It’s not easy living with depression, anxiety, or any mental health condition. They often come with physical symptoms, too, such as chest pains and digestive issues. But even then, many people feel ashamed about struggling with a mental health issue. So they think twice about seeing their doctor—especially if their insurance doesn’t cover it.
Not all insurance plans include mental health benefits. If yours does, it likely has treated mental health conditions differently than other medical conditions, when it comes to benefits. But new rules under the Affordable Care Act (ACA) have brought mental health coverage up to the same level as medical coverage.
Effective July 1, 2014, mental health or substance-abuse disorders benefits can’t be more restrictive than medical and surgical benefits. Before the final rules, health plans could impose financial requirements and treatment limitations on mental health conditions that they didn’t impose on medical and surgical benefits. Now, whatever a plan offers and requires regarding copayments, deductibles, and doctor visit limits must be the same for both mental and medical conditions.
The final rules (issued by the U.S. Departments of Health and Human Services, Labor, and the Treasury) also assure patients consumer protection in the following ways:
- Health plans must reveal to patients how coverage parity (or equivalence) is determined.
- Parity is promised for residential treatment or intensive outpatient care.
- Parity must apply to all aspects of the plan.
- No exceptions can be made for any of the plan’s standard benefits.
Before the new rules were issued, mental health parity applied only to bigger-group plans, such as those offered by employers. Included now are also small-group and individual plans—both on and off the Health Insurance Marketplace.
There are some plans to which the new rules do not apply, though. These include:
- Group plans offered by employers with 50 or fewer employees
- Medicare-managed plans
- Alternative-benefit plans
- The Children’s Health Insurance Program
- Plans for self-insured employees of state and local governments
- Retiree-only plans
The new rules bring attention to an important fact: Mental health conditions are no less important than medical and surgical ones. With parity in place, more people than ever will get the treatment and recovery services they need. This will make it easier for them to lead healthier and happier lives.