Help paying for depression treatment: the official and nonprofit routes

A directory of helplines, government cost programs and nonprofit assistance services, taken from the organisations' own current pages. It is not medical advice and it names no medicine.

Start with who pays

"What will treatment cost me?" has more than one answer, because there is more than one payer. A helpline, a state program, an insurance plan and a manufacturer assistance program each answer a different version of the question.

SAMHSA's paying-for-treatment page opens by saying that understanding the costs of treatment can be hard, and that many programs take Medicaid, the Children's Health Insurance Program (CHIP), Medicare, Veterans Affairs health care or private insurance, with free and low-cost options across the country ¹.

If you need to talk to someone now

The 988 Suicide & Crisis Lifeline is reached by call, text or chat ², and its own site states that it is available 24/7/365 and that conversations are free and confidential ³. The Lifeline describes itself as being for people facing mental health struggles, emotional distress, alcohol or drug use concerns, "or just need someone to talk to" ⁴.

The free national helpline for treatment referrals

SAMHSA's National Helpline is 1-800-662-HELP (4357), with TTY 1-800-487-4889 ⁵. SAMHSA describes it as a confidential, free, 24-hour-a-day, 365-day-a-year information service in English and Spanish, and says it provides referrals to local treatment facilities, support groups and community-based organizations ⁶.

Free and low-cost treatment options

SAMHSA keeps a page titled "Free & Low Cost Treatment Options for Mental Health and Substance Use" ⁷. It opens with the statement that if you don't have insurance, or treatment is still too expensive with your insurance, there are ways to get help ⁸.

The routes it lists are the practical part:

• A sliding-fee scale. SAMHSA states that many professionals who treat mental health and drug or alcohol use offer a sliding-fee scale payment option, where the price paid depends on how much money you make, and suggests asking when you call to set up an appointment ⁹.
• Grants, scholarships or charity care. Where these exist, SAMHSA advises asking whether the program covers the entire time of your treatment and whether you would have to pay the money back if you don't finish treatment ¹⁰.
• Payment plans. SAMHSA notes that some professionals and programs offer them, and advises knowing the terms of when and how much you have to pay back ¹¹.
• Your state agency. SAMHSA suggests trying your state mental health and substance use agency for information on getting treatment without insurance ¹².

The same section carries a state-by-state Medicaid or CHIP search, so you can go straight to your own state's program ¹³.

Peer and family support is a separate route: NAMI's HelpLine is 800-950-6264, NAMI can also be reached by texting NAMI to 62640, and its site directs people in a crisis to call or text 988 ¹⁴.

If you have Medicare

Medicare.gov states that there are programs run by the states that can help lower Medicare costs, and its page covers eligibility, how to apply and other ways to save ¹⁵.

For drug coverage, Medicare runs Extra Help. Medicare describes it as helping people with limited income and resources pay Part D premiums, deductibles, coinsurance and other costs ¹⁶.

Some people get Extra Help without applying. Medicare states that it mails a notice to people who automatically qualify ¹⁷, and that this automatic qualification covers people who have both Medicare and Medicaid, people who are in a Medicare Savings Program (MSP), and people who get Supplemental Security Income (SSI) benefits ¹⁸.

Medicare Savings Programs are described by Medicare as help from your state paying Medicare Part A and Part B premiums ¹⁹. You apply through your state, which determines which program(s) you qualify for ²⁰. It also states that you may still qualify in your state even if your income or resources are higher than the federal limits listed ²¹, so the federal table on that page is not the last word.

Two more details are worth having in hand. You can apply for Extra Help and Medicare Savings Programs at the same time ²², and in most cases qualifying depends on income and resource limits that may go up each year ²³, so limits read last year are worth re-checking.

If you do not have insurance

HealthCare.gov, the federal Marketplace, lets you check whether you might save on Marketplace premiums or qualify for Medicaid or CHIP based on your income ²⁴. It is also explicit that the estimate is not the number: you get exact plan prices and savings when you fill out a Marketplace application ²⁵.

Prescription assistance programs

Separately from insurance, many manufacturers run patient assistance programs. RxAssist, a nonprofit directory, describes them as run by pharmaceutical companies to provide free medications to people who cannot afford to buy their medicine, and offers a database of those programs ²⁶.

These programs are usually specific to one medicine and carry their own eligibility rules, so the useful step is to search the directory for the exact medicine name a prescriber has in mind, then confirm the current terms on the manufacturer's own page.

What to have ready

Four things make these calls shorter: which program you are calling and whether you are asking about insurance, a state program or a manufacturer program ^{16 26}; your insurance card if you have one, or a clear statement that you do not ⁸; a rough household income figure, which the sliding-scale question and the Marketplace estimate both turn on ^{9 25}; and, for a payment plan or grant, the two questions SAMHSA suggests about covering the whole course of treatment and what happens if you stop ¹⁰.

Program names, limits and phone numbers change. Every statement above is bound to a source with the date it was read.

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RR Editorial, Real Depression Help. Questions about what treatment is right for you belong with a clinician; questions about what a prescription costs you belong with your prescriber, insurer and pharmacist.