For Consumers

Your coverage rights for behavioral health issues

  Important! If you or someone you know is experiencing a mental health crisis, call, text or chat 988, the 988 Suicide and Crisis Lifeline (988lifeline.org) for immediate help.

If you have a mental health or substance abuse disorder, federal and Washington state laws require your health insurance plan to cover:

  • Behavioral health treatment (psychotherapy and counseling).
  • Inpatient, residential and outpatient mental health and substance use disorder treatment.
  • Prescription medication. 
  • Chemical dependency detoxification.
  • Services provided by a licensed behavioral health provider for a covered diagnosis in a skilled nursing facility.

What this means for you

Under mental health parity (leg.wa.gov), health insurers must provide you with the same level of benefits for mental health and substance abuse disorders, such as office visits, as they do for medical and surgical services. 

  • Your health plan’s deductible, copayments, coinsurance and out-of-pocket maximum must apply to all covered services, including mental health and substance abuse disorders.
  • Your prescription drug benefits must cover medications used to treat mental health and substance abuse disorder conditions just the same as other covered prescription drugs.
  • Health plans cannot create a blanket (also called “categorical”) exclusion for medically necessary mental health and substance abuse disorder services.
  • Your health plan can’t deny or limit your benefits for mental health and substance abuse disorder services based on your age, condition or because your treatment was interrupted, or you didn’t complete it.
  • If you’re experiencing an urgent mental health and substance abuse disorder crisis, health plans must make next-day appointments available to you.
  • U.S. military veterans can visit any Veterans Affairs or non-Veterans Affairs facility for free emergency mental health care.

Note: Mental parity laws do not apply to Original Medicare and Medicare Advantage plans.