Category Archives: Health Care Reform

Do Marketplace insurance plans cover mental health and substance abuse services?

Yes.  All Marketplace insurance plans cover mental health and substance abuse services as an essential health benefit.

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, 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.  There is a full list of what each plan covers in the Health Insurance 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 is in effect. There’s no waiting period for coverage of these services.

There are also 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 which 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, co-payments, 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

(taken from HealthCare.gov)

 

Oops! Did you miss the deadline?

I bet you have a hundred good reasons for missing the deadline to sign up for health insurance. But, regardless of why you did not sign up, if you are without health insurance after March 31st, you missed the deadline. You will likely be facing a fine for not having coverage and, you have missed your chance to purchase an Affordable Care Plan until the next open enrollment period begins in November.

Are there any exceptions?

In order to get Affordable Care coverage or make a change in your existing coverage outside the open enrollment period, you must have a qualifying life event. Qualifying life events include:

  • Getting married
  • Having, adopting, or placement of a child
  • Permanently moving to a new area that offers different health plan options.
  • For people already enrolled in Affordable Care coverage, having a change in income or household status that affects eligibility for tax credits or cost-sharing reductions.
  • Losing other health coverage due to a job loss, divorce, loss of eligibility for Medicaid or CHIP, expiration of COBRA coverage, or a health plan being decertified. Voluntarily quitting other health coverage or being terminated for not paying your premiums are not considered loss of coverage. Losing coverage that is not minimum essential coverage is also not considered loss of coverage.

Most special enrollment periods last 60 days from the date of the qualifying life event.

Enrollment for small businesses

Employers generally can start offering health insurance coverage to their employees at any time during the year.

Medicaid and CHIP: Enroll any time

You can enroll in Medicaid or the Children’s Health Insurance Program (CHIP) in your state at any time You can find out if you qualify for Medicaid or CHIP by filling out an Affordable Care application or going directly to your state Medicaid agency.

If you have a qualifying life event or are shopping for coverage for your small business, call me at 440-255-5700 to discuss your options. Let me help you choose the coverage that’s right for you.

 

Enrollment in Affordable Care Health Insurance

The Affordable Care Act, often referred to as Health Care Reform, is designed to remove obstacles to quality, low-cost health insurance for millions of Americans. It guarantees that no one will have to fear the loss of their health insurance if they change jobs or get laid off. There is also greater protection for people with pre-existing conditions.  Open enrollment takes place each fall, however you may qualify for a Special Enrollment Period outside of open enrollment if you have had a life changing event. Contact us for details.

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