Mental health & substance abuse coverage
All Marketplace plans cover mental health and substance abuse services as essential health benefits.
Mental and behavioral health services are essential health benefits
All plans must cover:
- Behavioral health treatment, such as psychotherapy and counseling
- Mental and behavioral health inpatient services
- Substance use disorder (commonly known as substance abuse) treatment
Your specific behavioral health benefits will depend on your state and the health plan you choose. You’ll see a full list of what each plan covers, including behavioral health benefits, when you compare plans in the Marketplace.
Pre-existing mental and behavioral health conditions are covered, and spending limits aren’t allowed
- Marketplace plans can’t deny you coverage or charge you more just because you have any pre-existing condition, including mental health and substance use disorder conditions.
- Coverage for treatment of all pre-existing conditions begins the day your coverage starts.
- Marketplace plans can’t put yearly or lifetime dollar limits on coverage of any
A set of 10 categories of services health insurance plans must cover under the Affordable Care Act. These include doctors’ services, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, mental health services, and more. Some plans cover more services.
Refer to glossary for more details.
Parity protections for mental health services
Marketplace plans must provide certain "parity" protections between mental health and substance abuse benefits on the one hand, and medical and surgical benefits on the other.
This generally means limits applied to mental health and substance abuse services can’t be more restrictive than limits applied to medical and surgical services. The limits covered by parity protections include:
- Financial — like deductibles, copayments, coinsurance, and out-of-pocket limits
- Treatment — like limits to the number of days or visits covered
- Care management — like being required to get authorization of treatment before getting it
FAQs
These may include detoxification, individual therapy, group therapy, family therapy, cognitive-behavioral therapy (CBT), motivational enhancement therapy, and more. Therapeutic Interventions: Implementing evidence-based therapeutic approaches to address the psychological, emotional, and behavioral aspects of addiction.
Are mental health and substance abuse related? ›
Both substance abuse and mental health problems have common risk and protective factors. Certain risk and protective factors are at play in the development of both mental health problems and substance use problems. Mental health problems are associated with later substance abuse.
What is the better mental health care for Americans Act? ›
The Better Mental Health Care for Americans Act would address these barriers by ensuring full parity and integration for mental and behavioral health – expanding access, improving outcomes, and lowering costs. payments, measure access and quality, and improve prevention services for mental and behavioral health care.
Which of the following requires insurance companies to treat mental health disorders the same as physical conditions? ›
The federal parity law requires insurance companies to treat mental and behavioral health and substance use disorder coverage equal to (or better than) medical/surgical coverage.
What are the three different types of treatment options? ›
Three principal types of medical treatment
- Curative – to cure a patient of an illness.
- Palliative – to relieve symptoms from an illness.
- Preventative – to avoid the onset of an illness.
The three main forms of treatment include:
- Detoxification.
- Cognitive and behavioral therapies.
- Medication-assisted therapies.
The answer is Anorexia Nervosa. A review of nearly fifty years of research confirms that Anorexia Nervosa has the highest mortality rate of all mental illnesses (Arcelus, Mitchel, Wales, & Nelson, 2011).
What is dual diagnosis in mental health? ›
Dual diagnosis is a term that means you have a mental health disorder and a substance use disorder simultaneously. Other names for dual diagnosis include co-occurring disorder and co-morbidity. Treatment for both conditions will occur at the same time.
What are the 5 refusal skills for drugs? ›
What Are Drug Refusal Skills?
- Explain Your Refusal.
- Stay Persistent.
- Use Proper Body Language.
- Try to Redirect the Situation.
- Leave the Situation.
Here are the best states in the U.S. for mental healthcare, according to the study:
- Vermont.
- Massachusetts.
- Rhode Island.
- Iowa.
- Wisconsin.
- Pennsylvania.
- Connecticut.
- Maine.
42% of adults with AMI reported they were unable to receive necessary care because they could not afford it. 10.8% (over 5.5 million) of adults with a mental illness are uninsured.
What is the number one most diagnosed mental health problem in the United States? ›
The most common category of mental health disorders in America—anxiety disorders—impacts approximately 40 million adults 18 and older. Anxiety disorders cause people to experience distressing and frequent fear and apprehension.
Why is mental health treatment so expensive? ›
Factors that make mental health care expensive: Specialized Training and Education. The mental health counselors you're working with have a bachelor's and a master's degree at minimum, which is at least six years of higher education and hundreds of thousands of dollars investment.
When did insurance start covering mental health? ›
Since 2010, mental health coverage has been considered essential, and all California and federal health care plans cover mental health and substance use disorders. Thanks to the ACA, you can't be denied insurance coverage due to pre-existing mental health conditions or be charged a higher rate than those without.
How much does mental health care cost in the US? ›
Mental health spend has increased twice as much as overall medical spending. The average annual health care cost for a person with major depression is $10,836. The annual incremental health care cost per depressed employee that also suffers from a chronic condition such as diabetes is $5,000.
What are three types of treatments for substance abuse? ›
Some of the most common forms of modern addiction treatment include behavioral therapies delivered as individual therapy, group therapy, and family therapy.
What are the types of treatment plan? ›
Types of Treatment Plans
- Cognitive Behavioral Therapy: A therapist using this approach wants to help you discover how your thoughts, emotions, and behaviors interact. ...
- Psychodynamic Therapy: A psychodynamic therapist explores the patterns in your life and helps you find the root emotional causes of these patterns.
Standard therapies used in addiction treatment can include, and are not limited to: Cognitive behavioral therapy (CBT), including rational-emotive behavioral therapy (REBT). Dialectical behavior therapy. Motivational interviewing.
What are two types of treatments typically used by professionals for a substance use disorder? ›
These are some of the most common types of treatment for addiction:
- Medical detox: Medical detox is designed to clear all the drugs from the addicted person's body. ...
- Inpatient rehab: Inpatient rehab for addiction provides a high level of structure and accountability for people who are recovering from addiction.
