According to the US Department of Health and Human Services, most individual and small group health insurance plans, including those sold on the Marketplace, are required to cover mental health and substance use disorder services as of the ACA’s enactment in 2014. Mental health and substance abuse treatment must be covered by Medicaid Alternative Benefit Plans.Essential health benefits must be covered by all ACA plans, which are divided into ten categories, one of which is mental health and substance use disorder services, and another is rehabilitative and habilitative services.
Mental and behavioral health services must cover the following as an essential health benefit:
- Psychotherapy and counseling are examples of behavioral health treatments.
- Inpatient hospital services for mental and behavioral health.
- Treatment for substance use disorder (also known as substance abuse).
- Mental and behavioral health issues that have existed
Furthermore, health plans must adhere to mental health and substance abuse parity requirements, which means that coverage for these services cannot be more limited than coverage for medical and surgical services.
Coverage under Medicaid and Medicare
Some mental health and substance abuse services are covered by Medicaid in each state. Counseling, therapy, medication management, social work services, peer support, and substance use treatment are all covered by the Children’s Health Insurance Program, according to HHS. The state determines adult coverage.
Many mental health services are also covered by Medicare: Inpatient mental health care services are covered by Medicare Part A (hospital insurance), which includes your room, meals, nursing care, and other services and supplies. Outside of a hospital, Medicare Part B (medical insurance) covers mental health services such as visits with a psychiatrist or other doctor, clinical psychologist or clinical social worker visits, and lab tests. Prescription drugs are covered under Medicare Part D (prescription drug coverage). However, because each Part D plan has its own formulary of covered drugs, not all plans cover the same medications. Mental and behavioral health are covered by Medicare Advantage plans (such as an HMO or PPO); details are provided by the plan.