By Lisa Zamosky
In today’s health insurance market, people buying coverage on their own often don’t have access to mental health and substance abuse services. In fact, according to the U.S. Health and Human Services (HHS), nearly 20% of people who buy a health plan outside of work have no coverage for outpatient and inpatient mental health services, and roughly one-third lack access to services for the treatment of substance abuse. When plans sold on the individual insurance market do provide mental health and substance abuse benefits, rarely is the coverage comparable to that for medical care.
Nearly 48 million Americans are currently uninsured, and roughly 1 in 4 has either a mental health condition, substance use disorder, or both.
The Affordable Care Act makes three important changes to insurance coverage for people dealing with mental health and substance use disorders.
- Mental health benefits included. All new health plans sold through the health insurance marketplaces being set up under the law are required to cover a list of 10 categories of care. This includes mental health and substance abuse services. No longer will consumers be able to buy a health insurance policy that omits this type of care from its benefits package. According to a research brief conducted by HHS, this requirement of the law will extend new mental health and substance use disorder services to more than 5 million people who currently buy their own coverage or receive insurance through a small employer.
- New benefits for people already covered. As I mentioned, among existing individual market plans that offer mental health and substance abuse services today, few offer them at the same level they do for medical care. The law will change that. Under the ACA, insurers must cover mental health and substance abuse services at a level that is comparable to those provided for medical care. The HHS report estimates that more than 30 million people currently receiving health benefits through plans they purchase on their own, as well as those who are covered through a plan offered by a small employer, will gain additional mental health and substance abuse benefits as a result of the law’s requirement.
- New access to services. Of course, the law’s main aim is to expand access to health insurance and reduce the number of uninsured Americans. According to estimates by the Congressional Budget Office, by 2023, 37 million Americans are expected to gain health insurance – and therefore mental health and substance abuse services – either by buying a health plan through the Marketplaces or as a result of Medicaid being expanded to allow more people into the program.
Will the new requirements for insurers to include mental health and substance abuse services impact you and your family? Please share your thoughts in the comments section below.