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Does My Health Insurance Cover Mental Illness Care?

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For more information about the Affordable Care Act, visit CBSChicago.com/ACA.

Does your health insurance cover care for mental illness? For the majority of Americans, the answer is yes. Health plans purchased through the health insurance marketplace must cover 10 essential health benefits. Mental health care is one of these benefits. Additionally, individual and small group health insurance policies issued after March 23, 2010, even if purchased outside of an exchange, must cover mental illness care.

If you have job-based health insurance through a large employer, or are insured through a government program such as Medicaid, Medicare or TRICARE, your plan must provide minimum essential coverage, which also includes services for mental health.

Some polices issued before the Affordable Care Act (ACA) went into effect have received “grandfathered” status, meaning they are still allowed although they may be substandard and not cover services for mental illness care. The grandfather provision was included in the health reform law to ensure individuals could keep current health plans.

Polices issued after the ACA was implemented, but before the October 1, 2013 launch of the ACA exchanges, may lack mental health coverage. The law originally banned these policies effective January 2014, but public outcry over cancellations, which were seen as a broken “If you like your plan, you can keep it” promise, caused the Obama Administration to amend its policies and allow insurance companies to continue in-force, non-compliant policies.

If your health insurance policy is grandfathered, contact your insurer and inquire about mental health coverage. You will find your insurer’s customer service phone number on your insurance card. If your policy lacks coverage for mental illness, you are eligible to purchase a Qualified Health Plan (QHP) through the health insurance marketplace at Healthcare.gov.

A QHP will include all 10 essential health benefits. If your current health plan is a bare-bones plan offering limited coverage, a QHP will lower your out-of-pocket costs and cover a larger range of services, but it may cost you more with higher premiums. Your application for health insurance cannot be rejected based on pre-existing conditions, including prior diagnoses and treatments for a mental illness.

One advantage of purchasing a new policy through an exchange is the availability of tax credits and cost-sharing reductions in the marketplace. These subsidies are available to households with incomes between 138 and 400 percent of the Federal Poverty Level.

Coverage for mental health services must be equivalent to coverage provided for other medical service. This parity protection means your health plan cannot require higher co-payments, deductibles or co-insurance for mental health services or medications. The number of covered doctor visits for mental health treatment, and the number of days allowed for inpatient services, must be equal to those covered for other medical services. The health plan cannot place additional burdens on a policyholder seeking mental health care, such as referrals and pre-authorizations that are not in place for other health care needs.

Gillian Burdett is a freelance writer covering all things home and living. Her work can be found on Examiner.com.