Second Opinion: Which Mental Health Services Have To Be Covered Under Obamacare?
Monday, November 18, 2013
Aired 11/18/13 on KPBS News.
Insurance providers must cover mental health services, but which ones and how well?
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Special Feature Second Opinion
Second Opinion is a weekly Q-and-A series that answers questions from San Diegans on the Affordable Care Act. Ask yours here.
The Question: Which mental health services will be offered in the new Covered California plans?
Sandra D'Alonzo is pretty frank about her depression. She was diagnosed with it early in life. It worsened during her time volunteering in El Salvador with the Peace Corps, she said. When she returned to the United States, she sought inpatient treatment and later spent a lot of time finding a counselor she likes. Now that she has one, she's not willing to give her up.
D'Alonzo will graduate from the University of Southern California (she attends its satellite campus in Rancho Bernardo) next year. When she gains her master's degree in social work, however, she'll lose her school-based health insurance.
She's hoping to find a new plan on Covered California and wants to know which mental health services she'll have access to.
Here's her question:
"When I graduate in May, I will be looking at Covered California plans, and I wondered what kind of mental health services are available under the different plans."
The Takeaway: Insurance companies must cover mental illness as they would a physical ailment.
California already had a law on the books that says insurance companies must cover mental illness as they would a physical ailment. So, if you can get outpatient services, hospitalization and medicine for a heart attack, you can get it for depression, too. And the law says it can't cost more.
The Obama administration recently announced the strengthening of a similar federal parity law, which is not tied to the Affordable Care Act.
The health reform law, however, does offer some new benefits for people with mental disorders. Depression and other disorders will no longer keep you from getting insurance or cause you to pay a higher premium. And depression screenings and behavioral assessments will be offered free of charge.
The law also specifically includes services for mental health and substance use disorders in its list of required benefits, so there's no getting around it. All new plans will let you see a counselor regularly, seek specialty care related to mental illness, be hospitalized and get prescription drugs. Generally, your copay or cost share for such services will match those for comparable medical services.
The Orders: Talk to your doctor about which insurance she accepts.
D'Alonzo said keeping her current counselor will be at the top of her wish list when she goes shopping on the exchange. Currently, Covered California's doctor directory is far from perfect, so it's best she asks her doctor which insurance she accepts before making a decision.
Other than that, it's all about comparing prices. Mental health is covered, but what she pays per visit depends on what she pays in premiums.
Update: Because Covered California open enrollment won't begin until October each year, D'Alonzo will have to apply for a special enrollment period when she graduates in May. A Covered California spokeswoman said losing school-based coverage is a "qualifying life event" that will allow D'Alonzo and other consumers to purchase a health plan outside of open enrollment.
Check out last week's Second Opinion: What does Obamacare mean for health savings accounts?