While almost all large group plans and most small group plans include coverage for some mental health and substance use disorder services, there are gaps in coverage. And, about one-third of those who are currently covered in the individual market have no coverage for substance use disorder services and nearly 20 percent have no coverage for mental health services, including outpatient therapy visits and inpatient crisis intervention and stabilization.
Not too long ago, an effort to improve benefits for people was made through the Mental Health Parity and Addiction Equity Act of 2008. The law required group health plans and insurers that offer mental health and substance use disorder benefits, but not individual health plans, to provide coverage that is comparable to coverage for general medical and surgical care. Additionally, the law left the decision whether to even offer the benefits to the discretion of the health plans.
Now with the Affordable Care Act (ACA), we will have one of the largest expansions of mental health and substance use disorder coverage in a generation. Following is an overview of key components of the final legislation:
Mental Health Benefits Become Standard
As of January 1, 2014, treatment for mental health and substance use disorders is a benefit category covered as part of the package of Essential Health Benefits (EHB) available to all Americans in non-grandfathered plans in the individual and small group markets. Additionally, all plans that do contain any EHB must remove annual and lifetime dollar limits for those services, including Large Group plans.
But note that the exact details of the treatments and services that will be offered is left up to the states to determine.
Mental Health and Substance Abuse Benefits Must be Comparable with Medical/Surgical Benefits
The Mental Health Parity an Addition Equity Act of 2008 finally has some “teeth.” Now, Americans accessing coverage through non-grandfathered plans in the individual and small group markets will now be able to count on mental health and substance use disorder coverage that is comparable to their general medical and surgical coverage.