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'Obamacare' and Mental Health

Easier access, coverage for pre-existing conditions among some of the benefits cited

WebMD News from HealthDay

By Serena Gordon

HealthDay Reporter

FRIDAY, Oct. 11 (HealthDay News) -- As the nation's health-care law continues to roll out, people with mental health issues are discovering ways that the landmark legislation directly affects them.

An estimated 32 million people will gain mental health or substance use disorder benefits, or both, as a result of the Affordable Care Act, according to the U.S. Department of Health and Human Services.

Much of this will stem from the requirement that small group and individual insurance plans offer coverage for mental health issues and substance abuse services. Most large insurance plans already include such coverage.

In addition, "parity has been written into the law so mental health coverage ostensibly should be much easier to access," said Susan Lindau, a licensed clinical social worker and associate adjunct professor at the University of Southern California School of Social Work in Los Angeles.

Parity means that coverage for mental health issues, for instance, must be comparable to the coverage provided for general medical and surgical care. The Affordable Care Act expands the limited parity that was first introduced into law in 2008.

However, Andrew Sperling, director of legislative advocacy for the National Alliance on Mental Illness (NAMI), is somewhat circumspect about the upcoming changes.

"We're still waiting for the final regulations," he said, noting that the government has promised that information by year's end. "And, because of the Supreme Court decision, the Medicaid expansion is optional, and a large number of states are talking about not participating." Because some benefits vary depending on where people live, he explained, people in some states won't see the full benefits accorded by the law.

However, changes that should help those seeking mental health care include:

  • Coverage for people with pre-existing conditions. No longer can insurers deny coverage to someone with a diagnosis of depression or bipolar disorder, for instance, nor can they cancel coverage if an insured person gets such a diagnosis.
  • Extended coverage for young people. Children also cannot be denied coverage because of a mental health diagnosis. And, young adults can now stay on their parents' health insurance policies until they reach age 26, rather than be bumped off years earlier if they weren't full-time college students -- enabling coverage of medication and therapy.
  • No annual or lifetime limits on the amount insurers will pay for basic health care, which now includes mental health and substance use disorders.
  • Financial help with premium costs and out-of-pocket health-care costs for people with low incomes. The law provides such aid for those whose annual income falls between 100 and 400 percent of the federal poverty level. For a family of four, that's between $23,550 and $94,200, according to NAMI. In addition, a tax credit may be available for people who purchase individual policies through the new state-run insurance exchanges, also called marketplaces.
  • Easier access to Medicaid coverage. The law expands the program to include anyone living at or below 138 percent of the federal poverty line (just under $16,000 for a single person), although specifics vary from state to state. Medicaid also must now cover mental health and substance abuse care at the same level and price as other medical care.

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