10 Things You Need to Know About Mental Health Care Coverage in 2014

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affordable care actThe Affordable Care Act will, and will not, change certain aspects of coverage for mental health care in the United States. As 2014 fast approaches, I wanted to make sure you know what is required, based on the final rule for mental health parity recently released by Health and Human Services, and how it applies to moms with postpartum depression, postpartum anxiety, bipolar disorder, antenatal depression and all other mental health conditions related to pregnancy and childbirth.

10 Key Facts About Mental Health Care Coverage for Moms with Postpartum Depression, Postpartum Anxiety & the Like

1. You cannot be denied health insurance because of a pre-existing condition of depression, anxiety or any other mental illness.

2. You cannot be charged more for your health insurance — for instance, higher premiums or deductibles — because of a pre-existing condition of depression, anxiety or any other mental illness.

3. Insurance plans cannot drop your coverage or raise your premiums if you get diagnosed with and need to be treated for a mental illness.

4. You cannot be charged more for coverage of mental health services than for other types of medical services. For example, insurance plans are not allowed to cover fewer inpatient hospital days or intensive outpatient hospital days for mental health or substance abuse treatment than they might, say, for a stroke or for having your gallbladder removed.

5. Treatment visits  for mental illness and substance abuse are not allowed to have any greater limitations than for other medical conditions. This means that the number of visits you make to a therapist, for example, can’t be limited differently than your insurance plan limits visits to other types of physicians for other types of health problems.

6. Insurance plans are not — I repeat, NOT — required by the government to offer any mental health care coverage at all. So the rules I mention here apply only to those plans that do offer it. If you’re shopping around for insurance plans, be sure to ask if mental health care coverage is included.

7. If your insurance offers mental health care coverage and you choose to use a provider that is not a preferred or in-network one, as in the past you will likely have to pay more to see that person, as you would for any other types of providers that are out of network.

8. Each plan has different rules about what prescription drugs are covered. To find out whether the medication you are taking is covered, the Washington Post suggests asking for your “plan’s drug formulary, or preferred-drug list, which tells you what’s covered. On the federal exchange, you may be able to find this when you click on the ‘details’ button for a specific plan. Your co-pay or co-insurance — the amount that you’re responsible for — could vary enormously.” These formularies often have different groups or tiers within them – you’ll pay the least for the cheapest or generic drugs, and more for the more expensive ones, and some medications may not be covered by insurance at all. If you find that you can’t afford the co-pay for the medication you need, check out this resource for various types of prescription drug assistance.

9. These rules do not apply to the Children’s Health Insurance Program (CHIP) or to Medicaid or alternative benefit plans, such as Medicaid expansions. That may change fairly soon, according to news reports, but is not the case at the moment.

10. Psychiatric healthcare providers are not required to accept insurance. In fact, a new study led by researchers at Weill Cornell finds that between 2005 and 2010, “… the percentage of psychiatrists who accepted private insurance dropped by 17 percent, to 55 percent, and those that took Medicare declined by almost 20 percent, also to about 55 percent. Their acceptance of Medicaid is 43 percent, the lowest among all medical specialties.” If the psychiatrist, social worker, therapist or psychologist you wish to see does not accept insurance, ask them if they offer a sliding scale fee based on your ability to pay.

Let me know if I’m missing anything or if you’ve heard differently from your insurance providers!

Photo credit: © RedDaxLuma – Fotolia.com

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About Katherine Stone

is the founder & editor of Postpartum Progress. She was named one of the ten most influential mom bloggers of 2011, a WebMD Health Hero and one of the top 25 parent bloggers using social media for social good. She also writes the Fierce Blog, and a parenting column for Disney's Babble.com.

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  1. As both an 17 year employee of a large health insurer and an advocate for mental health, I can confirm you nailed it Postpartum Progress. Thanks for the thorough overview. It’s my hope that employers will be more willing to purchase insurance plans with mental health care coverage “baked in” (and/or that states will mandate that only these plans should be provided). This is a carryover from the days when most insurance plans were “indemnity catastrophic care plans.” Things are evolving slowly (based primarily on employer purchasing requests) to provide coverage for more than just catastrophe (ER coverage/inpatient care), preventive care, wellness interventions and more. By the year 2020 it’s not unreasonable to believe that all medical plans will include coverage of illnesses of the mind, after all the mind affects the body, and vice versa. We would never “carve out” coverage of the heart; it’s time to treat the mind and heart as the equals they are. Employers are beginning to think about this too. We’ll get there!

  2. It makes me angry that mental health coverage isn’t mandatory. It’s like saying that it’s not an important facet of our health.

  3. My employer gets around this by not having any psychiatric services in the highest level of benefits offered. They have tiers of payment based upon being on a preferred list but of course the only tier with any psych care at all is the lowest tier of benefits. Kind of pisses me off