Are Pre-Existing Mental Health Conditions Covered by Health Insurance?

Health insurance policies generally cover pre-existing mental health conditions. Insurance carriers must provide coverage to policyholders as long as the plan is purchased during an open or special enrollment period on the ACA exchanges. You may also find policies outside the ACA exchange that offer coverage for pre-existing mental illnesses. However, some aren’t ACA-compliant and don’t include pre-existing health conditions.

Knowing what’s considered a pre-existing condition in mental health, the types of treatments covered and the steps to qualify for coverage can help you find the most suitable policy for your needs.

Pre-existing conditions refer to medical and health issues known before or at the time of enrollment for an insurance policy. These include physical and mental conditions.

According to the latest data from the Substance Abuse and Mental Health Services Administration (SAMHSA), approximately 57.8 million adults in the U.S. have mental health conditions. However, 52.8% remain untreated. Related expenses may vary greatly depending on the condition and its severity — for some, it can be significant.

Generally, any mental health illness known to exist before applying for a health insurance policy can be considered a pre-existing condition. However, insurance companies may have a specific list of conditions they consider as pre-existing, especially if you purchase outside the open enrollment periods. These typically include anxiety and mood disorders, personality disorders, psychotic disorders and other mental and behavioral conditions.

Various factors affect the costs of coverage and treatment. You can anticipate spending more money on more involved treatments even if you have a high-quality health insurance plan. Your plan will need to abide by the following rules and cannot:

• Have a higher deductible for mental health and substance use services.
• Require a higher copay or coinsurance.
• Cap the number of times you can see a mental health provider.
• Charge higher prices for psychiatric or mental health-related medications.
• Limit the number of days authorized in a treatment facility.
• Require pre-authorization if such pre-authorization isn’t typically required to see other types of health care providers.

As a policyholder, you can expect your health insurance plan to cover the following treatments:

Knowing how to qualify for the right benefits can help you better navigate health insurance and ensure you purchase proper coverage.

1. Review the health plan: Make sure your health plan is ACA-compliant. If not, check if it offers coverage for pre-existing mental health conditions.
2. Check the procedures and requirements: Qualification requirements vary per insurance carrier, especially those outside the open enrollment period. For instance, some companies may require medical underwriting. This is when your medical history is examined to evaluate your coverage application.
3. Disclose your condition: When buying a health insurance policy, it may be best to be honest about pre-existing conditions. This will help ensure financial protection. Remember, no insurance company can access your medical reports without your permission.

Health insurance providers can’t deny people with pre-existing mental health conditions. Under the ACA, all individuals are eligible for coverage regardless of whether they have an illness prior to purchasing the plan. It’s illegal for insurers to refuse if the policy is from the Marketplace during the open enrollment period.

Certain exceptions apply. This rule doesn’t apply to those who enrolled in a plan before 2010. Insurance providers that the ACA doesn’t regulate may also refuse coverage.

Two types of health insurance policies don’t follow the ACA rules: Grandfathered and short-term medical policies. If you have any of these plans, clarify what your insurance covers, as it may not include pre-existing mental health conditions.

One of the challenges people with pre-existing mental health conditions face is finding the best health insurance policy. With many options available, it may be a bit difficult to determine the right plan.

Understanding common sources of health insurance — ACA Marketplace, employer plans, private non-ACA-compliant policies, Medicaid, Medicare and Flexible Spending Accounts — can help you with your search for a health plan.

Mental health care can be expensive. People suffering from certain conditions may have difficulty accessing necessary treatments. This is especially true for those who don’t have health insurance.

According to Mental Health America, over 5.5 million U.S. adults with mental health conditions are uninsured. Fortunately, there are ways to find affordable medical care.

Resources can provide helpful information when looking for mental health care, treatment and coverage. To help you get started, MoneyGeek compiled some of them.

• American Academy of Child and Adolescent Psychiatry: This online finder connects you with a child and adolescent psychiatrist.
• American Psychiatric Association Foundation: Use the online search tool to find a psychiatrist offering treatment and diagnosis in your state.
• American Psychological Association: Input your location and find a psychologist offering services near you.
• Depression and Bipolar Support Alliance: Find a support group for people with depression or bipolar disorder. There are also peer-run online support groups for free.
• FindTreatment.gov: Enter your zip code and find a treatment facility near you.
• Make the connection: Find inspiration from stories of veterans and their loved ones as they share the challenges they faced and their road to recovery. Learn about the signs and symptoms of various behavioral and mental health disorders.
• National Alliance on Mental Illness: Access various infographics and fact sheets about mental health illness, parity law and access to care.
• National Empowerment Center: Find links to various resources, including a listening line and phone-based support groups.
• National Institute of Mental Health: Use these contact numbers if you or a loved one requires immediate help. Find a health care provider providing treatment for mental illnesses.
• Samaritans: Find suicide prevention services. Call their 24/7 helpline or text 988.
• Supportiv: This peer-support network helps you connect with people who may be experiencing the same struggles as you. The network is open 24/7 and promises trained moderators.
• U.S. Department of Health and Human Services: Under the Health Insurance Portability and Accountability Act (HIPAA), learn more about your rights and privacy rules on health information.