Please correct me if my interpretations are wrong, but I’m pretty damn sure that those with mental illness will rejoice—especially if they are without insurance.
The Affordable Care Act takes steps to change that:
- Right now, if you haven’t been able to find health insurance due to a pre-existing mental health condition, you may be able to access the new Pre-Existing Condition Insurance Plan. Be sure to check out this section on this site; plans may vary depending on where you live.
- The first time you renew or purchase health coverage after September of this year, plans that offer coverage for dependents are required to extend that coverage until a young adult turns 26. Some plans are making this coverage available now, so you should check with your insurance company or employer.
- Starting in 2014, substance abuse or mental illness can no longer be used by insurers to deny coverage as a “pre-existing condition” – and insurers also won’t be able to use those conditions to raise your premiums.
- Also in 2014, mental health and substance use disorder services will be part of the essential benefits package, a set of health care service categories that must be covered by certain plans, including all insurance policies that will be offered through the Exchanges, and Medicaid.
Note bene: this article was written in in 19 August 2010.
But the point is, mental illness will definitely be covered. It will no longer be classified as a pre-existing condition, which can be the basis for the denial of insurance. Also note that this WILL cover addiction, which has officially been added to/revised in the DSM-V.
- Small employers (companies with 50 or less employees) are exempt from the mental health parity of the Act.
- You are legally allowed to receive the insurance company’s ENTIRE criteria for denial,not just the reason that applies to the individual.
- A plan document outlines what is medically necessary. It is a “an agreement between the plan sponsor and GHP that explains how the plan will be administered.” Treatments depend on the plan, whether you get it from a company or the state.
- That said, all treatments and procedures cannot be more restricted than those for physical illness and ailments. They cannot be subject to separate cost-sharing requirements that would only apply to MH.
- Increase Cost Exemption for the win! If any changes are made to comply with the AHCA, there will be no cost increases if the cost increase would have been a 2% increase or 1% for every subsequent year. Currently, there are no guidelines for implementing this section of the act.Hopefully, I gave an accurate interpretation of how AHC affects mental health parity. It great expands upon Clinton’s 1996 MHPA, which left insurance caps to be determined by the insurance company and did not cover substance abuse. Clinton’s bill, although a step in the right direction, did not mandate mental health parity; instead, it applied only to those who already offered it. The offering was up to the employer/company. For more on Clinton’s handy work, see: http://www.nami.org/Content/ContentGroups/E-News/1996/The_Mental_Health_Parity_Act_of_1996.htm
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