If you or your child has a condition that affects behavior, the Affordable Care Act may help. That's because one of your benefits is mental health treatment. You will be able to get help for a number of disorders. They include anxiety, depression, ADD/ADHD, bipolar disorder, schizophrenia, autism, and dyslexia. You can also get help for substance abuse.
By law, you must now get the same coverage for this treatment that you get for other medical conditions. Before health reform, one of every three people who bought their own health insurance did not have coverage for substance abuse. One of five had no mental health benefits.
Essential Health Benefits
Your mental health or substance abuse treatment is seen as an essential health benefit. That means that health plans must offer it. You will be covered if you get Medicare or Medicaid. You also will be covered if you buy a health plan through your state's health insurance Marketplace.
What your plan covers for your treatment must be on par with what you get for medical or surgical care. Even the copays you're charged must be the same as what you pay to see your family doctor.
You may also use other essential health benefits that the law says must be part of any health plan. For instance:
Prescription drugs will be covered by your health plan. You may have to make a copay.
Chronic disease management must be part of your plan. This means you or your child will be covered even if the mental health or substance abuse problem lasts a long time. Also, a medical team will coach you on the best ways to manage your mental health.
Rehabilitation counseling will be available. If you can't go about your daily tasks at home or work, you can get help from a therapist. Your child can get the same type of help with problems at school or home. This can help you or your child gain the skills needed to get through the day.
You can get a screening as part of an annual checkup. Or, you can make an appointment for just the screening.
You will find your entire medical team taking an interest in your mental health. That's because the Affordable Care Act stresses what's called integrated and coordinated care. It encourages providers such as family doctors and therapists to work together.
Under the new health care law, having a mental health problem cannot affect your insurance coverage. For instance:
- You cannot be dropped from your plan if you develop a mental health disorder or addiction.
- Your children also must be covered by your plan, even if they have a mental health issue or addiction.
- Starting in 2014, you cannot be turned down for coverage if you have a mental health problem.
- Your children can stay on your plan until they reach age 26.
You also benefit from rules in the law that keep you from paying too much for your care or medicine. For instance:
- You will not have a dollar limit on how much can be spent on your care or your child's. Annual and lifetime limits go away.
- You cannot be charged more for insurance because you or your children have a health problem. This includes mental health issues.
- Your out-of-pocket costs are capped, meaning there's a limit on how much you will spend. After that, your plan covers all costs. That includes copays and deductibles.