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4 Ways Obamacare Expands Mental Health and Substance Use Coverage

Posted Jan 24, 2017
By Jenifer Dorsey

4 Ways Obamacare Expands Mental Health and Substance Use Coverage

 

Mental health illnesses and substance use disorders touch many lives, both directly and indirectly. An estimated 1 in 17 Americans face a serious mental health illness, and more than 1 in 7 Americans ages 12 and older have a substance abuse problem.1,2  

Recovery and access to care play an important role in these lives. According to the Substance Abuse and Mental Health Services Administration, in recent years, a focus on recovery has “signaled a dramatic shift in the expectation for positive outcomes for individuals who experience mental and/or substance use conditions.”3 SAMHSA goes on to state, “Recovery is built on access to evidence-based clinical treatment and recovery support services for all populations.” 

It is said that Obamacare is helping expand needed mental health and substance abuse coverage to those who need it. At MentalHealth.gov, the U.S. Department of Health and Human Services, “The Affordable Care Act offers one of the largest expansions of mental health and substance use disorder coverage in a generation.”4

Here are four ways the healthcare reform law is working to help provide more Americans with access to mental health and substance use coverage:

1. Guaranteed issues health insurance

Health insurance companies can no longer deny you major medical insurance coverage or charge you more based on preexisting conditions; this includes mental illness and substance abuse. 

2. Essential health benefits

Most individual and small employer health insurance plans must cover mental health and substance use disorder services as well as rehabilitative and habilitative services. 

These services are among the Affordable Care Act’s 10 essential health benefits, which major medical health insurance plans offered on and away from the state-based and federally facilitated exchanges. 

Essential health benefits cannot be subject to annual or lifetime dollar limits.

3. Free preventive care

Major medical health insurance plans sold on and away from the state-based and federally facilitated exchanges must include certain free preventive services. That means insured individuals can access them for no additional cost beyond their monthly premium—even if they haven’t met their deductible. 

Mental health and substance abuse services included in this free preventive care are as follows: 

  • For adults5,6: alcohol misuse screening and counseling, tobacco use screening and cessation interventions for tobacco users—including expanded counseling for pregnant women, and depression screening
  • For adolescents7: alcohol and drug use assessments, depression screening for adolescents

4. Parity protections

Building on the Mental Health Parity and Addiction Equity Act of 2008, major medical insurance plans sold on and away from the state-based and federally facilitated exchanges must provide certain parity protections. 

This generally means that limits applied to mental health and substance abuse services cannot be more restrictive than those applied to medical and surgical services.8 This includes financial, treatment and care management limits. 

As part of the healthcare reform law, these parity protections are extended to an estimated 62 million Americans.

Mental health, substance use and other types of health insurance

Medicaid, the Children’s Health Insurance Program (CHIP), and Medicare all cover some mental health services. If you are insured through one of these programs, it is important to check with that program to confirm specific benefits.

If you have questions about mental health and substance use disorder benefits covered by your health plan, contact your insurance company. It is always important to check with your health insurance company to verify your health insurance benefits, whether you have job-based coverage, enroll in a plan sold through your state’s state-based or federally facilitated exchange, or purchase a health plan in the private marketplace.

 

Originally posted September 29, 2015


References

HealthCare.gov. “Mental Health & Substance Abuse Coverage.” https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage/

Substance Abuse and Mental Health Services Administration. “National Recovery Month.” http://www.recoverymonth.gov/

U.S. Department of Health & Human Services. “Health Insurance and Mental Health Services.” http://www.mentalhealth.gov/get-help/health-insurance/

1 Miller, Alan B. “Obamacare Has Been a Huge Help for Mental Health Care.” CNBC. Jan. 26, 2015. http://www.cnbc.com/2015/01/26/obamacare-has-been-a-huge-help-for-mental-health-care-commentary.html

2 CASAColumbia. “Addiction: The Unmet Need.” Last updated July 15, 2015. http://www.casacolumbia.org/about

3 Substance Abuse and Mental Health Services Administration. “Recovery and Support.” Last updated Oct. 29, 2014. http://www.samhsa.gov/recovery

4 U.S. Department of Health & Human Services. “Health Insurance and Mental Health Services.” http://www.mentalhealth.gov/get-help/health-insurance/

5 HealthCare.gov. “Preventive Health Services for Women.” https://www.healthcare.gov/preventive-care-benefits/women/

6 HealthCare.gov. “Preventive Health Services for Adults.” https://www.healthcare.gov/preventive-care-benefits/adults/

7 HealthCare.gov. “Preventive Health Services for Children.” https://www.healthcare.gov/preventive-care-benefits/children/

8 HealthCare.gov. “Mental Health & Substance Abuse Coverage.” https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage/

About The IHC Group
The IHC Group is an organization of insurance carriers and marketing and administrative affiliates that has been providing life, health, disability, medical stop-loss and specialty insurance solutions to groups and individuals for over30 years. Members of The IHC Group include Independence Holding Company (NYSE:IHC), American IndependenceCorp. (NASDAQ: AMIC), Standard Security Life Insurance Company of New York, Madison National Life Insurance Company, Inc. and Independence American Insurance Company. Each insurance carrier in The IHC Group has a financial strength rating of A- (Excellent) from A.M. Best Company, Inc., a widely recognized rating agency that rates insurance companies on their relative financial strength and ability to meet policyholder obligations. (An A++ rating from A.M. Best is its highest rating.) Collectively, the companies in The IHC Group provide insurance coverage to more than one million individuals and groups. For more information about The IHC Group, visit www.ihcgroup.com.

About IHC Specialty Benefits, Inc.
IHC Specialty Benefits, doing business as Health eDeals Insurance Solutions is a full-service marketing and distribution company that focuses on small employer, individual and consumer products. Health eDeals markets products through general agents online, telebrokerage, advisor centers, private label and directly to consumers. For more information about Health eDeals visit www.HealtheDeals.com.

Continue Reading: 4 Ways Obamacare Expands Mental Health and Substance Use Coverage


What is a Fixed-Indemnity Health Plan?

Posted Jan 20, 2017
By Jenifer Dorsey

What is a Fixed-Indemnity Health Plan?

Sometimes, just as you are getting a grasp on major medical plan lingo and how the coverage works, you come across yet another health insurance term you don’t quite understand. Let’s say, for instance, fixed-indemnity plan.

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Out with Obamacare? That’s Okay, There’s Still the Affordable Care Act

Posted Jan 19, 2017
By Jenifer Dorsey

Out with Obamacare? That’s Okay, There’s Still the Affordable Care Act

There’s a facebook exchange circulating online that essentially boils down to this: One user celebrates the imminent repeal of Obamacare only to reveal that he thinks his own health insurance is safe because he isn’t covered by Obamacare, he’s covered by the Affordable Care Act.

Continue Reading: Out with Obamacare? That’s Okay, There’s Still the Affordable Care Act


Is There Obamacare in 2017?

Posted Jan 19, 2017
By Jenifer Dorsey

Is There Obamacare in 2017?

President-elect Donald J. Trump made repealing and replacing Obamacare a key promise in his bid for the White House. Now, he is likely to do so with the help of Georgia Rep. Tom Price, one of the ACA’s most “outspoken critics” and Trump’s nominee to lead the Department of Health and Human Services.[1] Add a GOP-controlled house and senate to the equation, and it looks as though the Trump administration will successfully follow through with its mission.

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Under Pressure?

Posted Jan 17, 2017
By Jenifer Dorsey

Under Pressure?

2017 open enrollment ends on January 31 – just two weeks from now. There are many reasons people have put off purchasing coverage until the last minute, but uncertainty may be the common theme – uncertainty over the future of the ACA, uncertainty over which plan to purchase, uncertainty over what you can afford.

Continue Reading: Under Pressure?


Your Next 2017 Obamacare Deadline: Enroll by 11:59 p.m. on January 15

Posted Jan 13, 2017
By Jenifer Dorsey

Your Next 2017 Obamacare Deadline: Enroll by 11:59 p.m. on January 15

 

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What Can I Do If Obamacare is Too Expensive?

Posted Jan 11, 2017
By Jenifer Dorsey

What Can I Do If Obamacare is Too Expensive?

How affordable is health insurance under the Affordable Care Act? It depends on whom you ask. With monthly premium rates increasing an average of 25 percent nationwide for 2017 and soaring as high as 176 percent in places such as Phoenix, Obamacare keeps getting more expensive while options keep dwindling.[1] And, consumers are getting frustrated.

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Obamacare Buyer’s Remorse

Posted Jan 10, 2017
By Jenifer Dorsey

Obamacare Buyer’s Remorse

The clock is ticking on 2017 open enrollment, which ends on January 31. If you haven’t bought health insurance for this year, it’s time to get busy. But what if you already purchased a plan that started January 1 and you’re just not sure you made the right choice?

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Ask Frank: Can I Still Enroll in Health Insurance?

Posted Jan 09, 2017
By Jenifer Dorsey

Ask Frank: Can I Still Enroll in Health Insurance?

 

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What is a MEC Health Plan?

Posted Jan 03, 2017
By Jenifer Dorsey

What is a MEC Health Plan?

ACA. HSA. HDHP. PPO. HMO.* Health insurance terminology loves a nice abbreviation. Another one you may hear or see is MEC, otherwise known as minimum essential coverage, otherwise known as what the Affordable Care Act requires most Americans to obtain under the individual shared responsibility provision.

Continue Reading: What is a MEC Health Plan?