Submitted by Evening_Attention_45 t3_11dp16q in newjersey
I am moving from PA to NJ and need to select a new healthcare plan from the marketplace. It's ridiculous how high these prices are and I'm even getting a break due to my income.
Anyway, all of the Horizon BCBS plans make you pay out of pocket for therapists until you meet your deductible. That can't be right!
Can anyone recommend a plan that covers mental health
I figured therapy would just be a copay and that you wouldn't need to pay the entire deductible before insurance kicking in.
The definition of deductible is the amount an insured pays before the insurer pays anything.
Hi, yes. Just wondering how that relates to what I’m saying? I don’t think someone should have to pay their entire deductible before a therapy session is covered.
What you are writing makes no sense. If the insurer paid before the deductible was met, then it would not be a deductible.
What you want is an insurance plan with no deductible.
Insurance plans generally have exceptions where deductibles aren't applicable.. it would make medical insurance useless for most people if they had to pay out of pocket till the deductible was reached for everything.
I have never heard of that. In health insurance, the only things covered before deductible I have seen are preventative visits mandated by law.
I have been to PT and only paid a copay so I know that exists. Not sure which other kinds of treatment are covered typically. Your plan benefits guide will mention which items fall under the deductible and which are exempt.
The link you posted literally states exactly what I'm saying.
This is taken directly from the link:
Deductible
"The amount you pay for covered health care services before your insurance plan starts to pay. With a $2,000 deductible, for example, you pay the first $2,000 of covered services yourself."
I would need to pay $2,000 out of pocket before any of the insurance plan pays.
…right, because that is what a deductible is. My original response was to this statement:
> I figured therapy would just be a copay and that you wouldn't need to pay the entire deductible before insurance kicking in.
I explained why this is not a thing.
Literally every insurance plan on Marketplace has a deductible. Most insurances have a deductible. I'm not sure how you haven't experienced this or at the very least know that a deductible is extremely common.
Most of the plans available via Marketplace for NJ you have to pay 100% out of pocket until you meet the $2,000 deductible. Even for basic blood work.
Laboratory Outpatient and Professional Services $100 Copay after deductible.
I can tell you from experience, when I had BCBS Omnia Bronze through the marketplace they did cover blood tests without anything out of my pocket. They also paid toward doctors visits, including specialists, and I also did not pay for ultrasounds. My deductible was high, so I didn’t meet it, but I never paid for basic testing.
Okay hopefully that is the case with me. I’m 43 so maybe that’s why. Idk
I went through the whole thyroid cancer diagnosis + treatment + follow up experience with good old marketplace insurance, and it sucked, but it could have been way worse and they did pay for a lot of stuff. They never let me hit my deductible, which is bullshit (I was forever $7 short, somehow) and that’s a different gripe altogether, but they did pay a lot without hitting the deductible.
Hey, so I'm a therapist that accepts Horizon BCBS. Unfortunately, that IS considered mental health coverage. Once you've met the deductible, plans have varying levels of coverage and varying co-pays that you will owe per appointment, and therapists usually fall under the "specialist" rate for co-pay
It does suck that mental health visits are subject to deductibles. The best advice I can give is to look for a plan that's deductible isn't too, too high, and maybe start with therapy every other week until it's paid to space out the financial burden. I would strongly advise sticking with BCBS as your marketplace plan though and avoid Amerihealth, very few therapists in the state accept it.
Thanks! I'm been in Pittsburgh for years and have only had to pay $10 for each therapy session and I had good insurance through marketplace paying about $330 per month.
Oh wow, that is a great price! Sorry to hear you’re not finding anything comparable in NJs marketplace :(
Horizon BCBS is actually considered OMNIA via marketplace. I started looking on Psychology Today and many therapists say they don't accept OMNIA.
Are people using marketplace insurance plans not served by therapists?
That’s very strange to me, when I joined BCBS I wasn’t even given the option to not accept omnia, and most therapists I know who take BCBS accept omnia plans as well. I have several clients with marketplace plans.
Edit to add: omnia is a type of plan through horizon BCBS, and it’s also not exclusive to the markets place. Lots of employers offer omnia plans in nj.
This particular therapist specifically called out We do not take Omnia.
It’s a federal mandated benefit. Mental health has to be treated the same as any other illness. So the rest of those benefits on marketplace plans are subject to that same high deductible. That’s how they make it “affordable “. It drives most of the cost to the member. But if you see an in network provider the cost is discounted and you only pay what insurance allows so even though you’re paying upfront to meet the deductible it may not be as high as you’re thinking.
So this is even for in network providers. Even if it’s an in network therapist, you have to pay the full deductible before insurance will pay for any therapy sessions. There is a $50 copay for a specialist but mental health is not covered. It’s no wonder there’s a mental health crisis with insurance not covering therapy.
Which plan are you looking at ? Omnia silver has a 30 copay for mental health, no deductible. I’m sure it’s pricey depending on your age bracket.
That's the one I'm looking at. Omnia silver is a $30 copay AFTER the deductible is met. That means I need to pay the $2,000 deductible before I get to pay $30 for each visit.
The silver actually only charges that copay if your IP. An outpatient office visit is straight copay. Im an insurance broker in nj. I don’t write individual plans but I’m familiar with them. Hope this helps. Good luck.
Oh it is. I’ve been needing a therapist bad for a while but I can’t afford my deductible n I have the cheapest insurance
Look at Oscar. They do telehealth with no cost sharing.
I have clients that use Oscar for MH services, not sure where they purchased the plan. No deductible for MH, just a copay that ranges in price. Oscar is part of the United healthcare umbrella.
albaspotting t1_jaa8lal wrote
It's fairly common for health plans to have a deductible.