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:
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.
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.
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:
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.
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
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/
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