Erik J. Martin is a Chicago area-based insurance writer whose articles have been featured in AARP The Magazine, The Chicago Tribune, Reader's Digest, USAA Magazine and other publications.
Erik Martin Insurance WriterErik J. Martin is a Chicago area-based insurance writer whose articles have been featured in AARP The Magazine, The Chicago Tribune, Reader's Digest, USAA Magazine and other publications.
Written By Erik Martin Insurance WriterErik J. Martin is a Chicago area-based insurance writer whose articles have been featured in AARP The Magazine, The Chicago Tribune, Reader's Digest, USAA Magazine and other publications.
Erik Martin Insurance WriterErik J. Martin is a Chicago area-based insurance writer whose articles have been featured in AARP The Magazine, The Chicago Tribune, Reader's Digest, USAA Magazine and other publications.
Insurance Writer Les Masterson Deputy Editor, InsuranceLes Masterson is a deputy editor and insurance analyst at Forbes Advisor. He has been a journalist, reporter, editor and content creator for more than 25 years. He has covered insurance for a decade, including auto, home, life and health. Before cove.
Les Masterson Deputy Editor, InsuranceLes Masterson is a deputy editor and insurance analyst at Forbes Advisor. He has been a journalist, reporter, editor and content creator for more than 25 years. He has covered insurance for a decade, including auto, home, life and health. Before cove.
Les Masterson Deputy Editor, InsuranceLes Masterson is a deputy editor and insurance analyst at Forbes Advisor. He has been a journalist, reporter, editor and content creator for more than 25 years. He has covered insurance for a decade, including auto, home, life and health. Before cove.
Les Masterson Deputy Editor, InsuranceLes Masterson is a deputy editor and insurance analyst at Forbes Advisor. He has been a journalist, reporter, editor and content creator for more than 25 years. He has covered insurance for a decade, including auto, home, life and health. Before cove.
| Deputy Editor, Insurance
Updated: Feb 15, 2024, 11:35am
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Health insurance plans typically cover mental health treatment like talk therapy, inpatient hospitalization, substance abuse treatment, emergency care and medications. But your need for these services and pharmaceuticals must be deemed medically necessary, which requires a diagnosis.
The Affordable Care Act (ACA), sometimes called Obamacare, requires that health insurance plans include coverage for mental health and substance use disorders.
That applies to ACA plans and small group employer-sponsored health plans with 50 or fewer employees (except in California, Colorado, New York, and Vermont, which define small group health plans as employer-sponsored plans with 100 or fewer employees)
Many large employers still offer mental health coverage even if it’s not required, according to Eric Calciano, lead employee benefits advisor with New City Insurance, an employee benefits consulting firm in San Diego.
Prior to the ACA law, a health insurance company that offered individual health insurance could turn you down because of a pre-existing mental health diagnosis or might have excluded mental health treatment from plan benefits.
The Mental Health Parity and Addiction Equity Act (MHPAEA) is another law that helps people seeking mental health care. The MHPAEA, passed in 2008, requires insurers that offer mental health coverage for mental health/substance use disorder treatment that’s equal to or better than a plan’s medical health coverage.
For example: An insurer can’t charge a $30 copay for an annual checkup with a primary care provider and then charge a $100 copay for a psychologist visit. This parity law also makes it more difficult for insurance companies to limit mental health-related appointments within a year.
Access to mental health coverage has improved over the past 20 years because of the Affordable Care Act and MHPAEA, but not everyone enjoys that access. “While some health plans have made strides to close the coverage gaps that exist for mental health care in employer-sponsored plans, there is still a long way to go,” says Ben Simmons, chief health plan officer at Gravie, a health benefits company.
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