After all the revelry of the holidays and the countdown to a new year, we are all getting back into the groove of daily life. After all of the hustle and bustle of the last few months, it can be easy to forget one of the biggest events that come with the start of a new year: healthcare plan changes.
Under the current healthcare laws, insurance plans are required to offer coverage for people in treatment and recovery for substance use and mental health disorders. However, the coverage that is offered can vary wildly from insurance program to insurance program.
Substance use disorders (SUDs) affect a significant percentage of the general population. Treatment and recovery programs are an important part of curbing the mortality rates for people who have used controlled substances and are now in remission.
Whether you are selecting a new insurance policy on a new healthcare plan or dealing with changes to an old one, it is important you know what is covered. This coverage will affect the care you are able to receive and the money you are going to have to pay.
Just like people with conditions like diabetes or asthma have to find plans that offer adequate coverage for their illnesses, individuals with SUDs have to prioritize their needs. That includes selecting the right insurance plan for them.
Knowing What Is Covered (And What Is Not)
One of the biggest changes over time to the healthcare law changes of 2010 has been the continuation of grandfathered plans. These are insurance plans that in some part did not meet the standards set forth in the Affordable Care Act and Patient Protection Act (ACA/PPA).
These plans were originally required to be phased out. However, insurance companies have now been allowed to continue many of these plans due to small changes in the healthcare law that brought them into compliance.
Mental health disorders and SUDs, once diagnosed, are considered pre-existing conditions. Under the ACA and PPA, insurance companies cannot deny coverage based on pre-existing conditions. This means all insurance plans should offer you coverage regardless of previous diagnoses.
Under the ACA and PPA, insurance plans are required to offer dental coverage for children under 25 living in a parent or guardian’s home. However, coverage for adults is optional. These laws do not have requirements to offer vision coverage.
Also, while insurance plans must include some type of mental health services, they are not required to offer the same level of benefits as traditional health coverage. Most insurance companies will only pay for a percentage of the mental healthcare costs up to a deductible, so choosing the right deductible with your plan is important.
Substance Use Disorders and Healthcare Law
More than any other healthcare initiative, the Affordable Care Act has had the greatest impact on the treatment and recovery of people with SUD. Substance use continues to be a major concern in public health, with opioid use alone costing the economy nearly $80 billion annually in recent years.
Advocates have recommended for decades that, as the needs of patients change, it is critical for insurance providers to cover extensive substance use services. However, before the ACA insurance coverage for SUDs often involved higher copays, limits on coverage, and higher-cost medications.
Under the ACA, insurance coverage is expanded in both private insurance and public insurance plans, such as Medicaid. Medicaid eligibility has allowed millions of people to receive quality treatment for SUDs and mental health disorders who were not previously insured.
One of the major changes to substance use treatment under the ACA is the new regulatory requirements placed on insurers. Under the ACA, healthcare plans must offer substance use treatment services at the same cost or less than medical and surgical coverage. This means you should qualify for copays, lower-cost medications, and few or no limits on coverage.
Navigating Healthcare Plan Changes and Mental Illness
Originally passed in 1996, the Mental Health Parity and Addiction Equity Act was extended by the Obama administration under the ACA. By linking this law to the requirements of the 2010 healthcare law, the administration instituted a requirement of mental health and substance use treatment equity in insurance programs and required that plans cover these services by 2014.
Some healthcare plans do have exceptions granted to them by the United States Department of Health and Human Services (HHS). These exceptions have allowed some larger plans not to offer full parity for mental health services on plans. When looking at plans, it is important to make sure that the insurer is complying with ACA requirements for mental health and substance use.
Medicare and Medicaid plans both offer mental health and SUD treatment under their programs. Medicaid beneficiaries are typically eligible for a full range of counseling and treatment services. Medicare Part A covers mental health hospitalization for the insured, while Medicare Parts B and D cover outpatient mental health services and prescription drug services respectively.
How to Make Your Healthcare Plan Changes Work for You
You, as a patient, have to advocate for yourself and often for your loved ones. If you receive insurance on a group plan, your plan is designed with a large number of people in mind. It may not be the coverage you and your individual needs. Choosing the right plan that is offered is crucial for your health and your financial future.
Talking about healthcare plans is usually the last thing many of us want to do. Searching the internet for information can yield thousands of different results. It can be frustrating, boring, and tedious, but it is important for our health and future.
As we move past the lights and memories of another holiday season, it is time to look forward to the new year and the changes you will make as you move onward and upward in life. Along with resolutions, new plans for fitness and nutrition, and goals you set for yourself, there is one often overlooked factor we all face in the new year: changes to our healthcare plans. Whether you have switched to a new provider in the open enrollment period, signed up for a new plan, or your existing provider has made updates, now is the time to find out how this will affect you. Your support team can help. Call us at (801) 308-8898 today.