American Mental Health Counselors Association
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Obamacare Mental Health Benefit Extended to 62 Million Americans 02/21/13


February 21, 2013 - Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced yesterday a final rule for the Accountable Care Act that will make purchasing health coverage easier for consumers. The policies give consumers a consistent way to compare and enroll in health coverage in the individual and small group markets. The rule outlines health insurance issuer standards for a core package of benefits, called “Essential Health Benefits,” which health insurance issuers must cover both inside and outside the health insurance “Exchanges.” The standards for essential health benefits greatly expand the availability of coverage for mental health and substance use disorder services. HHS projects the rules will eventually expand mental health and substance use disorder benefits and federal parity protections to 62 million more Americans. For more information on the rule, see: Essential Health Benefit Rule

The Obamacare statute does not enumerate detailed benefit levels, but requires that all plans covering essential health benefits include mental health and substance use disorder benefits with services at parity levels. Until Obamacare, nearly 20 percent of individuals purchasing insurance have not had access to mental health services, and nearly one third have no coverage for substance use disorder services. The new rule will bridge this huge gap by expanding benefits coverage in three ways:
  • Mental health and substance use disorder benefits are included as Essential Health Benefits
  • Federal parity protections are applied to mental health and substance use disorder benefits in the individual and small group markets
  • Mandated parity for mental health and substance use disorder benefits in the individual and small group market will expand benefits availability to 62 million more Americans
All states have been given the opportunity to define essential health benefits in a way that would best meet the needs of their residents. Most have elected to establish their own benchmark-based plan approach, including selecting a benchmark plan from options offered in their current state market. Benchmark plan benefits must be equal in scope to a typical employer plan. Twenty-six states have already selected a benchmark plan for their state, and the largest small business plan in each state will be the benchmark for the rest. States that decline this option will have their benchmark plan defined by the federal government. More information on health care reform and the state “Exchanges” or “Marketplaces” may be viewed here: Health Insurance Marketplaces