Most individual and small group health insurance policies, including those provided via the marketplace, were required to include mental health and drug use disorder services as of 2014. Medicaid Alternative Benefit Plans must also include mental health and drug abuse treatment. Some policies may have limitations on coverage for certain types of treatments or require you to meet a time limit to be eligible to receive benefits.
The importance of having health insurance cannot be overstated. If you are unable to pay for medical bills or if you need to seek additional care because your existing providers were not able to provide what was needed, you will be in trouble if you lack coverage. Even if you think you will be able to pay for all or part of your expenses out of pocket, it is still important to have health insurance. If an emergency occurs and you cannot pay, then you will need to seek help from a medical provider who will accept insurance as payment.
If you are interested in learning more about how health insurance works, why it is important, and how it can be used to cover costs associated with mental illness, read our article on the topic. It contains information anyone who needs to make decisions about insurance coverage should understand.
All plans purchased via the Health Insurance Marketplace must offer 10 essential health benefits under the Affordable Care Act. These services include mental health and substance abuse treatment. All Marketplace plans, whether state or federally regulated, provide mental health coverage. That coverage can be in the form of medical assistance (MA), which pays for some behavioral health services, or comprehensive coverage (CC), which usually includes longer-term support groups and counseling sessions.
Mental health conditions are one of many optional benefits that may be added to an insurance policy. If you have a mental illness such as depression or anxiety and you need help paying for your medication or therapy, your insurer may cover this cost.
However, not all insurers will cover mental health treatments the same way they cover physical illnesses. Some policies may have a limit on how much money it will pay out for mental health treatments. Other factors may come into play, such as whether the therapist is part of your plan's network of doctors or hospitals, or if you live in an area where there aren't any providers who accept the policy you're given. You should know what your policy covers before you sign up for care so you don't get stuck with a bill you can't pay.
If you believe you need help managing a mental health condition but can't afford to see a psychiatrist or psychologist, there are other options available.
Is the Affordable Care Act applicable to those who have mental health issues? Yes. Most individual and small business health insurance policies, as well as all plans sold through the Health Insurance Marketplace, are required by law to include mental health and drug use disorder treatments. These services must be included in all policy forms issued on or after March 23, 2014.
The law requires that these benefits be offered at no additional cost to your policyholder and that they be provided by any insurer who offers coverage for other medical conditions. If an insurer fails to meet these requirements, you have the right to receive compensation from the company in a timely manner. The amount of compensation will be based on how much longer the insurer was required to offer these benefits, which is called "extended coverage."
So if you have a policy that does not cover mental health now, you should be able to obtain it through the Health Insurance Marketplace. You may want to consider purchasing this coverage if you can't afford it out-of-pocket. Extended coverage may also be available for people who already have health insurance but would like to add certain services such as addiction treatment or behavioral health care.