Questions About Health Insurance for Mental Illness
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Your health insurance should now give you access to mental health services and substance abuse treatment, plus preventative care such as screenings for depression. If you have questions about the ACA, also known as "ObamaCare," we have provided links and information on this page.
How does the Affordable Care Act help people with mental health issues?
The Affordable Care Act provides one of the largest expansions of mental health and substance use disorder coverage in a generation, by requiring that most individual and small employer health insurance plans, including all plans offered through the Health Insurance Marketplace cover mental health and substance use disorder services. Also required are rehabilitative and habilitative services that can help support people with behavioral health challenges. These new protections build on the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) provisions to expand mental health and substance use disorder benefits and federal parity protections to an estimated 62 million Americans.
Because of the law, most health plans must now cover preventive services, like depression screening for adults and behavioral assessments for children, at no additional cost. And, as of 2014, most plans cannot deny you coverage or charge you more due to pre-existing health conditions, including mental illnesses.
Does the Affordable Care Act require insurance plans to cover mental health benefits?
As of 2014, most individual and small group health insurance plans, including plans sold on the Marketplace are required to cover mental health and substance use disorder services. Medicaid Alternative Benefit Plans also must cover mental health and substance use disorder services. These plans must have 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. Another is rehabilitative and habilitative services. Additionally, these plans must comply with mental health and substance use parity requirements, as set forth in MHPAEA, meaning coverage for mental health and substance abuse services generally cannot be more restrictive than coverage for medical and surgical services.
How do I find out if my health insurance plan is supposed to be covering mental health or substance use disorder services in parity with medical and surgical benefits?
In general, for those in large employer plans, if mental health or substance use disorder services are offered, they are subject to the parity protections required under MHPAEA. And, as of 2014, for most small employer and individual plans, mental health and substance use disorder services must meet MHPAEA requirements.
Does Medicare cover mental health or substance use disorder services?
Yes, Medicare covers a wide range of mental health services.
Medicare Part A (Hospital Insurance) exit disclaimer icon 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) exit disclaimer icon 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 ) exit disclaimer icon 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.
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 or 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 exit disclaimer icon. To see if a particular test, item or service is covered, please visit the Medicare Coverage Database.
What is the Health Insurance Marketplace?
The Health Insurance Marketplace is designed to make buying health coverage easier and more affordable. The Marketplace allows individuals to compare health plans, get answers to questions, find out if they are eligible for tax credits to help pay 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:
Look for and compare private health plans.
Get answers to questions about your health coverage options.
Get reduced costs, if you’re eligible.
Enroll in a health plan that meets your needs.