Форум

As of 2014, under the Affordable Care Act (ACA), all plans purchased through the Health insurance cover therapy Marketplace must cover 10 essential health benefits. These include mental health services and substance use disorder services, such as rehabilitation. The ACA also ended annual and lifetime benefit caps and for individual and small-group markets eliminated medical underwriting, which is the process of evaluating a health insurance applicant’s medical history. Plans can no longer deny coverage or impose cost barriers because of preexisting mental health conditions[6].

Medicaid
All state Medicaid programs provide some mental health services, which often include counseling, therapy, medication management, social work services, peer supports, and substance use disorder treatment. The state decides which mental health benefits to offer[3].

Children’s Health Insurance Program
The Children’s Health Insurance Program (CHIP) plays a vital role in financing behavioral health services for low-income children[4]. This program requires that children enrolled in Medicaid receive a wide range of medically necessary services including mental health benefits. CHIP is administered by states according to federal requirements and is funded jointly by states and the federal government[5].

Medicare
Generally, Medicare is available for people age 65 or older, younger people with disabilities, and those who have kidney failure requiring dialysis or transplant, known as End-Stage Renal Disease. Medicare premiums are based on your modified adjusted gross income or MAGI. That's the total adjusted gross income plus tax-exempt interest. Regarding coverage for mental health, here’s the breakdown of what each plan covers according to MentalHealth.gov:

Medicare Part A (Hospital Insurance) covers inpatient mental health services you would receive in a hospital, such as the room, meals, nursing care, and other related services and supplies. There is no additional premium for this health coverage.

Medicare Part B (Medical Insurance) helps cover mental health services that you would generally get outside of a hospital, including visits with a psychiatrist, clinical psychologist, or clinical social worker, and lab tests ordered by your doctor. Unlike Part A, everyone must pay for Medicare Part B if they want it. This monthly premium is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you do not get any of these payments, Medicare sends a bill for your Part B premium every 3 months.

Medicare Part D (Prescription Drug Coverage) helps cover medications used to treat mental health conditions. Each Part D plan has its own list of covered drugs, known as a formulary. Learn more about which plans cover various drugs. Like Part B, the Medicare Part D premium is an additional cost determined by income. Even for low-income Medicare beneficiaries, there are no Medicare Part D plans that are totally free, but there may be no (or a low) monthly premium, no deductible, no coverage gap, and very low drug costs in this case.

If you get your Medicare benefits through a Medicare Advantage Plan (such as an HMO or PPO) or other Medicare health plan, check your plan’s membership materials or call the plan for details about mental health benefits. If you get your Medicare benefits through traditional Medicare and want more information, view the pdf Medicare and Your Mental Health Benefits. To see if a particular test, item, or service is covered, visit the Medicare Coverage Database.

Insurance coverage of mental health services has improved greatly in the past decade and is something everyone should consider taking advantage of. Remember to check your plan’s membership materials or call the plan for details about your specific mental health benefits. You should never avoid seeking mental health services because you think you can’t afford it—there are always options.