New Rules Affect Mental Health Coverage Under the Affordable Care Act

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health insuranceThe federal government has issued a new ruling stating that mental health care will be included among the essential health benefits that must be offered by most insurance plans starting in 2014.  As part of the Affordable Care Act (ACA), the ruling was made to help define the types of health coverage that should be covered as well as the levels of coverage offered.

Yesterday, I was fortunate to be able to speak with Dr. Thomas Bornemann, Director of the Mental Health Program at The Carter Center, about mental health under the ACA. As of January 2014, Dr. Bornemann explained that small group and individual health insurance must include mental health coverage.

What exactly will insurance plans be required to cover when it comes to mental health treatment? The fact is, there’s no single answer to that question. “States have their own discretion, which means there may be quite a bit of variance across the country,” Dr. Bornemann said. “Additionally, large employers who self-insure are not required to cover mental health, even after 2014.”

New York Times reporter Robert Pear explained the different levels of coverage you will have the opportunity to purchase from your state’s exchange or from the federal government in 2014:

“The rule says the new health insurance policies can be offered at four levels of coverage. Under the least generous policies, known as bronze plans, consumers will pay 40 percent of the costs of covered benefits, on average, and insurers will pay the rest. Under the most generous policies, known as platinum plans, consumers will pay 10 percent. The administration, however, declined to set a uniform national standard and allowed states to set many of the specific requirements … Minimum benefits will vary from state to state, as each state will have a benchmark plan, reflecting coverage typically offered by employers. In more than 30 states, the benchmark, or standard, is an insurance plan offered by Blue Cross and Blue Shield.”

I think many of you may be surprised to learn that the coverage isn’t necessarily free, nor is it going to be available to all. There may be varying deductibles, based on which type of plan you go with, and varying levels of coverage. It will depend a lot on where you live and who your insurer is.  If you are insured by a large employer that self-insures, for instance, they may elect not to offer mental health coverage. This is why it’s going to be very important to pay close attention to what is happening in your own state.

USA Today health reporter Liz Szabo adds that the new provisions also mean, “Plans won’t be able to discriminate against patients with a previously existing mental health condition. The law also eliminates the lifetime cap on benefits, so that families won’t exhaust their coverage.” Dr. Bornemann agreed that those people who have been denied health insurance in the past because they’ve previously been treated for postpartum depression should become eligible as of January 2014 thanks to the elimination of pre-existing conditions as part of the ACA.

Bornemann also added that insurers will generally not be allowed to require visit limits, capping the number of psychotherapy appointments you can have, for example. They are expected to cover whatever is medically necessary as determined by your healthcare provider, though that provider may be required to justify what it is you need and why.

For more stories on mental health care under the Affordable Care Act, you might consider:

Politico: ACA Mental Health Plan’s Growing Pains

Wall Street Journal: Health Plan Details Unveiled

USA Today: HHS Releases Rules on Insurers’ Essential Health Benefits

Photo credit: © Kudryashka – 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. And, on some plans (like mine), you’re SOL if your therapist happens to be out of network until you meet your deductible. Lovely how that works!