Answer: The Affordable Care Act will provide one of the largest expansions of mental health and substance use disorder coverage in a generation, by requiring that health insurance plans on the Health Insurance Marketplaces cover mental health and substance use disorder services. These new protections will build on the Mental Health Parity and Addiction Equity to expand mental health and substance use disorder benefits and federal parity protections for behavioral health to 62 million Americans.
Because of the law, health plans must now cover preventive services like depression screening for adults and behavioral assessments for children at no cost. And starting in 2014, most plans won’t be able to deny you coverage or charge you more due to pre-existing health conditions, including mental illnesses.
Here are three steps you can take right now:
The Health Insurance Marketplace is designed to make buying health coverage easier and more affordable. Starting in 2014, the Marketplace will allow individuals and small businesses to compare health plans, get answers to questions, find out if they are eligible for tax credits for private insurance or health programs like the Children’s Health Insurance Program (CHIP), and enroll in a health plan that meets their needs.
The Marketplace Can Help You:
Open Enrollment begins in October 2013: Learn more and get ready!
Answer: Starting in 2014, health insurance plans in the individual and small group markets and Medicaid Alternative Benefit Plans must include coverage of essential health benefits, which include 10 categories of benefits as defined under the health care law. One of those categories is mental health and substance use disorder services. These plans must meet health and substance use parity, as set forth in the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), meaning coverage for mental health and substance abuse services generally cannot be more restrictive than those for medical and surgical services.
Answer: In general, for those in large employer plans, if mental health or substance use disorder services are offered, those services already are subject to the parity protections required under the Mental Health Parity and Addiction Equity Act (MHPAEA). And in 2014, for those in most small employer and individual plans, mental health and substance use disorder services will also become subject to the MHPAEA requirements.
If you have questions about your insurance plan, we recommend you first look at your plans’ enrollment materials, or any other information you received from the plan, to see what the coverage levels are for all benefits. Because of the Affordable Care Act, health insurers are required to provide you with an easy-to-understand summary about your benefits which should make it easier to see what your coverage is. Contact your insurance provider or your employer’s benefits administrator for more information or to ask questions.
More information may also be available with your state Consumer Assistance Program (CAP). In states where no CAP exists, there is a list of specific state resources.
Answer: All state Medicaid programs provide some mental health services and some offer substance use disorder services to enrollees. These services often include counseling, therapy, medication management, licensed clinical social work services, peer supports, and substance abuse treatment. While states determine which of these services to cover for adults, Medicaid requires that children enrolled in Medicaid receive all medically necessary services, including mental health services.
Answer: Yes, Medicare covers a wide range of mental health services.
Medicare Part A (Hospital Insurance) covers inpatient mental health care services you get in a hospital. Part A covers your room, meals, nursing care, and other related services and supplies.
Medicare Part B (Medical Insurance) helps cover mental health services that you would generally get outside of a hospital, including visits with a psychiatrist or other doctor, visits with a clinical psychologist or clinical social worker, and lab tests ordered by your doctor.
Medicare Part D (Prescription Drug ) helps cover drugs you may need to treat a mental health condition. Each Part D plan has its own list of covered drugs, known as formulary. Learn more about which plans cover various drugs .
If you get your Medicare benefits through a Medicare Advantage Plan (like an HMO or PPO) or other Medicare health plan, check your plan’s membership materials and call the plan for details about how to get your mental health benefits.
If you get your Medicare benefits through traditional Medicare (not a Medicare Advantage plan) and want more information, visit Medicare & Your Mental Health Benefits . To see if a particular test, item or service is covered, please visit the Medicare Coverage Database .