Understanding Your ACA-Mandated Mental Health Services

Understanding Your ACA-Mandated Mental Health Services

Mental health is just as important as physical health to your over-all well-being, but health insurance plans didn’t always see it that way. Two federal laws,  the 2008 Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) and the 2010 Affordable Care Act (ACA), changed that. Wellstone-Domenici requires “coverage for services for mental health, behavioral health and substance-use disorders to be comparable to physical health coverage.” ACA included coverage for mental  health and substance-abuse disorder as well rehabilitative and habilitative services in its 10 essential benefits mandated for all ACA-compliant healthcare plans. Both laws go a long way toward assuring that people who need help can get it.

Unfortunately, a 2014 survey by the American Psychological Association (APA) found that over 90% of Americans were unfamiliar with the mental health parity law. While there’s no comparable research yet for familiarity with ACA’s mental health benefits, it’s probably safe to guess that the average American isn’t up to speed there, either. That’s regrettable when you consider how prevalent mental illness is and how many conditions can be effectively and affordably treated.

Mental Illness Statistics

The Nation Alliance of Mental Health (NAMI) compiled these alarming statistics about mental illness in the U.S.

  • Approximately 1 in 5 U.S. adults (43.7 million) experiences mental illness in a given year
  • Approximately 1 in 20 U.S. adults experience a mental illness serious enough to interfere with or limit one or more major life activities in a given year
  • 21% of U.S.  youths 13-18 and 13% of children 8-15 experience a severe mental disorder in a given year
  • In the past year 16% of U.S. adults experienced at least one major depressive episode
  • Only 62.9% of U.S. adults and 50.6% of children 8-15 received mental health services last year

NAMI also points out the serious consequences resulting from lack of treatment:

  • Serious mental illness costs America $193.2 billion in lost earnings each year
  • Individuals living with serious mental illness are at increased risk of chronic medical conditions that are largely treatable and they die on average 25 years sooner than others
  • Suicide is the tenth leading cause of death in the U.S., and second among people 15-24

Mandated Mental Health Benefits

If you have an ACA-compliant healthcare plan (which is required by law for just about every U.S. citizen and legal alien resident), you are entitled to a variety of mental health and substance use disorder services, rehabilitative (restoring or improving lost functions or skills) and habilitative (learning, keeping or improving skills and functions that haven’t developed normally) services. This includes free depression screening for adults and behavioral assessments for children. As of 2014, even small employers and individual plans must meet MHPAEA standards. If you aren’t sure, check with your health insurance provider; ACA requires that your insurer provide you with an easy-to-understand summary of your benefits including mental health benefits.

If you or a family member is receiving Medicaid, all state programs provide some level of mental health services, which may include counseling, therapy, mediation management, social work services, peer support and substance use disorder treatment.

Use Your Benefits

As of 2014, most healthcare plans cannot deny you coverage or charge you more due to pre-existing health conditions including mental illness. So there’s no reason to suffer in silence. See your primary care provider today and get the benefits you’re entitled to.

Need health insurance coverage? Shop for quotes online for ACA-compliant healthcare plans for individuals and small businesses as well as short-term health insurance.


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