New Year, New Coverage: Your Minnesota Guide to Insurance That Supports Real Mental Health Care

The end of the year brings a strange mix of reflection and planning. For many people in Minnesota, it also brings one of the most important parts of healthcare, choosing the right insurance plan. Open enrollment can feel confusing even for people who work in health care, and it becomes even more overwhelming when you are trying to stay consistent with therapy, medication management, an ADHD evaluation, or other mental health needs. Your insurance plan determines how smoothly your care will continue into January, and it affects your budget more than most people realize.

This is why understanding your options before January first makes such a difference. A little bit of preparation now can prevent surprise costs, gaps in care, pharmacy delays, and new year headaches that nobody has the patience for.

Understanding what your plan actually covers

Insurance language can feel like a different dialect, but the basics matter.

Your premium is the amount you pay monthly to keep your coverage active.

Your deductible is the amount you pay before your plan begins to contribute.

Your copay is the set charge you pay every time you see a provider or fill a prescription.

Coinsurance is the percentage you pay once you have met your deductible.

Finally, your out of pocket maximum is the most you will pay in a single year. Once you reach that cap, most plans begin covering care at one hundred percent.

Knowing these pieces helps you pick a plan that makes sense for your life. Someone who uses mental health care frequently may save money by choosing a slightly higher premium in exchange for lower deductibles and smaller costs at each visit. Someone who rarely uses care may prefer a lower monthly premium even if their deductible is higher. There is no “perfect” plan, but there is a plan that matches your realistic needs.

Open enrollment in Minnesota

In Minnesota, most people choose or update their plan between November first and January fifteenth. Coverage then starts in either January or February depending on when you enroll. Missing this window means you may be locked out of making changes until the next open enrollment period unless you qualify for a special enrollment event like moving, losing employer coverage, or a major change in family status.

Because mental health care depends on consistency, it is important to know if your current providers remain in network. A plan might look good on paper but could cost you far more in the long run if your psychiatrist, therapist, or an ADHD testing provider is not covered.

Avoiding coverage interruptions

Every year we see patients who discover in January that their plan changed without them realizing it. Their medications suddenly require new approvals, their copays doubled, or their provider is no longer in network. These disruptions slow down care that should be continuous.

The easiest way to avoid this is by checking the details now. Look up your provider’s name on your plan’s website. Confirm that Mending Mental Health is still in network under the new plan (we take most plans, so it’s unlikely that we are not in network). Review whether your pharmacy benefits are staying the same. If you already know you are going to need ongoing treatment, choose a plan that will support that from day one of the new year.

Forecasting your mental health needs

The best insurance decisions involve looking ahead. Ask yourself a few questions.
Do you expect to continue therapy next year?
Will you need medication management once a month or once every three months?
Are you planning ADHD testing, genetic testing, or a medication change?
Are you on medications that often require prior authorizations?

Thinking through these needs now helps you match your plan to your actual life, not the life you hope you will have.

Prior authorizations explained in simple terms

A prior authorization is approval from your insurance company that confirms a service or medication is medically necessary. Without this approval, many services are not covered.

If you change insurance plans at the new year, your old approvals do not transfer. They reset completely. The new insurance must review and approve everything again. This is a point most people do not learn until a pharmacy rejects their refill or a test appointment suddenly gets postponed.

At Mending Mental Health we process authorizations quickly, often the same day or within twenty four business hours. Our approval rate is roughly 98%, which is significantly higher and faster than many larger clinics. Our workflow is streamlined, and we maintain strong communication with all major Minnesota insurance plans to minimize delays. This helps you stay on track with treatment even when your insurance changes.

Choosing a plan that supports your mental health care

Mental health and psychiatry services are not add ons. They require predictable access, clear coverage, and timely authorizations. When comparing insurance plans, pay close attention to the mental health section. Look for coverage of psychiatric appointments, therapy visits, ADHD testing codes, medication management visits, and telehealth benefits.

Plans that offer better mental health coverage often save money in the long run. Lower copays, lower deductibles, and easier authorizations can make a measurable difference in your care throughout the year.

Costs, budgeting, and planning ahead

Many people underestimate how much their mental health care protects their quality of life. When reviewing your plan, look at total annual costs rather than just the monthly premium. Consider the number of visits you expect to attend. Consider pharmacy costs. Look for out of pocket maximums that feel realistic. These details help you plan and prevent financial stress later.

Minnesota changes for the upcoming year

Each year brings small adjustments to rules, networks, prescription coverage and mental health benefits. Stay updated by reviewing information from MNsure, your specific insurer, and your employer’s benefits portal if applicable. These changes may affect testing coverage, telehealth rules, and medication authorizations.

Staying informed now helps you avoid surprises in January. It keeps you connected to your providers and ensures your care continues without interruption.

Final thoughts

Choosing insurance is rarely fun, but it is part of taking care of yourself. The right plan supports your progress, it shouldn’t disrupt it. At Mending Mental Health we can help you make sense of your benefits, check your codes, and prepare any authorizations needed for the new year. Starting with a solid plan gives you stability, clarity, and better care in the months ahead.

Recap

• Minnesota open enrollment runs November first through January fifteenth

• Always confirm that Mending Mental Health is in network for your new plan

• Review premiums, deductibles, copays, coinsurance and out of pocket maximums

• Mental health and psychiatry benefits can vary widely between plans

• Prior authorizations reset when you change insurance

• We process prior authorizations same day or within twenty four business hours

• Our approval rate is roughly 98%

• Choose a plan that supports therapy, psychiatry, ADHD testing and telehealth

• Review pharmacy benefits and coverage for your current medications

• Consider total annual cost, not just your monthly premium

Frequently asked questions

What happens if I switch plans and my provider is no longer covered?
You may have higher out of network costs or lose coverage entirely. Always verify in network status before switching.

Do prior authorizations carry over when I switch plans?
No. They must be resubmitted and approved by the new plan. That is why planning ahead is so important.

How do I know if my new plan covers ADHD testing?
Check for testing codes 96132 and 96133. Ask your insurer to review these codes for your benefits.

What if I forget to enroll by the deadline?
You may need to wait until next year unless you qualify for a special enrollment event.

How can I avoid unexpected costs in January?
Review your plan’s summary of benefits, confirm provider network status, and ask about changes to pharmacy coverage.