The Affordable Care Act has made a huge impact on the coverage of mental health and substance abuse disorders. The law requires that most individual and small employer health insurance plans, including those offered through the Health Insurance Marketplace, cover mental health and substance use disorder services. This includes behavioral health treatment, such as counseling and psychotherapy; inpatient mental and behavioral health services; and substance use disorder treatment. If you get your Medicare benefits through a Medicare Advantage plan or another Medicare health plan, check your plan's enrollment materials or call the plan for details on how to get your mental health benefits.
Medicare Part A (hospital insurance) covers the inpatient mental health care services you receive in a hospital. It's important to note that states determine which of these services should cover for adults, while Medicaid and CHIP require that children enrolled in Medicaid receive a wide range of medically needed services, including mental health services. Patient advocates say that insurance companies continue to interpret mental health claims more strictly than those for physical illnesses. In February, researchers from the Congressional Budget Office reported that private insurance companies pay 13 to 14 percent less for mental health care than Medicare.
If you or a loved one has mental health or substance abuse problems, you're not alone. There is a completely anonymous and confidential resource for anyone seeking treatment for substance use disorders or mental health problems in the United States. You can also learn more through the prototype of the mental health and addiction insurance assistance consumer portal and your state's Consumer Assistance Program (CAP). The three-digit national suicide hotline number, 988, works like 911, but for mental health-related emergencies.Cathryn Donaldson, a spokesperson for the trade group America's Health Insurance Plans, says that the industry supports parity, but that it's also more difficult to demonstrate when mental health treatment is needed.
However, many patients continue to struggle to get their health insurers to cover the mental health treatment they need. According to a national survey, less than 1 in 5 people with substance use disorders receive treatment and, overall, nearly 6 out of 10 people with mental illness do not receive treatment or medication, according to the National Institute of Mental Health. It's clear that there is still much work to be done when it comes to ensuring that everyone has access to quality mental health care. While two federal laws were designed to achieve parity between mental and physical health care coverage, many patients continue to struggle to get their insurance companies to cover their mental health treatment.
