Making the Most of Your Mental Health Insurance Benefits Before the Year Ends

Understanding Your Insurance: The Basics That Actually Matter

Insurance terminology can feel like it’s designed to confuse you. Let’s break down what these terms actually mean and why they matter for getting mental health care before the year ends.

What Is a Deductible?

Your deductible is the amount you must pay out of pocket before your insurance begins to cover services. Think of it like a threshold you need to cross before your insurance kicks in.

For example, if you have a $1,000 deductible, you’ll pay the full cost of your healthcare services until you’ve spent $1,000 total for the year. Once you hit that amount, your insurance starts helping with costs, usually through coinsurance or copays.

Here’s what matters right now: if you’ve already met your deductible this year (maybe you had surgery, a hospital stay, or you’ve been seeing other healthcare providers regularly), your mental health appointments for the rest of the year might be significantly cheaper than they would be in January when everything resets.

What Is a Copay?

A copay is a fixed amount you pay for a healthcare service after you’ve met your deductible. It’s usually a set dollar amount, like $30 per therapy session or $50 for a psychiatry appointment.

Copays are often different amounts for different types of services. Your copay for a primary care visit might be $25, while a specialist visit (which typically includes mental health providers) might be $50. The key thing to understand is that copays don’t usually count toward your deductible, but they do count toward your out-of-pocket maximum.

What Is Coinsurance?

Coinsurance is the percentage of costs you pay after meeting your deductible. If your plan has 20% coinsurance, you pay 20% of the service cost, and your insurance covers the other 80%.

So if a mental health appointment costs $200 and you have 20% coinsurance, you’d pay $40, and insurance would cover $160. This is different from a copay, which is always the same fixed amount regardless of the service cost.

What Is an Out-of-Pocket Maximum?

This is the maximum amount you’ll pay for covered healthcare services in a year. Once you reach this limit, your insurance pays 100% of covered services for the rest of the year.

Out-of-pocket maximums include your deductible, copays, and coinsurance, but don’t include your monthly premiums. For 2025, the maximum out-of-pocket limit for marketplace plans is $9,200 for individuals and $18,400 for families, though many plans have lower limits.

If you’re close to hitting your out-of-pocket maximum, any mental health services you get before December 31st could be completely free. 

Why End-of-Year Is Prime Time for Mental Health Care

The final months of the year create a unique opportunity to maximize your insurance benefits. Here’s why scheduling that appointment you’ve been putting off might make more financial sense right now than in January.

You’ve Already Paid Into Your Deductible

If you’ve had medical expenses earlier this year, you’ve likely made progress toward your deductible without even thinking about mental health care. Every doctor’s visit, urgent care trip, prescription, or medical test has been chipping away at that threshold.

Let’s say you have a $1,500 deductible and you’ve already spent $1,200 on healthcare this year. You’re only $300 away from having your insurance start covering a larger portion of mental health services. If you wait until January, you’re starting over at $0, and you’ll need to spend that full $1,500 again before getting the same level of coverage.

Your Out-of-Pocket Maximum Might Be Within Reach

If you’ve had significant medical expenses this year, you might be closer to your out-of-pocket maximum than you realize. Once you hit that number, your insurance covers 100% of additional services, which means mental health appointments could be completely free for the rest of the year.

Even if you’re not quite there, getting care now means those costs count toward next year’s out-of-pocket maximum if you continue care into January. You’re essentially getting a head start.

FSA and HSA Funds Expire (Sometimes)

If you have a Flexible Spending Account (FSA), those funds typically expire on December 31st. Some plans offer a grace period or allow you to roll over a small amount, but many operate on a use-it-or-lose-it basis.

Health Savings Accounts (HSAs) roll over indefinitely, but if you’ve been contributing all year and haven’t used the funds, now is a great time to invest in your mental health with money that’s already set aside.

Mental health services are eligible expenses for both FSAs and HSAs. Don’t let that money disappear when it could be supporting your well-being.

You’ll Start Fresh in January Anyway

Whether you start care now or wait until January, you’re going to be working toward next year’s deductible eventually. The difference is that starting now means you’re getting care during a time when your benefits might be working harder for you, and you’re not waiting another 4-6 weeks to address something that’s already affecting your quality of life.

Getting Started at Mile High Psychiatry

We’ve built our practice specifically to make mental health care more accessible for people throughout Colorado. We understand that dealing with insurance is stressful enough without adding the burden of trying to find a provider who actually takes your plan.

Telepsychiatry That Works With Your Schedule

All of our services are available via telepsychiatry, which means you can meet with your provider from home, from your office during lunch, or wherever you’re comfortable. No commuting, no sitting in waiting rooms, just direct access to care when you need it.

This is especially helpful during the busy end-of-year season when your calendar is packed with holidays and obligations.

Verify Mile High Psychiatry Is In-Network

We accept many major insurance plans in Colorado. You can check our participating insurance networks or contact our office directly, and we’ll verify your coverage and let you know what your expected costs will be before your first appointment.

Having this information upfront means no surprises and a clear understanding of what you’ll pay.