Mental Health & Substance Abuse Insurance Coverage
All Marketplace plans cover mental health and substance abuse services as essential health benefits.
Mental and behavioral health services are essential health benefits
All plans must cover:
Behavioral health treatment, such as psychotherapy and counseling
Mental and behavioral health inpatient services
Substance use disorder (commonly known as substance abuse) treatment
Your specific behavioral health benefits will depend on your state and the health plan you choose. You’ll see a full list of what each plan covers, including behavioral health benefits, when you compare plans in the Marketplace.
Pre-existing mental and behavioral health conditions are covered, and spending limits aren’t allowed.
Marketplace plans can’t deny you coverage or charge you more just because you have any pre-existing condition, including mental health and substance use disorder conditions.
Coverage for treatment of all pre-existing conditions begins the day your coverage starts.
Marketplace plans can’t put yearly or lifetime dollar limits on coverage of any essential health benefit, including 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 generally means limits applied to mental health and substance abuse services can’t be more restrictive than limits applied to medical and surgical services. The limits covered by 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
What to consider if you do not have insurance:
Programs that offer payment assistance or scholarships for treatment.
Check if you’re eligible for Medicaid.
Look into community health centers and state-run options.
States have federally funded government treatment centers, hospital facilities.
Community health centers are nonprofit health providers that may be able to assist with treatment costs or offer payment on a sliding scale.
Ask about payment assistance.
Research nonprofit programs, such as The Salvation Army which offer no cost treatments which may be an option.