More of us are looking for professional help with mental health and substance abuse issues. Good news! Health insurance will pay to get that help.
Before the Affordable Care Act (aka Obamacare) was enacted, mental health coverage was often lacking from health plans sold for Under 65 Individuals and Families. Unfortunately, many still believe that’s so and aren’t getting the help they need. We want you to get that help and have it covered by your insurance.
Now, the Affordable Care Act requires all individual and small-group plans with effective dates of January 2014 or later to cover ten essential health benefits with no annual or lifetime dollar limits.
- Mental health and addiction treatment (collectively referred to as behavioral health services) are among the essential health benefits.
- There are co-pays for mental health specialists like Psychiatrists, Psychologists and Therapists just as you would have for a medical specialist like a Dermatologist or Oncologist. Some plans even allow the co-pay before your deductible is met.
- Prescription drugs are also an essential health benefit under the ACA. All new individual and small-group plans cover prescriptions, including medications to treat behavioral health problems.
- There is a range of Preventative Care that is covered at no cost to the patient. Among the benefits included are depression and alcohol misuse screening for adults and adolescents, as well as autism screening and behavioral assessments for children.
- Children can remain as dependents on their parents’ policy until age 26 whether they live with their parents or are married. (Their families are not covered). This is important because as Johanna Jarcho, Ph.D, a postdoctoral fellow at the National Institute of Mental Health explains, “the vast majority of mental health disorders do emerge during one’s adolescence or early 20s.”
- An Affordable Care Act plan must pay 100% of claims with no annual or lifetime dollar limits once the Out of Pocket Maximum is met.
In 2013, a person with a bipolar diagnosis was unable to obtain private individual health insurance in most states. The same was true for people with schizophrenia and other psychotic disorders, anorexia, alcoholism, and a variety of other serious mental or behavioral illnesses.
Even for people with relatively minor mental health diagnoses, health plans were allowed to increase premiums during the initial underwriting process, and some would still reject these applicants.
For those who had insurance, it often didn’t cover mental health care. According to a 2013 analysis conducted by HealthPocket, only 54 percent of individual health plans in the United State included coverage for substance abuse treatment, and 61 percent covered mental health treatment. (Coverage was better among employer-sponsored plans.)
The Affordable Care Act was a turning point in terms of access to behavioral health coverage. The ACA eliminated medical underwriting in the individual and small group markets starting in 2014, so medical history — including mental health history —no longer results in enrollment denials or higher premiums.
There are still access problems stemming from the fact that carriers can – and do – restrict their formularies (covered drug lists), despite the fact that mental health drugs appear to work differently for different individuals. But compared with pre-2014 when health plans could opt to not cover medications at all – or to only cover generic drugs – the ACA has made prescriptions much more accessible.
If you are still paying for a pre-2013 (Grandfathered) health insurance plan or have Temporary/Catastrophic health insurance or want to make sure your plan is giving you the coverage you need for mental health and substance abuse issues, call us, Jerry S. Pearlstein Insurance 847-362-8888. Our conversations are HIPAA covered and our services are free and without obligation. We want to help you to the best insurance and the best life.