Paying for Mental Health Treatment

Insurance/Payment Information

Visit this link to MHA Wisconsin's web site to find a list of Quick Links on the following Topics:

  • Employer-sponsored or Private Health Insurance
  • State Programs
  • Federal Programs
  • Resources for the Unisured
  • Additional Resources
  • Paying for Prescription Medication


Affordable Care Act

All Marketplace insurance plans cover mental health and substance abuse services as an essential health benefit.  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.  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

Additional Resources

HealthCare.gov - a federally managed site by the U.S. Department of Health and Human Services

The Affordable Care Act Timeline (SAMHSA)

Health Care Reform Webinar Series (SAMHSA)

Wisconsin Commissioner of Insurance

FAQs About Affordable Care Act Implementation Part V and Mental Health Parity Implementation (U.S. Department of Labor)

Health Reform Source - Kaiser Family Foundation; basic information on the ACA, research and analysis about the ACA, state-by-state comparisons, public opinions polls, and the latest news

 

Parity

“Parity” refers to the effort to treat mental health financing on the same basis as financing for general health services. In recent years advocates have repeatedly tried to expand mental health coverage—in the face of cost-containment policies that have been widespread since the 1980s. The fundamental motivation behind parity legislation is the desire to cover mental illness on the same basis as somatic illness, that is, to cover mental illness fairly. A parity mandate requires all insurers in a market to offer the same coverage, equivalent to the coverage for all other disorders.  ... evidence of the effects of parity laws shows that their costs are minimal.   From Mental Health: A Report of the Surgeon General

The economic impact of higher medical costs and loss of productivity that accompanies untreated mental illnesses. Just consider depression: this disease affects 16% of all Americans; medical costs for people with depression average twice the cost of others; and, people with depression are seven times more like to be unemployed or underemployed.

In November 2013, rules which will ensure that mental health will be covered in the same way as coverage for physical ailments, were put in place.  Although the Mental Health Parity and Addiction Equity Act passed in 2008, it has not been fully followed and enforced.  Now copays, deductibles, and services will be equally covered and pre-existing mental health conditions cannot exempt anyone from coverage.  (see CNN article for more details)

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