Insurance Coverage for Mental Health and Substance Abuse Coverage

As you are getting new insurance or evaluating the insurance you currently have, it is important to remember to take advantage of mental health and substance abuse coverage for you or your family members. Within the healthcare marketplace, all plans cover these areas as essential health benefits. Specific behavioral health benefits do depend on your state and what health plan you choose, so when choosing what plan works best for you or your loved ones, be sure to make sure your needs are covered.

What does this mean for you or your loved ones?

  • Behavioral health treatment, like counseling and psychotherapy, is covered.
  • Behaviors and mental inpatient services are covered.
  • Substance abuse treatment is covered.

 When it comes to these matters, it is important to note that pre-existing mental and behavioral health conditions are covered and spending limits are not allowed. The plans within the marketplace cannot deny you any coverage or charge you more just because you may have pre-existing conditions (like mental health and substance use disorder conditions).  This coverage begins right away from the start of your coverage and does not have any sort of waiting period. These plans cannot put any sort of yearly or lifetime dollar limit on any of the coverage options of any essential health benefit, which includes substance use disorder services as well as mental health coverage.

 The Marketplace plans must provide certain “parity” protections between substance abuse benefits and mental health on one hand and medical and surgical benefits on the other. What this typically means is that limits applied to mental health and substance abuse services cannot be more restrictive than limits applied to medical and surgical devices. These limits covered by parity protections include:

  • Treatment – limits to the number of days or visits covered.
  • Financial – deductibles, copayments, coinsurance, and out-of-pocket limits
  • Care Treatment – is required to get authorization for treatment before getting it.

When it comes to picking your insurance policies, make sure that your policy covers exactly what is needed for you. Speak to a LIG agent today to go over all your medical needs and find the right policy for you to be covered.

To learn more about your insurance choices, connect with one of our agents today to discuss all your options and answer any questions you may have. The experts at LIG Solutions have licensed health insurance professionals intending to offer a simple and transparent view of healthcare coverage. There’s no need to spend hours trying to understand different plan options – we’ll work with you to understand your needs and budget to recommend a plan that will work the best for you. And because we have no vested interest in which insurance carrier you go through, you can rest easy knowing we are truly looking out for your employee’s best interests. 


Get the Insurance You Need and Save Today!

Leave a Comment

Skip to content