Health Insurance for Substance Abuse and Mental Health Quick Sheet:
- Millions of people with drug and alcohol abuse problems are now eligible for treatment through the Affordable Care Act.
- Under the Affordable Care Act, all health insurance plans are required to cover substance abuse treatment as one of 10 “essential health benefits” specified in the law. This elevates substance abuse services to the same level as pediatric care, cancer treatment, and childbirth.
- Drug and alcohol abuse should now be approached as a disease with the same protocols of screening, detection and preventative care as heart disease or diabetes.
- Substance use disorders, far less severe than addiction, are now covered.
- If you buy an insurance policy through the healthcare.gov site, the plan you pick will have mental health services as a part of the coverage. This is not optional, it is a mandate for the insurance policies.
- If you qualify for Medicaid (which had been greatly expanded) you will also have mental health and substance treatment services available to you.
- Open enrollment started November 15th.
- Open enrollment (for most) closes February 15th (see sheet at bottom of article). Enrollment for Medicaid is year round.
- 7 million eligible people with substance abuse or mental illness, still do not have healthcare. I learned this from a training. The link is here: SAMHSA Healthcare Webinar (it’s an hour and a half long)
Here are the provisions, as told by the Affordable Care Act website.
- Mental and behavioral health services are essential health benefits
- Health insurance plans available in the Marketplace must cover 10 categories of essential health benefits. One of these categories is mental health and substance abuse services. (Substance abuse is also known as substance use disorder.)
- These services include behavioral health treatment, such as psychotherapy and counseling. They also include mental and behavioral health inpatient services and substance use disorder treatment.
- Your specific behavioral health benefits will depend on the state you live in and the particular health plan you choose. You’ll see a full list of what each plan covers when you compare plans in the Marketplace.
- Mental and behavioral health and pre-existing conditions
- Marketplace plans can’t deny you coverage or charge you more just because you have a pre-existing condition. This includes mental health and substance use disorder conditions.
- Coverage for treatment of pre-existing conditions begins as soon as your Marketplace coverage starts.
- There’s no waiting period for coverage of these services.
- No lifetime or yearly dollar limits for mental health services
- Marketplace plans can’t apply yearly or lifetime dollar limits on coverage of essential health benefits. This includes benefits for mental health and substance use disorder services.
Parity protections for mental health services
- Marketplace plans must provide certain “parity” protections between mental health and substance abuse benefits on the one hand, and medical and surgical benefits on the other.
- This means that in general, limits applied to mental health and substance abuse services can’t be more restrictive than limits applied to medical and surgical services. The kinds of limits covered by the parity protections include:
Financial — like deductibles, copayments, coinsurance, and out-of-pocket limits
Treatment — like limits to the number of days or visits covered
Care management — like being required to get authorization of treatment before getting it.
Are you convinced that The Affordable Care Act provides one of the largest expansions of mental health and substance use disorder coverage in a generation? Also required (under the law) are rehabilitative services that can help support people with behavioral health challenges. 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. Plans cannot deny you coverage or charge you more due to pre-existing health conditions, including mental illnesses.
If you have questions about your insurance plan, look at your plan’s enrollment materials, or any other information you have on 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 including mental health benefits, which should make it easier to see what your coverage is.
All state Medicaid programs provide some mental health services and some offer substance use disorder services to beneficiaries. These services often include counseling, therapy, medication management, social work services, peer supports, and substance use disorder treatment. For additional information on Medicaid and mental health and substance use disorder services, visit: Medicaid Site
Here are three steps you can take right now:
Learn more about how you, your friends, and your family can obtain health insurance coverage by visiting HealthCare.gov.
Share this infographic with your friends, family, and colleagues so more people know about the mental health benefits accessible under the Affordable Care Act.
Find out more about how the law is expanding coverage of mental health and substance use disorder benefits and federal parity protections: Mental Health Parity
Some important information:
- You are required to enroll in a health insurance plan or you will be fined.
- If you miss the deadline and do not have coverage, you could be hit with fines of $325 per adult or 2 percent of family income, whichever is higher.
- The fine is actually not a bill that is sent to you, it is taken from your tax refund.
- You could file taxes in a way, so that you don’t receive a refund, however, you would need to do this every year.
Why is this information unknown to people:
The new health care law is complicated with lots of components applied different across state lines. People with substance abuse disorder just don’t know about the range of treatment options available to them. I hope after this quick guide, you have a better understanding of your benefits.