Look no further. You most likely are not aware that treatment for addiction and alcoholism are essential health benefits under the Affordable Care Act.
All plans must cover:
- Behavioral health treatment ( like counseling and therapy)
- Mental and behavioral health inpatient services
- Substance use disorder treatment (commonly referred to as alcoholism, addiction or substance abuse)
Your specific behavioral health benefits will depend on your state and the health plan you choose. You’ll see a full list of what each plan covers, including behavioral health benefits, when you compare plans in the Marketplace.
Pre-existing mental and behavioral health conditions are covered, and spending limits aren’t allowed
- Marketplace plans can’t deny you coverage or charge you more just because you have a pre-existing condition, including mental health and substance use disorder conditions (like addiction or alcoholism).
- Coverage for treatment of all pre-existing conditions begins the day your coverage starts.
- Marketplace plans can’t put yearly or lifetime dollar limits on coverage of any essential health benefit, including mental health and substance use disorder services (like alcoholism or drug addiction).
- Parity protections for mental health services. (parity is just a fancy word meaning “equal”).
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. In other words, treating addiction must be treated in an equal way, as if the person had diabetes or heart problems.
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 limits covered by 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
You still don’t believe me? This information is taken directly from the Whitehouse website. And, there is an important reason I am bringing this up, because there are some key dates to take note of.
Affordable Care Act: Key Dates
November 1, 2015 is when open enrollment begins. This means that on November 1st, you can enroll in a plan in the marketplace, where prices for insurance are competitive. Before this date, you can shop for plans and get an idea of what you need by visiting Healthcare.gov.
January 1, 2016 is the first day coverage begins. This means if you sign up for a plan by December 31, 2015, you will have insurance on January 1, 2016.
January 31, 2016 is the last day to enroll in a plan in the marketplace. If you don’t apply by this day, you won’t be covered for 2016.
If you don’t have some form of coverage for healthcare through work, another government program, or a spouse, you will have to pay a fine.
Can I Enroll for Care in 2015?
The deadline to enroll for 2015 was February 15, 2015. However, you may still be able to enroll if you’ve experienced certain situations. If you have had a major life event, such as marriage, divorce, birth, or loss of coverage, you can still enroll. The Healthcare.gov website has a tool you can use to see if you qualify for these special enrollment categories.
If you’re in a low-income bracket, you may qualify for insurance through a government program, such as Medicaid, Medicare, or CHIP. Medicaid and CHIP are programs that are free or very affordable for families, children, pregnant women, people over 65, or people with disabilities. Medicare is a program for seniors (people over 65). These programs have open enrollment year round, so you can apply at any time. If you need coverage for 2015 and you aren’t sure if you qualify, visit Healthcare.gov or call your state Medicaid program to see if you can apply.
In 2010, Congress passed the Affordable Care Act (ACA). The ACA has changed the way insurance and healthcare operate. The ACA is designed to give everyone access to quality, affordable healthcare, even people with preexisting conditions. The Supreme Court upheld the law in 2012.
The law covers many specifics on healthcare, including who is covered, what coverage individuals should receive from insurance companies and federal programs, and how much individuals should pay. Some key facts about the law are:
- An online marketplace is set up that offers a variety of options. It’s where people can shop for plans and compare prices.
- Insurance companies cannot drop or deny individuals healthcare because of preexisting conditions.
- Individuals can appeal decisions when insurance companies deny coverage for procedures or care.
- Businesses and individuals who choose a plan get a tax discount.
- Young adults can stay on their parents insurance until age 26.
- Insurance companies cannot discriminate against individuals based on gender.
- Under the ACA, individuals who don’t enroll in a plan will pay an annual penalty on their taxes. Each year has a specific enrollment period. In some cases, if you don’t enroll on time, you could be left without health insurance at a time when you may need it.
Millions of Americans are still without healthcare, but with the new law, there’s a marketplace where you can compare premiums, deductibles, and plan options. Make sure you plan ahead so you can apply in time, and make sure you understand when your healthcare plan begins. If you don’t apply in time or have a major life event, you may qualify even if you miss the deadline. Many people don’t realize that signing up for healthcare is required by law. You will be given a financial penalty or “fined” if you don’t.