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Health benefits & coverage

Mental health & substance abuse coverage

All Marketplace plans cover mental health and substance abuse services as essential health benefits.

Mental and behavioral health services are essential health benefits

All plans must cover:
  • Behavioral health treatment, such as psychotherapy and counseling
  • Mental and behavioral health inpatient services
  • Substance use disorder (commonly known as substance abuse) treatment
Your specific behavioral health benefits will depend on your state and the health plan you choose. Youโ€™ll see a full list of what each plan covers, including behavioral health benefits, when you compare plans in the Marketplace.

Pre-existing mental and behavioral health conditions are covered, and spending limits arenโ€™t allowed

  • Marketplace plans canโ€™t deny you coverage or charge you more just because you have any pre-existing condition, including mental health and substance use disorder conditions.
  • Coverage for treatment of all pre-existing conditions begins the day your coverage starts.
  • Marketplace plans canโ€™t put yearly or lifetime dollar limits on coverage of any
    , including mental health and substance use disorder services.

Parity protections for mental health services

Marketplace plans must provide certain "parity" protections between mental health and substance abuse benefits on the one hand, and medical and surgical benefits on the other.
This generally means limits applied to mental health and substance abuse services canโ€™t be more restrictive than limits applied to medical and surgical services. The limits covered by parity protections include:
  • Financial โ€” like deductibles, copayments, coinsurance, and out-of-pocket limits
  • Treatment โ€” like limits to the number of days or visits covered
  • Care management โ€” like being required to get authorization of treatment before getting it