Nearly one in five Americans are currently living with a mental health disorder, which puts them at a higher risk for complications such as sleep disorders, heart or respiratory diseases, diabetes and substance abuse. Since the Affordable Care Act was signed into law over a decade ago, there’s been a significant increase in the number of people who have health insurance with coverage for mental health services.
Even so, accessing mental health services is still a challenge for many. According to one study, about one in five adults with a mental illness who were seeking treatment couldn’t get the services they needed. Despite the significant progress the country has made in the past decade, there are still coverage gaps for millions of Americans.
What Does Mental Health Parity Provide?
“Mental health parity” means that a health insurance plan has to provide coverage for mental health services comparable to the coverage it has for general medical care.
The Mental Health Parity Act of 1996 and the Mental Health Parity and Addiction Equity Act of 2008 ensured that all large-group, employer-based health insurance plans that offered mental health services had to have the same coverage for them as for medical and surgical services. However, there were plenty of loopholes that left many individuals without mental health coverage.
In some cases, health insurance companies screened patients for mental health problems and denied coverage to those with histories of substance abuse or mental illness. Also, these laws only applied to large-group plans, meaning that those with small-group or individual plans may not have any coverage for mental health services. Different states enforce varying parity laws, and underwriting protections through HIPAA are insufficient.
The Affordable Care Act, which was passed in 2010, greatly expanded health insurance coverage for mental health services. The law guaranteed this coverage for those with individual, small-group and Medicaid expansion plans by requiring the plans to cover 10 essential health benefits. Those with comprehensive health insurance plans were guaranteed the same level of coverage for mental health services that they had for medical care, regardless of whether their plan was through their employer or purchased from the federal Marketplace.
The law also required full coverage for preventative services such as mental health screenings, and insurance companies were required to have adequate provider networks to make care accessible to all policyholders.
Finally, the ACA put an end to annual and lifetime benefit caps, and it eliminated a health insurance company’s ability to deny coverage based on a preexisting mental health condition.
Mental Health Coverage Still Has Significant Barriers
While the ACA made high-quality health insurance plans more widely available and guaranteed mental health services to those with coverage, there are still significant barriers that prevent individuals from accessing mental health care.
Inadequate Health Insurance Coverage
The ACA requires a certain level of coverage for mental health services. Unfortunately, many health insurance companies still aren’t providing adequate mental health care coverage.
Small Provider Networks
Expanded mental health coverage means nothing if the individual can’t get treatment when and where they need it. Under the ACA, qualified health insurance plans have to have provider networks that are large enough and have an appropriate number of specialists who provide necessary mental health and substance abuse services. Unfortunately, as late as 2018, there was a class-action lawsuit brought against a health insurance company for inadequate provider networks.
An inadequate mental health network can have a serious impact on an individual’s ability to get the care they need through:
- Longer waiting periods for treatment
- Forcing them to travel farther to see an in-network provider
- Having to see an out-of-network provider and pay a higher out-of-pocket cost
While problems with provider networks still exist under the ACA, the good news is that patients now have recourse and can push health insurance companies to expand their networks.
Restrictive Standards for Coverage
Health insurance companies have to provide mental health coverage for members, but many companies limit their coverage by requiring individuals to meet strict criteria for services. Just as a doctor has to justify medically necessary services and operations to treat a patient’s physical condition, they must prove that mental health treatment is necessary before an insurance company pays for coverage.
Unfortunately, these standards tend to be very restrictive. Unless the individual has a very serious mental illness, the health insurance company may deny coverage for care. Obviously, this can be dangerous for patients with conditions such as depression, eating disorders and post-traumatic stress disorder that can be life-threatening if not treated properly and promptly.
Even those who have health insurance coverage for mental illness may be reluctant to seek necessary treatment due to persisting stigmas. Stigmas come when an individual is defined by their mental health disorder rather than who they are as a person. For many, fear that others will treat them differently because they seek treatment for a disorder is enough to keep them from getting help.
In some cases, this fear is justified; there are some circles in which getting treatment is seen as shameful or unnecessary. However, as more information on the importance of mental health and the prevalence and seriousness of mental illness is available, more people see the immense value in getting this type of care. Many individuals who seek mental health treatment discover their community to be very supportive.
Many mental health providers operate within normal business hours. Unfortunately, their office hours line up with many potential clients’ work schedules, making it difficult for many people to see a therapist regularly.
Fortunately, there’s an increasing number of options for those with inflexible work schedules. Some mental health providers offer evening and weekend hours, while others provide virtual visits that may enable clients to meet with them on lunch breaks.
Limited Health Insurance Options
The ACA expanded affordable comprehensive health insurance coverage to those whose income qualifies them for cost-saving subsidies. However, most people rely on employer-subsidized health insurance. Losing their job likely results in losing that coverage, disrupting mental health services.
Inaccurate Ideas About Mental Health Care
Persisting ideas about mental health care—that it’s too expensive or that it doesn’t work—can be a major hindrance for those who need treatment.
The truth is that we have a greater understanding than ever before about how to effectively treat mental illnesses. Health providers use individualized approaches that may include medication, therapy or both.
The Future of Mental Health Treatment
While the ACA has made mental health coverage more accessible to millions of people, coverage gaps remain. Populations that were underserved prior to 2010, including those with limited incomes and ethnic minorities, continue to have very limited treatment options.
Additionally, the ACA requires individual and small-group plans to have mental health coverage, but large-group plans aren’t subject to this requirement but to state laws. State laws tend to be lax and there are still loopholes that result in patients not getting the coverage they need. Accessibility also continues to be a problem, with over 119 million people living in areas with shortages of mental health providers, according to one source.
Fortunately, policymakers have plenty of options for expanding on the progress that’s been made. In the future, we may expect to see Medicaid expansion in the 12 states that still haven’t made the program available to those under age 65. We may also see an elimination of non-ACA-compliant health insurance plans and a requirement for large-group employer-based plans to provide better coverage for mental health services.