Presentation (CTI)

OBJECTIVES: The pluralistic nature of the US healthcare system results in disparate policies from public and private health insurers. While mental health is a clear priority, reflected in the requirement for individual and family plans sold through the Health Insurance Marketplace to include mental health services, coverage levels vary among insurers. This study aimed to identify the differences between public and private payment policies, coverage decisions, and clinical guidelines related to mental health.
METHODS: A targeted literature review was conducted on the main, publicly funded healthcare schemes and the top three largest healthcare insurance companies.
RESULTS: Medicaid and the CHIP are the largest national payers for behavioral health services, with CMS providing comprehensive details of its mental health policies in the public domain. Among these, Medicare Part B offers the most extensive services, including care planning, ongoing assessments, medication, counseling, and other recommended treatments.
In 2024, the top three private health insurers in the US were UnitedHealth Group, Elevance Health, and Kaiser Permanente. While private insurers demonstrate mental health coverage, details in the public domain are limited. Elevance Health provides the most transparency, offering evidence-based therapies for conditions like depression, alcohol abuse, infertility, and learning disabilities. Educational information is available on the link between chronic health conditions and depression, and the importance of telehealth during the COVID-19 pandemic. Similarly, Kaiser Permanente highlights its coverage of in-person and telehealth services, with information available on substance use disorders and childhood trauma linked to the pandemic. Conversely, UnitedHealth Group offers limited details, noting that mental health benefits vary by plan and provider.
CONCLUSIONS: Mental health coverage varies significantly between CMS and private insurers, leading to inconsistent access for patients. The limited transparency of private insurers’ policies highlights the need for greater consistency in mental health coverage across the US healthcare system.