It is estimated that one in 17 Americans suffer from a serious mental illness. Up until the rollout of the Affordable Care Act, many Americans couldn’t afford the health care insurance they needed to get mental health support services. Out of pocket rates for psychiatrists can be in the hundreds of dollars per half-hour, with therapist’s rates for a 50-minute hour following closely behind. However, due to the Affordable Care Act, the nation is seeing a shift in the accessibility and use of behavioral health services. For these one in 17 Americans, this is very good news that is well overdue.
Despite the fact that nearly 50% of Americans will experience a mental health issue in their lifetime, mental health has carried a stigma that has kept it in obscurity. Even for those who were able to afford health insurance before the Affordable Care Act (ACA), there was spotty and inconsistent coverage for mental health issues. However, the ACA has changed this for the better. With the ACA, mental health issues are treated the same as any other medical health issue. This means that by law, treatment for depression or substance abuse carries the same financial weight as treatment for cancer or diabetes. Healthcare.gov reports that these parity protections mean that limits applied to mental health services can’t be more restrictive than those applied to medical and surgical services. These limits include the following:
- Financial limits: Financial limits such as deductibles, coinsurance, copayments, and out-of-pocket limits cannot be treated any differently for mental health care coverage than they are for medical or surgical care.
- Treatment limits: Prior to the Affordable Care Act, limits on the number of appointments or “visits” covered by insurance existed regardless of the condition and the desires of the patient or the health care provider. This often meant that someone being treated for depression would be limited to 10 or 15 sessions (decided by the insurance company) with their therapist or psychiatrist regardless of the severity of the condition or how much treatment was really needed. With the ACA, these limits were eradicated and can only be decided by your doctor.
- Care mangement: The new health care laws require mental health services to be treated just like any other health care service in regards to treatment authorizations.
In addition, the ACA has removed yearly or lifetime dollar limits on mental health services
It is estimated that 3.7 million Americans with previously untreated significant mental illness now have coverage through insurance exchanges and expanded Medicaid programs. One benefit of the Affordable Care Act was to expand the time that young adults are able to stay on their parent’s insurance. Data on the effects of raising this age to 26 is very encouraging. Inpatient mental health care within this population has increased while emergency room use for behavioral health care issues has dropped. This also means that younger people are getting the help they need when they need it, as opposed to visiting the emergency room in crisis. Considering that 75% of all mental health and substance abuse issues begin before age 24, we can see the future benefits to not only these youth, but the future of the mental health in this country.
Another benefit of the ACA to mental health care is the rules for pre-existing conditions.
Healthcare.gov states that marketplace plans can’t deny you coverage for pre-existing conditions. This includes mental health as well as substance abuse disorders. It is now illegal to be denied health care coverage for a condition that existed before opting in for that insurance. That means that even if you are suffering from a major depressive episode or have in the past, insurance companies cannot refuse you coverage. Previously this was a big barrier for people suffering or recovering from physical illnesses such as diabetes or heart disease. The ability to change insurance without worry means that those sufferers can now change jobs or locations without the worry of losing health coverage.