Mental-health coverage to get a big boost under Obamacare
When my brother, who had severe epilepsy, died of a massive seizure at 32, I needed to see a grief counselor. I had been his primary caretaker, and his death hit me hard.
I was fortunate to have access to workplace insurance that included quality mental-health services. It’s a benefit I have come to really appreciate.
But many people don’t have access to such care.
I was thinking about this as I followed news reports on the shooting rampage at the Washington Navy Yard, in which 12 people were killed, as well as the gunman, and several others were injured. Police records and comments from people who knew the gunman, who had served in the Navy as a full-time reservist, indicate that he may have had mental-health issues.
Now comes the recovery. At least two workers at the Navy Yard reported that they were standing beside people who were gunned down, one shot in the head. One person said that when he got up from a crouched position, there were bullet holes near the top of the wall. I would ask the question, why not me? And I might need someone to help me deal with the trauma or guilt.
I think about the folks who were working at the Navy Yard or other workplaces who have to deal with the aftermath of such tragedies. And while such incidents are rare, it is likely that you are working with people who are struggling with mental illnesses and need help to handle their condition. They aren’t likely to go on a shooting spree, but they may drink too much, take illicit drugs or fall into a depression they can’t shake.
Although many large and small group insurance plans include services for some mental-health and substance-use illnesses, there are gaps in coverage. About one-third of those who are now covered in the individual market have no coverage for substance-use disorders and nearly 20 percent have no coverage for mental-health cases, including outpatient therapy visits and inpatient crisis intervention and stabilization, according to the Department of Health and Human Services.
But starting next year, this will change for many workers.
Under the Affordable Care Act, insurance plans offered in the new marketplaces will have to cover a core set of services called “essential health benefits.” Included on the list of 10 benefits are mental-health and substance-use disorder services, which include behavioral health treatment, counseling and psychotherapy. Specifically, as part of what’s considered preventive services, plans will also cover alcohol-misuse screening and counseling, depression screening for adults and adolescents, domestic and interpersonal violence screening for women, and behavioral assessments for children.
Here are two important points about mental-health coverage under Obamacare. First, the coverage for behavioral health services must be generally comparable with coverage for medical and surgical care. Second, plans offered in the marketplace have to cover preventive services without charging customers a co-payment or coinsurance even if you haven’t met your yearly deductible. But the services have to be delivered by a network provider.
The Kaiser Family Foundation noted in a report released this month that benefits will be extended in many cases to cover services typically now excluded, such as mental health. Starting next year, health plans won’t be able to deny coverage or charge you more because of a pre-existing health condition, including a mental illness.
Think this issue doesn’t affect you? Well, take a look at these statistics from MentalHealth.gov:
?One in five adults has experienced a mental-health issue.
?Half of all mental-health disorders first show up before a person turns 14. Three-quarters of mental-health disorders begin before 24. But less than 20 percent of children and adolescents with mental-health problems receive the treatment they need.
?One in 20 Americans lived with a serious mental illness, such as schizophrenia, bipolar disorder or major depression.
We are reminded of the seriousness of mental illness when there’s an incident such as the one at the Navy Yard. But this issue should matter to workers and employers more often than just at the time of a tragedy.
Open enrollment in the health insurance marketplace begins Oct. 1. Visit HealthCare.gov to learn more about the behavioral health services offered.
The Affordable Care Act will provide one of the largest expansions of mental-health and substance-use disorder coverage in a generation, the Obama administration says. I hope that by expanding access to mental-health coverage, we can get people the help they need, and in the most severe situations prevent tragedies that result in the loss of life.
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Source: Washington Post