5 Facts About Mental Health Coverage And Health Insurance Reform

34pzwc7.jpgMany mental health advocates are cheering healthcare reform. Although there was a separate bill requiring mental health parity in insurance coverage–meaning that it should be treated equally to physical conditions when it comes to benefits–passed in 2008, this legislation goes farther. Here are five facts about the health insurance reform bill and its impact on the treatment of mental health conditions.

  1. With the eventual ban from denying people with pre-existing conditions, those with mental health conditions will have easier access to affordable health insurance. Many times, health insurers refuse to underwrite someone with a diagnosis of depression, anxiety disorder, bipolar disorder, or schizophrenia. That is regardless of how well-controlled the condition may be, and regardless of their physical health. The newly passed bill changes that. Insurers will also no longer be allowed to exclude that particular condition from any coverage they extend.
  2. Small businesses with under 50 employees are now subject to the mental health parity laws, while they were not under the previous bill. Their previous exclusion was due to the increased cost of coverage, but Democrats and other supporters of reform believe that the upcoming exchange markets (run by the states) will assist small employers. The plans sold in the exchanges will meet the parity standards.
  3. The bill doesn’t necessarily mean that people will receive gold-plated mental health coverage. Instead, it states that the coverage should be equal to physical health coverage. If someone picks a bare-bones, high-deductible health insurance plan, their coverage will be limited all-around. What is outlawed is inequality; for example, an insurer cannot charge a higher co-payment for a psychiatrist visit than they would for any other medical specialist. Neither can they deny a patient the opportunity to receive out-of-network mental health treatment, if patients are allowed to seek medical care out-of-network. Also, they cannot limit the number of visits or days of inpatient treatment for substance abuse or mental illness any more strictly than they would for surgery or physical illnesses.
  4. The elimination of lifetime and annual caps on benefits will also be helpful. Mental health treatment can be very costly. Inpatient rehabilitation for substance abuse or eating disorders can cost tens of thousands of dollars per month, which can quickly eat up the limits of most health insurance plans. Fewer patients will suffer from incomplete treatment due to their inability to afford continued help.
  5. The bill’s expansion of Medicaid eligibility will help the mentally ill, whom many experts believe are more likely to be uninsured. Moreover, all Medicaid coverage (not just managed care programs) will now offer equal coverage for mental health conditions.

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