Insurance Plans

“Our goal at Alma Y Salud is to remove the barriers that make navigating healthcare difficult.”

— Rebecca G.

HMO & PPO Plans

  • According to Orfield et al. (2015), an HMO Plan limits care to a specific group of in-network providers within a defined geographic area.

    Sullivan et al. (2022) explains that patients must work with these providers, including primary care doctors and specialists.

  • According to Orfield et al. (2015), a Preferred Provider Organization (PPO) plan has a network of preferred physicians, but you are not required to see them.

    The PPO plan provides more flexibility, allowing you to see any physician who accepts your PPO insurance (Orfield et al., 2015).

    Sullivan et al. (2022) explains that most people prefer a PPO plan because you typically do not need a referral to see a specialist or physician.

    However, a PPO plan has higher monthly rates than an HMO plan (Sullivan et al., 2022).

  • If you don't qualify for an HMO or PPO plan, you may qualify for Medicaid or Medical. Medi-Cal is for low-income individuals who meet the eligibility criteria, while Medicare is for people over sixty-five who also meet the eligibility criteria (Burns et al., 2016). Both programs provide coverage for various health services, including mental health (Burns et al., 2016). For more information, a quick web search will provide accessible, bilingual, and free eligibility consultation services

MEDICAID & MEDICARE

  • In California, Medicaid is referred to as Medi-Cal.

  • Medi-Cal and Medicare cover many levels of services in mental health, including therapy (U.S. Department of Health and Human Services, n.d.).

  • Medi-Cal is designed like an HMO plan and might require a referral or prior authorization for mental health services (Burns et al., 2016).

    • Start by visiting your primary care physician for a referral to mental health services (U.S. Department of Health and Human Services, n.d.).

Important questions to ask your providers!

Discussing with your provider what mental health services are covered under your insurance can be helpful. Conversations about your coverage can ensure transparency and assist you in accessing the right services. You and your provider can explore the best treatment options for you or your loved ones. It all starts with a conversation!

(Anxiety and Depression Association of America, n.d.)

How to find mental health services

  • You can do this by calling the behavioral health services or member services number on the back of your insurance card (Covered California, n.d.).

  • Search the insurance company with your state and the keyword member services for the number (Covered California, n.d.).

  • Log in to your health insurance website, create an account if necessary, and then search for the details of your plan's mental health benefits (Covered California, n.d.).

  • Contact the mental health provider directly and ask them if they accept your insurance

  1. Do I have a copayment?

  2. How many sessions are covered?

  3. Do I have a deductible?

  4. Can I use an out-of-network (OON) provider?

  5. Does my plan cover in-person or virtual sessions?

No insurance or under-insured?

We understand that for some of us in the LatinX community, it can be hard to enroll in health insurance for several different reasons.

Don’t let the lack of insurance keep you from finding the mental health services you need!

Here are a few resources…

  • Many neighborhood clinics offer mental health services at little or no cost (Sulzer et al., 2024).

  • Federally Qualified Health Centers (FQHC) provide free to no-cost health services for local residents (Lombardi et al., 2022).

    Click HERE to find an FQHC near you!

  • A sliding scale is when an organization briefly evaluates your income and ability to pay for their services. They establish a reasonable and fair price so you can access their services (Gandy et al., 2019).

In California, all commercial healthcare plans must cover mental health and substance use disorders. The law also requires health plans to arrange out-of-network services when in-network options are not available (American Psychological Association, n.d.).

You have the right to file a grievance if you cannot access mental health services through your healthcare provider (American Psychological Association, n.d.).

It's important to research the Mental Health Parity Law or Federal Parity Law of 2008 to understand your rights (American Psychological Association, n.d.). The LatinX community must actively participate in expanding our knowledge of accessing quality mental health services.

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