All Marketplace insurance plans cover mental health and substance abuse services as an essential health benefit.
Health insurance plans available in the Marketplace must cover ten categories of essential health benefits. One of these categories is mental health and substance abuse services, also known as substance use disorder.
These services include behavioral health treatment, such as psychotherapy and counseling. They also include mental and behavioral health inpatient services and substance use disorder treatment.
Mental and behavioral health and pre-existing conditions
Marketplace plans can’t deny you coverage or charge you more just because you have a pre-existing condition. This includes mental health and substance use disorder conditions.
Coverage for treatment of pre-existing conditions begins as soon as your Marketplace coverage is in effect. There’s no waiting period for coverage of these services.
There are also no lifetime or yearly dollar limits for mental health services. Marketplace plans can’t apply yearly or lifetime dollar limits on coverage of essential health benefits which includes benefits for mental health and substance use disorder services.
Parity protections for mental health services
Marketplace plans must provide certain “parity” protections between mental health and substance abuse benefits on the one hand, and medical and surgical benefits on the other.This means that in general, limits applied to mental health and substance abuse services can’t be more restrictive than limits applied to medical and surgical services. The kinds of limits covered by the parity protections include:
· Financial, like deductibles, copayments, coinsurance, and out-of-pocket limits
· Treatment, like limits to the number of days or visits covered
· Care management, like being required to get authorization of treatment before getting it
(taken from HealthCare.gov)
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