When looking for the right insurance plan, more people than ever before are checking for mental health benefits. Why? They realize taking care of your mental health is as important as taking care of your physical health. If you had high blood pressure, caught a virus, or broke your arm, you wouldn’t hesitate to see a doctor. As social stigma around mental healthcare wanes, more and more people in the U.S. are seeking professional help for mental health issues that interfere with living a healthy, fulfilling life.
Research shows it’s working. The American Psychiatric Association reviewed studies on the effectiveness of therapy and found that 75% of people who get therapy show some benefit.
Many people may not know their insurance covers therapy or that it may not cost as much as they thought. If you have coverage with Tufts Health Plan, keep reading to learn about the mental health benefits your plan offers, how to check your coverage, and where to find an in-network therapist.
Does Tufts Health Plan Cover Mental Health Services?
Yes, Tufts Health Plan provides members with multiple resources to support their mental health. They primarily serve members in Massachusetts, but also cover members in Connecticut and Rhode Island.
Therapy Tufts Health Plan Covers
Tufts insurance covers therapy for many concerns, both in-person and virtual providers, for their Massachusetts members. While coverage varies based on the plan, here are a few of the conditions that are typically covered:
These are some of the types of therapy modalities covered:
- Dialectical Behavioral Therapy (DBT): Therapy that focuses on skills-based training (like mindfulness, interpersonal communication, emotional regulation, and stress tolerance) to improve well-being.
- Cognitive Behavioral Therapy (CBT): Therapy that helps people understand and work on helpful thought and behavior patterns.
- Family/Couples Therapy: Families or couples attend therapy together.
- Group Therapy: Therapy and counseling for a small group of people. Some groups are designed to address specific issues such as depression, obesity, or grief.
- Early Intensive Behavioral Intervention (EIBI): Services for eligible children under three years old who have autism.
- Inpatient Mental Health Services: Treatment in a hospital for acute psychiatric conditions.
- Rehabilitation for Substance-Use Disorders: Residential treatment for people recovering from alcohol or other drug problems. Includes individual and group therapy.
What Therapy Tufts Health Plan Does Not Cover
Tufts Health Plan doesn’t cover experimental treatment or treatment deemed not medically necessary. They also exclude therapy in non-conventional settings such as spas, educational or vocational settings, wilderness retreats or camps.
How to Check Your Tufts Health Plan Insurance Coverage
You have a few options to check out the mental health benefits of your specific plan.
Online
Log in to the member portal online and search for your Summary of Benefits + Coverage (SBC).
If you don’t already have a username and password, you can create one using information from your insurance ID card.
Phone
You shouldn’t hesitate to call member services if you have any questions about what you found online. If searching online isn’t your thing, you can always call and ask for an explanation of your mental health benefits.
How Much Does Therapy with Tufts Health Plan Cost?
We’ll break it down so you can navigate your plan benefits like a pro. A few elements of your health plan determine how much you’ll pay for therapy:
Plan Type
Your insurance card will tell you what type of plan you have (e.g. HMO, EPO, PPO. POS).
The specific plan you have determines your deductible, copay, co-insurance, and the covered network of providers you can see.
POS: Point of service
HMO: Health Maintenance Organization
PPO: Preferred Provider Organization
EPO: Exclusive Provider Organization
Most plan types require a referral from your primary care physician (PCP) to see a specialist. However, you don’t need a referral to see a therapist. One less step to contend with.
As far as cost goes, you can think of it like this: usually, the lower the monthly premium, the higher the copayments/coinsurance, deductibles, and out-of-pocket maximums. Tufts Health Plan offers multiple plans at varying price points.
Tufts Health Plan is one of the few health plans in Massachusetts to participate in the commercial, Medicare and Medicaid/subsidized markets, offering coverage across the life span regardless of age or circumstance.
Deductible
Your deductible is how much you have to pay for covered healthcare services before your insurance kicks in and starts paying your medical expenses (except for free preventive services, like wellness checkups). Typically, the lower the deductible, the higher the monthly premium.
Copays
Co-pays are small payments that you pay your therapist for each of your therapy sessions, usually around $20-30. Copays generally don’t count toward meeting your deductible.
Co-Insurance
Co-insurance is the percentage of your healthcare costs you will pay after your deductible is met. For example, say your deductible is $1,500 and your co-insurance 20%. You pay 100% of your healthcare expenses until you reach $1,500. After that, you’ll pay only 20% of expenses until you reach your out-of-pocket maximum or the end of the year.
Out-of-Pocket Maximum
The out-of-pocket maximum is the most you will have to pay for covered services in a year. If you reach this amount, any more allowed healthcare expenses will be covered 100% by your insurance.
In-Network vs Out-of-Network Providers
What is the network? Insurance companies negotiate rates with providers. Providers who agree to those negotiated rates are part of the network. Some plans pay for in-network providers only. POS and PPO plans cover both in-network and out-of-network therapists.
Keep in mind that out-of-network providers usually cost more because they don’t have negotiated rates with your insurance provider. Also, if your plan covers out-of-network therapists, the insurance will pay around 50-70% of the therapist’s fee.
How to Find a Therapist who Takes Tufts Health Plan
Online Directory
If you’re looking for a therapist that participates in the network, go to their website. Click “Find a Doctor or Hospital” on the top right. Tufts Health Plan members can log in and search the network associated with their plan.
Customer Service
If you’d like help searching for an in-network therapist, give the member services number (on the back of your ID card) a call. You can also find a plan-specific directory of member services numbers.
For people new to Tufts who already have a therapist, log in to your member portal and search for your provider’s name. If your provider is not in the network, call the member services number on the back of your ID card. They can call your provider to ask if they’ll join the network or can help you find an in-network professional who is a good fit for you.
Employee Assistance Program
Some employers offer Employee Assistance Programs (EAP) included with their health plans. Tufts Employee Assistance Programs provide treatment for substance abuse, mental health benefits, and professional counseling for personal problems. Services are available at no cost to you 24-hours a day, seven days a week. Their representatives can help you get counseling for family problems, stress-related disorders, marital difficulties, or financial problems.
Consider Tele-therapy
If your plan allows, you may want to consider using Tufts’ telehealth service. It gives you 24/7 access to an in-network counselor by phone, web, or mobile app. Find out more at here.
Grow Therapy
Through the Grow Therapy marketplace, you can not only find an in-network therapist, but you can also book your session directly on the provider’s profile.
Find a Tufts therapist
Inpatient Services for Substance and Alcohol Use Disorder
Tufts Health Plan also covers you when you need inpatient treatment or help with substance or alcohol use disorder.
Inpatient Care
For access to inpatient care, you have some options:
- Call member services at the number on the back of your card to learn what inpatient behavioral health facility is covered under your benefits.
- Search for a mental health facility on the Tufts home page. Tufts Health Plan contracts with inpatient behavioral health facilities that are not on our designated facility list.
- Go to the Emergency Room. If you feel you need immediate inpatient care, you can go to the nearest emergency room (ER) for an evaluation. The ER team will then contact Tufts Health Plan to determine the next steps based on your clinical needs and your coverage.
Treatment for Substance and Alcohol Use Disorder
Tufts Health Plan can connect you with a local treatment program. These programs offer many advantages:
- Your personal support system can be involved in your care.
- You can stay in treatment longer if you need it.
- Nearby physicians and therapists can help you stay on track.
- Your Tufts Health Plan includes high-quality care options and resources, all covered.
Get Support
When your mental health is suffering, it’s hard to take steps to get the help you need. Take courage. Help is right around the corner; you don’t have to suffer alone anymore. Find a therapist and get on the path to feeling good.
