Mental Health and Substance Abuse Disorders in The Marketplace

The Affordable Care Act requires that most individual and small employer health insurance plans, including all plans offered through the Health Insurance Marketplace cover mental health and substance use disorder services. Also required are rehabilitative and habilitative services that can help support people with behavioral health challenges.

What Is Covered?

Most plans cover preventive services like:

  • Behavioral health treatment, such as psychotherapy and counseling
  • Mental and behavioral health inpatient services
  • Substance use disorder (commonly known as substance abuse) treatment

Your specific behavioral health benefits will depend on your state and the health plan you choose. You’ll see a full list of what each plan covers, including behavioral health benefits, when you compare plans in the Marketplace.

Pre-existing Conditions are Covered and Spending Limits Aren’t Allowed

  • Marketplace plans can’t deny you coverage or charge you more just because you have any pre-existing condition, including mental health and substance use disorder conditions.
  • Coverage for treatment of all pre-existing conditions begins the day your coverage starts.
  • Marketplace plans can’t put yearly or lifetime monetary limits on any essential health benefits including mental health and substance use disorder services.

Protections for Services

Marketplace plans must provide certain “parity” protections between mental health and substance abuse benefits on the one hand, and medical and surgical benefits on the other.

This generally means limits applied to mental health and substance abuse services can’t be more restrictive than limits applied to medical and surgical services. This includes:

  • Deductibles, copayments, coinsurance, and out-of-pocket limits
  • Limits to the number of days or visits covered
  • Requirements to get authorization for treatment before getting it

For more information on The Affordable Care Act, don’t hesitate to call Bell & Associates Consulting Firm or send us a message here on our website. We’ll be sure to get back with you as soon as possible.



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