How Health Reform Affects Your Depression Care

Medically Reviewed by Smitha Bhandari, MD on August 25, 2022
Written by WebMD Editorial Contributors
3 min read

If you have depression, you're not alone. In fact, in every group of 10 people, chances are that one person is clinically depressed.

Because depression is so common, the Affordable Care Act includes ways to get you the help you need. That includes free depression screening, as well as treatment with counseling and medicine.

You should be able to get evaluated for depression free of charge. Most plans must offer this as a preventive service.

Only so-called grandfathered plans offered by employers do not have to offer free screening. These are plans that were in place before the Affordable Care Act was signed into law on March 23, 2010 and have not substantially changed. Read your plan's summary of benefits to see what's covered and how much your share of the cost is.

Treatment for mental health conditions, including depression, is one of the 10 essential health benefits. The Affordable Care Act requires all health plans sold on state Marketplaces, in the individual market, and through small employers – those with 50 or fewer employees – to include essential health benefits. Each state sets the details of the required mental health coverage, however, so coverage may vary from state to state. Most plans will cover treatments such as:

  • Psychotherapy
  • Medicine for depression
  • Inpatient mental health treatment
  • Case management
  • Crisis intervention

You might even find your family doctor taking part in your depression treatment. As part of health reform, primary care doctors are urged to work with specialists on complex conditions like depression. Your  doctor may screen you for depression at a routine visit and treat your symptoms.

The goal is to make it easier for you to treat your depression. And, with the right treatment, you may be better able to prevent a relapse.

Other Protections

Besides new benefits, the Affordable Care Act protects your insurance coverage in several ways:

  • You cannot be dropped from your plan because you have depression.
  • You cannot be turned down for coverage or charged more for your insurance because you have depression.
  • Your children can stay on your plan until they reach age 26.
  • Your plan cannot put a dollar limit on how much it spends on your care. There are no more annual and lifetime limits.
  • Your out-of-pocket costs are capped. There's a limit on how much you will spend each year. After reaching that amount, your plan covers all costs. That includes copays and deductibles.

 

If you have Medicare and take medicine for depression, you may be pleased to know that the donut hole -- the gap in Medicare coverage for prescription drugs -- is slowly going away. It will be gone by 2020, leaving you to pay just 25% of the cost of your brand-name and generic medications. See "What Medicare Costs, Part D" to get the details, including what discounts are available until the donut hole closes.