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. You’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 aren’t allowed
Marketplace plans can’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 can’t put yearly or lifetime dollar limits on coverage of any
A set of 10 categories of services health insurance plans must cover under the Affordable Care Act. These include doctors’ services, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, mental health services, and more. Some plans cover more services.
Refer to glossary for more details.
, 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 can’t be more restrictive than limits applied to medical and surgical services. The limits covered by parity protections include:
Financial — like deductibles, copayments, coinsurance, and out-of-pocket limits
Treatment — like limits to the number of days or visits covered
Care management — like being required to get authorization of treatment before getting it