Mental Health and the Affordable Care Act
Learn more about the Health Insurance Marketplace and learn how to seek out mental health resources when choosing an insurance plan.
Content
Wondering about mental health coverage in the new health insurance marketplace?
Do you or someone you know have a mental illness and have had trouble getting health insurance to cover your treatment and medication?
Are you confused about all the talk about the Affordable Care Act, Obamacare, and the Health Insurance Marketplace, and want to know what it actually means for you?
Read on for more information…
Health Insurance Marketplace
I keep hearing about the Health Insurance Marketplace opening soon. What is it and what does it mean for me?
The Health Insurance Marketplace (also called “The Exchange”) is a new and easy way to find affordable health insurance for individuals and small businesses. Fill out one application, and find out which plans and financial assistance you qualify for.
What is so different about these health plans?
1. Every health plan MUST cover services within the ten categories of Essential Health Benefits. These include mental, behavioral health and substance use care. 2. These health plans offer the largest expansion of mental health and substance use disorder coverage in a generation, and require that mental health care must be provided on an equal basis as coverage of physical health care. 3. If you do not qualify for Medicaid and your yearly income is 100% to 400% of the Federal Poverty Level (FPL), the government will provide subsidies to help you buy a health plan. 4. The new health law says that plans are not allowed to reject, fail to renew, or charge more to an individual due to a pre-existing condition such as mental illness. 5. Plans cannot put annual or lifetime limits on basic health or mental health care.
What else should I know?
• All health plan benefits must be explained in two pages of clear, plain language with NO fine print. • An online tool will help you decide which plan provides the right level of care for you at the best price. • Health plans will only be able to charge different rates based on age, tobacco use, geographic area, and family size. • All plans must offer a simple, quick way to complain or ask questions about treatment decisions. • Young adults can be covered on a parent’s plan until age 26. • Plans must cover preventative care at no cost, including depression screening. • Individuals who are not on Medicaid or insured through their work will be penalized if they do not buy basic health insurance.
How long do I have to get this new coverage?
• October 1, 2013: Open enrollment to buy health plans in the Marketplace begins. • January 1, 2014: Your new health insurance coverage begins. • March 31, 2014: Open enrollment to buy health plans in the Marketplace closes.
How can I get started?
1. Start making a list of all the mental health services you would like to have covered by your health plan. 2. Determine your total annual income. 3. Compare plans to find the one that best fits your needs and budget. 4. Ask for help! There are many people who are available to help in person or by telephone. 5. Pick a plan, enroll, and enjoy!
Some questions to consider before picking a plan:
1. Is your specific diagnosis covered in the plan? 2. Are the medications you like best covered in the plan? 3. Is your preferred doctor or hospital covered in the plan? 4. Are the rehabilitative services you need, such as case management or housing assistance, covered in the plan?
Important! Once you enroll, you must stay with that plan for one year. Not all plans are the same, so remember:
• Plans may have differences in what type of mental or behavioral health services they cover, what medications are covered, what diagnoses are covered, and what providers are covered so make sure your plan covers your needs. • Plans will be put into 4 categories – Bronze, Silver, Gold, and Platinum. All plans’ categories offer the same set of essential health benefits, and do NOT reflect the quality or amount of care the plans provide. The category you choose affects how much you pay each month, and the amount of your co-pays for doctor visits, etc.
Marketplace Lingo
Essential Health Benefits – This includes wellness & disease management; prescription drugs; hospitalization; laboratory services; emergency services; maternity and newborn care; children’s care (dental and vision); rehabilitation and habilitation; mental, behavioral health and substance use care; and outpatient clinic services. Parity – Requires mental health services to be provided equally to medical services. Deductible – The amount you owe for health care services your health insurance or plan covers before your health insurance or plan begins to pay. Out of Pocket Cost - Your expenses for medical care that aren’t reimbursed by insurance. Out-of-pocket costs include deductibles, coinsurance, and copayments for covered services plus all costs for services that aren’t covered. Navigator – A person or organization that’s trained and able to help individuals, small businesses, and their employees as they look for health coverage options through the Marketplace, including completing eligibility and enrollment forms. These people and organizations are required to be unbiased. Their services are free to individuals. Subsidies - Beginning in 2014, tax credits will be available to individuals who purchase coverage in the new health insurance exchanges and who have income up to 400% of the federal poverty level. The premium tax credits will be advanceable and refundable, meaning they will be available when an individual purchases coverage and will be available regardless of whether or not an individual owes any taxes. The premium tax credits will vary with income and are structured so that the premium an individual or family will have to pay will not exceed a specified percentage of income, ranging from 2% for those with incomes up to 133% of the poverty level (about $14,400 for an individual) to 9.5% for those with incomes between 300 and 400% of the poverty level ($32,490 to $43,320 for an individual).
100% to 400% of Federal Poverty Level
Family Size 1 2 3 4
100% FPL 400% FPL $11,490 $45,960 $15,510 $62,040 $19,530 $78,120 $23,550 $94,200
Where can I go for help?
There are many organizations and volunteers who can help you figure out which plan is best for you and answer your questions. Please remember, the navigators who have been trained to help walk you through the enrollment process, by law are prohibited from recommending plans or advising you about which option is best for you. If you need help deciding, make sure to talk to an outside organization, volunteer, or community member you trust. Some resources that can help or give more information: National Alliance for Mental Illness (NAMI) – www.nami.org/healthcoverage Enroll America - http://www.enrollamerica.org/about-us Henry J. Kaiser Family Foundation - http://kff.org/health-reform/ Texas Health Institute (THI) www.covertexasnow.org Center for Public Policy Priorities (CPPP) Mental Health America of Texas (MHAT) Community Centers/MHMRA
TEXAS INTERFAITH CENTER for public policy
Produced by Texas Interfaith Center for Public Policy with the generous support of the Meadows Foundation
Do you or someone you know have a mental illness and have had trouble getting health insurance to cover your treatment and medication?
Are you confused about all the talk about the Affordable Care Act, Obamacare, and the Health Insurance Marketplace, and want to know what it actually means for you?
Read on for more information…
Health Insurance Marketplace
I keep hearing about the Health Insurance Marketplace opening soon. What is it and what does it mean for me?
The Health Insurance Marketplace (also called “The Exchange”) is a new and easy way to find affordable health insurance for individuals and small businesses. Fill out one application, and find out which plans and financial assistance you qualify for.
What is so different about these health plans?
1. Every health plan MUST cover services within the ten categories of Essential Health Benefits. These include mental, behavioral health and substance use care. 2. These health plans offer the largest expansion of mental health and substance use disorder coverage in a generation, and require that mental health care must be provided on an equal basis as coverage of physical health care. 3. If you do not qualify for Medicaid and your yearly income is 100% to 400% of the Federal Poverty Level (FPL), the government will provide subsidies to help you buy a health plan. 4. The new health law says that plans are not allowed to reject, fail to renew, or charge more to an individual due to a pre-existing condition such as mental illness. 5. Plans cannot put annual or lifetime limits on basic health or mental health care.
What else should I know?
• All health plan benefits must be explained in two pages of clear, plain language with NO fine print. • An online tool will help you decide which plan provides the right level of care for you at the best price. • Health plans will only be able to charge different rates based on age, tobacco use, geographic area, and family size. • All plans must offer a simple, quick way to complain or ask questions about treatment decisions. • Young adults can be covered on a parent’s plan until age 26. • Plans must cover preventative care at no cost, including depression screening. • Individuals who are not on Medicaid or insured through their work will be penalized if they do not buy basic health insurance.
How long do I have to get this new coverage?
• October 1, 2013: Open enrollment to buy health plans in the Marketplace begins. • January 1, 2014: Your new health insurance coverage begins. • March 31, 2014: Open enrollment to buy health plans in the Marketplace closes.
How can I get started?
1. Start making a list of all the mental health services you would like to have covered by your health plan. 2. Determine your total annual income. 3. Compare plans to find the one that best fits your needs and budget. 4. Ask for help! There are many people who are available to help in person or by telephone. 5. Pick a plan, enroll, and enjoy!
Some questions to consider before picking a plan:
1. Is your specific diagnosis covered in the plan? 2. Are the medications you like best covered in the plan? 3. Is your preferred doctor or hospital covered in the plan? 4. Are the rehabilitative services you need, such as case management or housing assistance, covered in the plan?
Important! Once you enroll, you must stay with that plan for one year. Not all plans are the same, so remember:
• Plans may have differences in what type of mental or behavioral health services they cover, what medications are covered, what diagnoses are covered, and what providers are covered so make sure your plan covers your needs. • Plans will be put into 4 categories – Bronze, Silver, Gold, and Platinum. All plans’ categories offer the same set of essential health benefits, and do NOT reflect the quality or amount of care the plans provide. The category you choose affects how much you pay each month, and the amount of your co-pays for doctor visits, etc.
Marketplace Lingo
Essential Health Benefits – This includes wellness & disease management; prescription drugs; hospitalization; laboratory services; emergency services; maternity and newborn care; children’s care (dental and vision); rehabilitation and habilitation; mental, behavioral health and substance use care; and outpatient clinic services. Parity – Requires mental health services to be provided equally to medical services. Deductible – The amount you owe for health care services your health insurance or plan covers before your health insurance or plan begins to pay. Out of Pocket Cost - Your expenses for medical care that aren’t reimbursed by insurance. Out-of-pocket costs include deductibles, coinsurance, and copayments for covered services plus all costs for services that aren’t covered. Navigator – A person or organization that’s trained and able to help individuals, small businesses, and their employees as they look for health coverage options through the Marketplace, including completing eligibility and enrollment forms. These people and organizations are required to be unbiased. Their services are free to individuals. Subsidies - Beginning in 2014, tax credits will be available to individuals who purchase coverage in the new health insurance exchanges and who have income up to 400% of the federal poverty level. The premium tax credits will be advanceable and refundable, meaning they will be available when an individual purchases coverage and will be available regardless of whether or not an individual owes any taxes. The premium tax credits will vary with income and are structured so that the premium an individual or family will have to pay will not exceed a specified percentage of income, ranging from 2% for those with incomes up to 133% of the poverty level (about $14,400 for an individual) to 9.5% for those with incomes between 300 and 400% of the poverty level ($32,490 to $43,320 for an individual).
100% to 400% of Federal Poverty Level
Family Size 1 2 3 4
100% FPL 400% FPL $11,490 $45,960 $15,510 $62,040 $19,530 $78,120 $23,550 $94,200
Where can I go for help?
There are many organizations and volunteers who can help you figure out which plan is best for you and answer your questions. Please remember, the navigators who have been trained to help walk you through the enrollment process, by law are prohibited from recommending plans or advising you about which option is best for you. If you need help deciding, make sure to talk to an outside organization, volunteer, or community member you trust. Some resources that can help or give more information: National Alliance for Mental Illness (NAMI) – www.nami.org/healthcoverage Enroll America - http://www.enrollamerica.org/about-us Henry J. Kaiser Family Foundation - http://kff.org/health-reform/ Texas Health Institute (THI) www.covertexasnow.org Center for Public Policy Priorities (CPPP) Mental Health America of Texas (MHAT) Community Centers/MHMRA
TEXAS INTERFAITH CENTER for public policy
Produced by Texas Interfaith Center for Public Policy with the generous support of the Meadows Foundation
