The Affordable Care Act (ACA), also known as ObamaCare, has increased people’s access to mental health care. There are some significant benefits for those who need these services, especially on a regular basis.
Effects of the ACA on Mental Health Care
The existence of the Marketplace means that many more Americans have access to health insurance than they had before the passage of the ACA. Previously, unless a family had job-based insurance or qualified for Medicaid, private insurance was often unaffordable or otherwise unattainable. Many lower-income Americans, or Americans with jobs that didn’t offer insurance, were denied much needed mental health care. Due to the changes that came with ObamaCare, these same Americans now have much greater access to the care they need.
Health insurance available in the Marketplace must offer coverage for specific essential health benefits, including mental and behavioral health services and substance abuse services. This coverage requirement also holds true for new plans in the individual and small-group markets offered outside the Marketplace. However, essential health benefit requirements do not apply to the large-group market of companies that are self-insured. Many individuals with insurance already have access to mental health benefits in their current plans, although coverage varies.
Marketplace and new insurance policies cannot apply yearly or lifetime dollar limits to treatment that is an essential benefit, including mental health services. The ACA also mandates that Marketplace and new insurance plans cannot deny coverage or charge higher premiums for pre-existing conditions, including mental health and substance abuse. There is also no waiting period on coverage of existing conditions. As a result, many Americans who were previously unable to get coverage for their mental health or substance abuse needs will be able to be covered moving forward.
Understanding Health Insurance Parity
Mental health parity is a phrase that is often referenced when discussing health care and mental health. ObamaCare builds on existing mental health parity law that applies to many large group plans and mandates that Marketplace and most individual and small group health insurance plans provide certain “parity protections” between mental health and substance abuse benefits in comparison to medical and surgical benefits. This means that insurance plans generally cannot have more restrictive limits for one type of treatment than another.
The three areas this mandate impacts are:
- Treatment – the scope and duration of mental health benefits must be comparable to the scope and duration of medical benefits.
- Cost to Individuals – financial requirements must not be stricter for mental health treatment than for medical treatment, and plans can’t charge a separate deductible for mental health services, but keep in mind expenses vary by type of treatment.
- Care Management – insurance plans cannot require more authorization for mental health treatment than they require for other forms of medical care
Please be mindful that, despite more widespread access to mental health care, in-network and out-of-network restrictions still apply to mental health services. Since many office psychiatrists do not always accept insurance, it important that you check your mental health care network to be sure that a particular practitioner accepts your plan before choosing coverage. Your specific benefits will depend on the state you live in and the particular health plan you choose.
If Your Plan Doesn’t Comply With Mental Health Requirements
If you feel that your plan does not comply with ACA requirements regarding mental health or substance abuse treatment, you can file a complaint. Look at the plan’s coverage information to make sure you know what the treatment limits are for all benefits. Then contact the plan provider or administrator directly to voice your concerns. If that does not resolve the issue, you can contact your state’s Department of Insurance.
If you receive coverage through a self-insured private employer, you will want to direct your concerns to the Department of Labor, whom you can contact online or by calling 1-866-444-3272. If you are covered by a state or local government employer plan, contact the state’s Department of Health and Human Services by calling 1-877-267-2323 Ext 61565, or by email. Medicaid coverage concerns can be directed to the state’s Medicaid office.
The ACA has changed much about how Americans access health care — and that includes mental health care. With no lifetime limits on coverage, no exclusion of pre-existing conditions, and important parity guidelines, Americans who need mental health care or substance abuse treatment are positioned to get the care they need.