The ACA and mental health care coverage
With these statistics in mind as we approach the end of the open enrollment period, it is important to understand which insurance plans provide mental and behavioral health coverage.
“The Affordable Care Act, also known as the ACA or ‘Obamacare,’ ensured that all health plans cover mental health and substance abuse services as essential health benefits,” says Don Truong, director of sales at Sharp Health Plan.
“Plans must cover behavioral treatment, such as psychotherapy and counseling, mental health inpatient services and substance use disorder treatment.”
What's more, according to Truong, preexisting mental health and substance use conditions are covered, and plans cannot put limits on coverage of these essential health benefits.
Medicare, the federal health insurance program for people who are 65 or older and certain younger people with disabilities, also covers some mental health and substance use care.
Medicare Advantage Plans, which are “bundled” plans offered by Medicare-approved private companies, vary in the mental health services they cover. You can
compare the quality of Medicare health and drug plans using Medicare's Star Ratings system, which rates plans on a one-to-five scale.
Dr. Arian and Truong recommend that you take the time to review a plan's network of doctors and the medications covered before enrolling. You also want to familiarize yourself with the level of customer service that support plans provide.
“It is important to do your research about the doctors and therapists within a plan's network, as well as the services and medications covered,” Truong says. “Covered California,
the state's health insurance marketplace, can help you find and compare health insurance plans, including Sharp Health Plan, so that you can feel confident in making your health care coverage decisions.”