Can I get individual health insurance with mental health coverage?

April 19, 2010 11:52 PM

Can I buy individual insurance with mental health coverage with a pre-existing condition?

I work for a small employer who reimburses employees for individual health insurance. My current health insurance policy has an exclusion on mental health coverage because it was/is a pre-existing condition. (I'm in the United States.)

I currently see a psychiatrist every few months, see a therapist weekly, and pay for prescriptions, all out of pocket.

Is it possible to get a policy that includes mental health coverage, given that I am currently receiving treatment for depression?

I have seen vague references to pre-existing conditions in articles about health care reform, but am unclear on the details. Will things be different a year from now?

Thanks.

posted by anonymous to health & fitness (6 answers total)

We have been in the private insurance market for about 5 years now...
Shop around. Insurers differ greatly in their treatment of mental health coverage. Our experience has ranged from one insurer capping mental health coverage to a $5000 lifetime benefit (including medications!), to our current insurer where we simply pay a $25 copay.

Some will accept your pre-existing condition immediately, some will impose a 6-month freeze on coverage, some will disallow it. As I'm sure you know, the private coverage market is a minefield when it comes to pre-existing conditions.

So, the short answer is "Yes" you most certainly can get coverage for a pre-existing mental health issue. You just have to shop around for it. And, your premiums might get bumped-up a bit for the privilege. You might want to look into finding an independent insurance agent who can do the searching for you.

FWIW, my current insurer (the one with the $25 copay) is Anthem. I don't know if they have a presence in your state. It's hella expensive, though. The one with the crazy lifetime cap rhymes with Molden Pool. As always, YMMV.
posted by Thorzdad at 4:24 AM on April 20, 2010

Some will accept your pre-existing condition immediately, some will impose a 6-month freeze on coverage, some will disallow it.

Some will outright deny you any coverage at all because of a pre-existing condition and you will have to disclose you've been denied whenever you apply to another insurer (if asked). Its going to be a few years (2014) until insurers can't deny adults for pre-existing conditions.
posted by Bunglegirl at 7:42 AM on April 20, 2010

True, though the trend will be to simply bump-up the premiums rather than outright denial for most conditions. We've already seen, when we transitioned from a previous private insurer to Anthem, Anthem allowed pre-existing conditions as long as we had a certificate of creditable coverage, just as if we were jumping from group to group policies. I think insurers know the private market is their growth market and don't necessarily want to poison the well too much. And I'm saying that not as a big fan of the insurance industry.

A history of cancer, to be sure, will probably still elicit denial. Our experience with mental health coverage, though, has been acceptance (of one sort of another). And that's the subject at-hand.

Hospitalization due to mental health issues may bring about denial, though.
posted by Thorzdad at 11:41 AM on April 20, 2010

It took me forever to find individual insurance with depression as a pre-existing condition - I also see a psychiatrist every few months, a therapist, and have medications. But it's out there, hard as it might be to believe. I got coverage with Aetna.
posted by cecic at 11:47 AM on April 20, 2010

I hate to be a downer but I had registered for insurance with Anthem; at first pass it was 200 something for pretty decent insurance. Once the underwriters found out I had biological depression they cut the coverage in half and jacked the monthly cost up to 650 dollars. They told me that had I not been a previous Anthem customer I would have been declined. I hope you have better luck, but it can be incredibly tough.
posted by zennoshinjou at 1:45 PM on April 20, 2010

I thought that in some states, insurance companies are not allowed to deny you coverage for pre-existing conditions, but I can't find a list of said states.

At any rate, even if you find a company that will provide you with coverage, they can still price it way, way out of your range. I used to be in the same situation as you and they wanted to charge me $1000/month just for THE PREMIUM. Absurd. I dropped my therapy and pay for my meds out of pocket. I spend between $300-$400 a month.

See if your therapist can cut you a deal, try to get enrolled in prescription assistance programs (although you may make too much to qualify, plus many of the programs are at capacity or no longer exist), consider switching to generics. I save $100/month by using a generic of one of my meds. It gives me a rash, but I need that $100 more than I need itch-free living.

I, too, am sorry to be a downer, but this inspires white-hot rage in me. I wish it were better for all of us.
posted by Fui Non Sum at 5:32 PM on April 20, 2010