalizations, coinsurance for long-term stays that last more than 60 days, and 20% of mental health service costs from doctors and other providers while you’re in a hospital.

• Medicare Part B is non-hospital coverage that includes an annual depression screening in a primary care clinic or doctor’s office, individual and group psychotherapy, family counseling, testing and evaluation, medication management and outpatient services for substance use disorder. These services are subject to the Part B deductible and other enrollee costs. Medicare enrollees pay 20% of the Medicare rate for visits to appropriate providers and may be subject to copayments or coinsurance.

• Medicare Part D is supplemental prescription drug coverage, including psychiatric medications. Among the nearly 1,000 stand-alone Part D plans offered in 2019, costs vary widely depending on where you live and what type of coverage you want. Premiums range from $12 to nearly $200 per month. Part D plans typically include a deductible, copayments or coinsurance and different coverage phases, ultimately including catastrophic coverage, which kicks in once enrollees have spent $6,350 out-of-pocket in 2020.

MEDICAID

• Medicaid is the public health insurance program that covers about one-fifth of adults under age 65 with mental illness and funded 25% of all mental health treatment and 21% of all addiction treatment in 2014. Behavioral health conditions qualify some adults as disabled and eligible for Medicaid.
• If you have a very low or no income, you might qualify for Medicaid. To apply, visit your state Medicaid agency or insurance marketplace. You can start with Healthcare.gov or your state government website to avoid insurance fraud.
• Medicaid typically offers a narrower selection of providers compared to private insurance, but benefits are comprehensive and free or very low cost. Medications, if you need them, may be free or available for very low copayments.

FREE CLINICS AND COMMUNITY HEALTH PROGRAMS Free and low-cost treatment for people is available through community-based and public programs. Community-based options may include federally qualified health centers, community mental health centers, public hospitals and health departments.

Employers must increasingly face the rising cost of mental illness, and most employers now offer mental health benefits in their employer-sponsored health insurance.

If you have a job, your employer may offer an employee assistance program (EAP) to provide support, resources and counseling. Anxiety, stress, financial worry, substance use and addiction and trauma are among the issues EAPs tend to support. EAPs are usually free to employees, so it could be a significant first step. If you’ve recently lost your job, or face a job loss, ask your employer if you can keep using the EAP.

COBRA If you lose your job or you’re furloughed and lose your health benefits, you may be eligible for the Consolidated Omnibus Budget Reconciliation Act, commonly known as COBRA. COBRA can be very expensive, and may not be the best option unless you need maximum flexibility or access to specialty providers. Though you’ll have to pay the full premium, under COBRA, your mental health costs should otherwise be the same as when you were employed.

Many mental health providers in private practice do not accept insurance but are free to set their own rates and to negotiate those rates. Established therapists with busy practices may be less willing to reduce their fees, but if you have an existing relationship, they may be more flexible. If money is an obstacle for you, speak up. Even if they don’t lower their fees, you might be able to manage costs with less-frequent visits or shorter sessions.

If you’re struggling right now, you are not alone, but it can be hard to ask for help. Plater-Zyberk says, "The more practice that you can give yourself in asking people for help, the more natural it will become to ask for help about your mental health."

Start with groups like NAMI, DBSA and other organizations.

• The Substance Abuse and Mental Health Services Agency (SAMHSA) offers directories of addiction services and mental health providers.
• The National Association of Free and Charitable Clinics similarly offers clinic listings.
• Nonprofit Thero has crowdsourced a directory to connect mental health providers with people in need.

Dr. Rosenquist believes that "the need for people to have access to mental health care will likely be a powerfully held belief by many more Americans going forward." Hopefully, one of the most important outcomes of COVID-19 will be increased awareness of the importance of affordable mental health care access.