Do you have a mental health condition such as depression but lack a job that offers health insurance? If so, the Affordable Care Act, also known as Obamacare, may help. The law requires health insurers to cover mental health just like they would cover other health conditions, such as high blood pressure, diabetes or pneumonia.
Most group health insurance plans provided by employers cover mental health and substance abuse treatment, but 90 percent of people with serious mental illnesses are unemployed and unable to get this coverage, according to an analysis of health care reform by the Judge David L. Bazelon Center for Mental Health Law.
But experts say the Affordable Care Act, which goes into full effect in January of 2014, will make it much easier for individuals with mental health conditions to buy individual insurance. It will require plans sold in the health insurance exchanges, or marketplaces, to cover mental health in exactly the same way they cover other health care. Additionally the law will increase access to government programs such as Medicaid.
“It really will afford people an opportunity they haven’t had – and give them peace of mind,” says Debbie Plotnick, senior director of state policy for Mental Health America.
Will Obamacare expand coverage of mental health care?
Here are four key ways that Obamacare changes mental health coverage:
1. People with preexisting mental health conditions will be able to buy insurance -- and won’t be charged more.
Many consumers with preexisting conditions, including those related to mental health, have been denied individual insurance on the open market, experts say. According to the U.S. Government Accountability Office, preexisting conditions can include:
• Bipolar disorder.
• Suicide attempts.
• Addiction to substances such as alcohol, cocaine, barbiturates or prescription painkillers.
But the Affordable Care Act requires insurers to accept consumers with preexisting conditions when the health insurance marketplaces open in October 2013. The marketplaces, called exchanges, will be operated in each state by either the state or federal government and will offer individual and small group health insurance plans. And, insurers no longer will be able to charge consumers with preexisting conditional higher premiums. “This will be a welcome change,” says Chuck Ingoglia, senior vice president of public policy for the National Council for Community Behavioral Healthcare.
2. Any plan you buy in a health insurance exchange will provide mental health care.
Right now, many individuals who buy their own insurance do not have mental health or addiction coverage in their plans – or, if they do, it’s often skimpy, experts say. According to the U.S. Department of Health and Human Services, 34 percent of individual plans don’t cover substance abuse treatment, 18 percent don’t cover mental health services and nine percent don’t cover prescription drugs.
Obamacare requires that all plans sold in the exchanges offer coverage that includes 10 essential health benefits. These benefits include:
• Mental health and addiction services, including outpatient services such as counseling.
• Inpatient services such as hospitalization for psychiatric illnesses.
• Prescription drugs, which include anti-depressants and other psychiatric medications.
• Rehabilitative and habilitative services, which could include housing and employment support to help patients function in the world, Ingoglia says.
And just like in group plans that offer mental health benefits now, mental health coverage must be equal to other health coverage in all plans sold on the exchanges. For example, there can’t be differences in the number of visits allowed for mental health services versus other services. Copayments and coinsurance, which are amounts the patient pays toward a service, must be equal for mental health coverage.
Also, the way services are managed, such as whether pre-authorization is required for a visit, also must be the same, Ingoglia says. For example, he says, a hospitalization for a psychiatric illness can’t be treated differently by a plan than a hospital stay for another type of illness.
“These plans will cover the same kinds of services that most employers cover now,” Ingoglia says.
3. There will be no annual or lifetime caps on mental health care.
Before the Affordable Care Act, insurance companies could impose annual and lifetime limits on the dollar amount of services policyholders could receive. But health care reform prohibits insurance companies from imposing lifetime or annual limits on essential benefits such as hospital stays. “This is important to anyone with a disability or chronic illness,” Ingoglia says. He also notes that mental health disorders and addiction can be chronic conditions. “People will require lifetime support if they struggle with chronic illness.”
4. More people who need mental health care will have access to Medicaid.
Medicaid is geared toward low-income individuals and people with disabilities, so it can be the best health insurance option for people with psychiatric disabilities, according to the Bazelon Center report.
The Affordable Care Act will allow many more people to get Medicaid by making income the only criteria for eligibility in states that expand Medicaid. Anyone with a household income of less than 133 percent of the federal poverty level, or $15,282 for one person and $31,322 for a family of four for 2013, will qualify.
However, a 2012 Supreme Court decision allows states to opt out of expanding Medicaid. In states that decided not to expand Medicaid by 2014, some low-income consumers without dependents won’t qualify. For those who are ineligible, the only option to get health insurance will be to purchase individual insurance or to rely on community mental health centers, experts say.