Are Mental Health Covered Under U.S. Health Plans?

health plans

All the Affordable Care Act-compliant plans are required to cover mental health according to both ACA and the Mental Health and Addiction Parity Act.

What is the Mental Health and Addiction Parity Act (MHPA)?

The MHPA Act was signed into law in 1996 to ensures that mental health issues are seriously taken as medical issues and health insurers provide comparable health insurance coverage for mental health, physical healthcare services, and substance use disorder. This law required that no annual or lifetime limits should be lower than any limits for medical or surgical benefits. However, in 2008, the MHPA was largely suspended by the Mental Health Parity and Addiction Equity Act (MHPAEA) that was in addition to the MHPA act and sought to fill the gaps that were left by the MHPA. According to the MHPA, no health plan was allowed to have either financial requirement on mental health coverage benefits or treatment limitations more restrictive than the financial requirements or treatment limitations for healthcare or surgical benefits.

ACA Role for Mental Health Coverage

All the marketplace plans under the Affordable Care Act are supposed to cover ten essential health benefits. Though some specific services may vary depending upon the state’s specific requirements. The ten essential health benefits of the ACA-compliant plans include:

  • Hospitalization
  • Emergency services
  • Ambulatory patient services
  • Pediatric services
  • Laboratory services
  • Mental health and substance use disorder services
  • Preventive and wellness services
  • Prescription drugs
  • Pregnancy, maternity, and newborn care
  • Rehabilitative and Habilitative Services

Thus, with ACA-compliant plans, individuals do have mental health services covered just as they can expect other essential services to be covered like hospital visits and prescription drug benefits. All the ACA-compliant health insurance plans should cover the ten essential health benefits. Though all plans are required to cover these benefits the plans can choose the way they will these benefits. The health insurance companies put a cap on the customers’ out-of-pocket spending on all the ACA-compliant plans, and they also place limits on annual or lifetime coverage for these services.

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Was Mental Health Covered Before?

Before the Affordable Care Act, most of the health plans sold on the health insurance marketplace was not offering coverage for mental health. Only the employer-sponsored health plans were offering mental health coverage. Besides, earlier individuals were also denied coverage based on their pre-existing medical conditions that also included their mental health conditions. Thus, individuals suffering from mental health problems were unable to find health insurance coverage or in finding coverage at an affordable rate. In addition to this, even marketplace plans were not allowed to put annual or lifetime limits on coverage of any essential health benefits that also included mental health and addiction services. It was due to the ACA, that individuals having a pre-existing or a history of mental health problems cannot be denied health coverage or charged higher premiums compared to others.

Mental Health Coverage with ACA-compliant Plans

Individuals can expect mental health coverage while having any of the ACA-compliant plans. Their plan may cover some part of the expense of mental health services as well as behavioral health services. If their ACA-compliant plans deny them comprehensive mental health coverage, then they should talk with their health insurance carrier or can make a formal appeal in writing. Besides, all ACA-complaint plans should also provide coverage for behavioral health services like psychotherapy and counseling, along with substance use disorder treatment. In addition to these, all plans also provide coverage for mental and behavioral health inpatient services. Individuals who require a lot of mental health services should opt for a higher metallic level plan like Gold or Platinum to enjoy more coverage.

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There are more chances of a therapist’s office visit to be out-of-network than a primary care appointment, so people should opt for a plan like a PPO plan that does not have high out-of-network costs. Individuals are advised so because there are more chances of their preferred mental healthcare provider to be out-of-network, or they may find it hard to find a therapist from the in-network of doctors.

Where to find a Plan with Mental Coverage?

Individuals can find health plans offering mental coverage as per their requirement on their state or a federal health insurance marketplace. Besides, they can also shop at leading health insurance portals to find a plan that offers mental coverage at best rates. People can start shopping at health insurance portals by stating their mental health coverage needs with any of their licensed health insurance agents who can suggest to them some really good plans in their budget.

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