Substance Abuse and Mental Healthcare Coverage

Health and Wellness

Many Americans suffer from mental health problems and/or substance abuse disorders. These two serious health crises were not covered prior to the ACA (or not often covered), but they have now become essential health benefits, meaning that insurers are required to cover them.

Mental Healthcare Coverage
All health insurance plans must cover behavioral health treatment including therapy and counseling. If someone with a mental disorder is hospitalized inpatient, the plan must cover their care. Behavioral health benefits vary based upon your home state, but insurers still must meet that minimum requirement.

Substance Abuse Coverage
Substance abuse disorder is covered under these plans. Treatment for substance abuse, which often requires counseling and therapy, is also required. Substance abuse and mental health problems are considered pre-existing conditions, which is why many insurers, prior to the ACA, were able to deny coverage to sufferers. Now coverage goes into effect the day that your plan starts.

No spending limits are permitted when it comes to treating mental health and substance abuse disorders. Plans are also required to have “parity protections”. Parity protections mean that limits applied to mental/substance abuse-related conditions must not be more restrictive than those applied to conditions that do not fall under these categories. Essentially, the ACA seeks to treat mental health issues and substance abuse with the same amount of respect and coverage levels as health problems that do not fall into these two categories.

Parity protection limits include:

  • Care management: this includes limits and restrictions on treatment authorization requirements. If you are required to get authorization from a doctor to treat a condition, this restriction must be applied evenly—no extra authorization required for mental health and substance abuse issues.
  • Financial: deductibles, out-of-pocket payments, and co-payments cannot be higher under these conditions.
  • Treatment: there cannot be more restrictive limits on the number of days or visits covered.

The ACA has made groundbreaking changes to the field of health insurance, making health care more affordable for millions of people.