Mental Health and the Affordable Care Act

7/27/2019 Mental Health and the Affordable Care Act

1/6

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 conused about all the talk about theAordable Care Act,Obamacare, and the Health Insurance Marketplace, and want to knowwhat it actually means or you?

Read on for more information

Wonderingabout mental healthcoverage in the new healthinsurance marketplace?


2/6

I keep hearing about the Health Insurance Marketplace opening soon.What is it and what does it mean or me?

The Health Insurance Marketplace (also called The Exchange) is a new and easy way to nd aordable healthinsurance or individuals and small businesses. Fill out one application, and nd out which plans and nancialassistance you qualiy or.

What is so different about these health plans?

1. Every health plan MUST cover services within the ten categories o Essential Health Benets. These includemental, behavioral health and substance use care.

2. These health plans oer the largest expansion

o mental health and substance use disordercoverage in a generation, and require thatmental health care must be provided on anequal basis as coverage o physical health care.

3. I you do not qualiy or Medicaid and your

yearly income is 100% to 400% o the FederalPoverty Level (FPL), the government will providesubsidies to help you buy a health plan.

4. The new health law says that plans are not

allowed to reject, ail to renew, or charge more

to an individual due to a pre-existing conditionsuch as mental illness.

5. Plans cannot put annual or lietime limits on

basic health or mental health care.

Health Insurance

Marketplace


3/6

How long do I have toget this new coverage

October 1, 2013: Open enrollment tohealth plans in the Marketplace beg January 1, 2014: Your new health

insurance coverage begins. March 31, 2014: Open enrollment to

health plans in the Marketplace clos

What else should I know?

All health plan benets must be explained in two pages oclear, plain language with NO ne print.

An online tool will help you decide which plan provides the

right level o care or you at the best price. Health plans will only be able to charge dierent rates based

on age, tobacco use, geographic area, and amily size.

All plans must oer a simple, quick way to complain or askquestions about treatment decisions.

Young adults can be covered on a parents plan until age 26.

Plans must cover preventative care at no cost, includingdepression screening.

Individuals who are not on Medicaid or insured throughtheir work will be penalized i they do not buy basic health

insurance.

How can I get started?

1. Start making a list o all the mental health services you would like to have covered by yourhealth plan.

2. Determine your total annual income.3. Compare plans to nd the one that best ts your needs and budget.4. Ask or help! There are many people who are available to help in person or by telephone.

5. Pick a plan, enroll, and enjoy!


4/6

Some questions to consider before picking a plan:1. Is your specic diagnosis covered in the plan?2. Are the medications you like best covered in the plan?3. Is your preerred 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 mustay with that plan for one year. Noall plans are the same, so remembe

Plans may have dierences in what type o mental

or behavioral health services they cover, whatmedications are covered, what diagnoses arecovered, and what providers are covered so makesure your plan covers your needs.

Plans will be put into 4 categories Bronze, SilverGold, and Platinum. All plans categories oerthe same set o essential health benets, and doNOT refect the quality or amount o care the plansprovide. The category you choose aects how mucyou pay each month, and the amount o your co-pa

or doctor visits, etc.


5/6

Marketplace LingoEssential Health Benefts This includeswellness & disease management;prescription drugs; hospitalization; laboratoryservices; emergency services; maternityand newborn care; childrens care (dentaland vision); rehabilitation and habilitation;mental, behavioral health and substance usecare; and outpatient clinic services.

Parity Requires mental health services to beprovided equally to medical services.

Deductible The amount you owe or healthcare services your health insurance or plan covers beore your health insurance or plan begins to pay.

Out o Pocket Cost- Your expenses or medical care that arent reimbursed by insurance. Out-o-pocket cosinclude deductibles, coinsurance, and copayments or covered services plus all costs or services that arencovered.

Navigator A person or organization thats trained and able to help individuals, small businesses, andtheir employees as they look or health coverage options through the Marketplace, including completingeligibility and enrollment orms. These people and organizations are required to be unbiased. Theirservices are ree to individuals.

Subsidies - Beginning in 2014, tax credits will be available to individuals who purchase coverage in the nehealth insurance exchanges and who have income up to 400% o the ederal poverty level. The premium tacredits will be advanceable and reundable, meaning they will be available when an individual purchasescoverage and will be available regardless o whether or not an individual owes any taxes. The premium taxcredits will vary with income and are structured so that the premium an individual or amily will have topay will not exceed a specied percentage o income, ranging rom 2% or those with incomes up to 133o the poverty level (about $14,400 or an individual) to 9.5% or those with incomes between 300 and400% o the poverty level ($32,490 to $43,320 or an individual).

100% to 400% Family Size 100% FPL 400% FPLo Federal Poverty Level 1 $11,490 $45,960

2 $15,510 $62,0403 $19,530 $78,1204 $23,550 $94,200


6/6

Where can I go for help?

There are many organizations and volunteers who can help you gure out whichplan is best or you and answer your questions.

Please remember, the navigators who have been trained to help walk you throughthe enrollment process, by law are prohibited rom recommending plans or advisingyou about which option is best or you. I you need help deciding, make sure to talkto an outside organization, volunteer, or community member you trust.

Some resources that can help or give more information:

National Alliance or Mental Illness (NAMI) www.nami.org/healthcoverage

Enroll America - http://www.enrollamerica.org/about-us

Henry J. Kaiser Family Foundation - http://k.org/health-reorm/

Texas Health Institute (THI)

www.covertexasnow.org

Center or Public Policy Priorities (CPPP)

Mental Health America o Texas (MHAT)Community Centers/MHMRA

Produced by Texas Interaith Center or Public Policywith the generous support o the Meadows Foundation

TEXAS INTERFAITH

CENTER

for public policy

Documents

Mental Health and the Affordable Care Act