Medical insurance can be confusing enough, but if you or a loved one requires mental health benefits, what coverage is available?
Mental health coverage has been included in medical care for many years. However, the relative cost, scope of coverage and realistic availability of mental health services has been a subject of discussion and debate. Primarily, people argue over how big of a role the federal government should play.
Mental Health Coverage –
Equal Coverage Laws
Equal coverage laws are also known as mental health parity. Parity requires that insurers and health care plan providers offer the same level and quality of benefits for mental illness and substance abuse as for other physical illness and disease. Under the protection of parity laws, benefits such as visit limits, deductibles and copayments must be fair for all. However, even parity laws vary by state, with some regions offering benefits for a comprehensive range of mental illness, and others restricting equal coverage to a specific list of biological or serious mental illnesses. There is no federal law directly mandating parity to the same extent as state laws.
Many state laws are not considered full parity because they permit discrepancies in benefit level depending on the disease or condition being treated. While some experts feel that any level of treatment for the mentally ill is a positive trend, advocates claim that nothing short of full parity is acceptable.
Mandated Offering Laws
Mandated offering laws are different from parity laws in that they do not mandate benefits be provided at all. A mandated offering law can require that an option of coverage for mental illness or substance abuse be provided to the insured. This coverage can be accepted or rejected by the policy holder, but if accepted will typically result in a higher premium. However, a mandated offering law may also stipulate that require when mental health benefits are offered, then they must be equal to traditional disease or illness coverage benefits.
Did You Know? Laws in 38 states include coverage for substance abuse, alcohol or drug addiction.
The ACA and Mental Health Coverage
In 2014, the ACA (Affordable Care Act) expanded mental health and substance use coverage significantly. Under the law, all new small group and individual market plans were required to cover ten Essential Health Benefit categories, and to cover them at parity with medical and surgical benefits.
While almost all large group plans included coverage for some mental health and substance abuse services, there were gaps in the coverage plans and federal parity protections were missing. However, the Essential Health Benefits rule implemented this missing coverage and protection.
When seeking medical benefit coverage which includes the highest level of mental health and substance abuse parity, it is best to speak to an insurance professional. Although laws exist to ensure minimum coverages, different insurance providers generally provide different levels of coverage – some more robust than others. It is best to consult with a local Sarasota or Bradenton area insurance professional to better understand the options available to you based on your situation.
An insurance broker has the ability to provide you with quotes and policy options from a wide range of insurance providers, so that you can choose the plan which is best for you and your family. While contacting an insurance company directly may give you one or two options, a broker can assist you in comparing and contrasting many policy offerings from many high quality companies. When looking to obtain the best medical insurance coverage for your illness or condition, arm yourself with as much information as possible. Call Anderson & Associates Insurance Group today.
