All Marketplace insurance plans cover mental health and substance abuse services as an essential health benefit.
Mental and behavioral health services are essential health benefits
Health insurance plans available in the Marketplace must cover 10 categories of essential health benefits. One of these categories is mental health and substance abuse services. (Substance abuse is also known as substance use disorder.)
These services include behavioral health treatment, such as psychotherapy and counseling. They also include mental and behavioral health inpatient services and substance use disorder treatment.
Your specific behavioral health benefits will depend on the state you live in and the particular health plan you choose. You’ll see a full list of what each plan covers when you compare plans in the Marketplace.
Mental and behavioral health and pre-existing conditions
Marketplace plans can’t deny you coverage or charge you more just because you have a pre-existing condition. This includes mental health and substance use disorder conditions.
Coverage for treatment of pre-existing conditions begins as soon as your Marketplace coverage starts.
There’s no waiting period for coverage of these services.
No lifetime or yearly dollar limits for mental health services
Marketplace plans can’t apply yearly or lifetime dollar limits on coverage of essential health benefits. This includes benefits for mental health and substance use disorder services.
Parity protections for mental health services
Marketplace plans must provide certain “parity” protections between mental health and substance abuse benefits on the one hand, and medical and surgical benefits on the other.
This means that in general, limits applied to mental health and substance abuse services can’t be more restrictive than limits applied to medical and surgical services. The kinds of limits covered by the parity protections include:
- Financial, like deductibles, copayments, coinsurance, and out-of-pocket limits
- Treatment, like limits to the number of days or visits covered
- Care management, like being required to get authorization of treatment before getting it