Health Insurance and Mental Health Services

Dec 15, 2014

Let’s take a moment to talk about where we are when it comes to health insurance and mental health services. The Affordable Care Act (ACA) provides one of the largest expansions of mental health and substance use disorder coverage in a generation. Learn how you can take advantage of the mental health benefits available to you and your loved ones today.

What can I do if I think I need mental health services for myself or family members right now?

Here are three steps you can take:

1. If you don’t have insurance, learn more about how you, your friends, and your family can get health insurance coverage provided by Medicaid or CHIP or the Health Insurance Marketplaces by visiting HealthCare.gov.
2. If you do have insurance, read below to see what mental health benefits may be available to you and your loved ones.
3. Read more about how the law is expanding coverage of mental health and substance use disorder benefits and federal parity protections.

How does the Affordable Care Act help people with mental health conditions?

The ACA requires most individual and small employer health insurance plans including all plans offered through the Health Insurance Marketplace to cover mental health and substance use disorder services. Also required are rehabilitative and habilitative services that can help support people with mental health conditions. These new protections build on the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) provisions to expand mental health and substance use disorder benefits and protections to an estimated 62 million Americans.

Most health plans must now cover preventive services, like depression screening for adults and behavioral assessments for children, at no additional cost. Most plans cannot deny you coverage or charge you more due to pre-existing health conditions, including mental illness.

How do I find out if my health insurance plan is supposed to be covering mental health or substance use disorder services equally to medical and surgical benefits? What do I do if I think my plan is not meeting parity requirements?

In general, for those in large employer plans, if mental health or substance use disorder services are offered, they are subject to the parity protections required under MHPAEA. And for most small employer and individual plans, mental health and substance use disorder services must meet MHPAEA requirements.

If you have questions about your insurance plan, we recommend you first look at your plan’s enrollment materials, or any other information you have on the plan, to see what the coverage levels are for all benefits. Because of the ACA health insurers are required to provide you with an easy-to-understand summary about your benefits including mental health benefits, which should make it easier to see what your coverage is. More information also may be available with your state Consumer Assistance Program (CAP).

Does Medicaid cover mental health or substance use disorder services?

All state Medicaid programs provide some mental health services and some offer substance use disorder services to beneficiaries, and Children’s Health Insurance Program (CHIP) beneficiaries receive a full service array. These services often include: counseling, therapy, medication management, social work services, peer supports, and substance use disorder treatment. While states determine which of these services to cover for adults, Medicaid and CHIP requires that children enrolled in Medicaid receive a wide range of medically necessary services, including mental health services. In addition, coverage for the new Medicaid adult expansion populations is required to include essential health benefits, including mental health and substance use disorder benefits, and must meet mental health and substance abuse parity requirements under MHPAEA in the same manner as health plans. Learn more about Medicaid and mental health and substance use disorder services.

Does Medicare cover mental health or substance use disorder services?

Yes, Medicare covers a wide range of mental health services.

Medicare Part A (Hospital Insurance) covers inpatient mental health care services you get in a hospital. Part A covers your room, meals, nursing care, and other related services and supplies.

Medicare Part B (Medical Insurance) helps cover mental health services that you would generally get outside of a hospital, including visits with a psychiatrist or other doctor, visits with a clinical psychologist or clinical social worker, and lab tests ordered by your doctor.

Medicare Part D (Prescription Drug ) helps cover drugs you may need to treat a mental health condition. Each Part D plan has its own list of covered drugs, known as formulary. Learn more about which plans cover various drugs.

If you get your Medicare benefits through a Medicare Advantage Plan (like an HMO or PPO) or other Medicare health plan, check your plan’s membership materials or call the plan for details about how to get your mental health benefits.

If you get your Medicare benefits through traditional Medicare (not a Medicare Advantage plan) and want more information, visit Medicare & Your Mental Health Benefits. To see if a particular test, item or service is covered, please visit the Medicare Coverage Database.