The ACA and mental health care coverage
According to Don Truong, director of sales at Sharp Health Plan, the Affordable Care Act, also known as the ACA or 'Obamacare,' ensured that individual and family plans and small employer group plans cover mental health and substance abuse services as essential health benefits. There are also California laws that require coverage of treatment for mental health and substance use disorders for all individual and employer groups (both large and small). Therefore, health plans in California 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, counseling, inpatient services and substance use disorder treatment. 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.
"For example, Sharp Health Plan offers over 250 behavioral health providers for our members to choose from." Dr. Arian adds, "We make it convenient too with video visits and no referral needed for outpatient therapy with a provider in your network."