Skip to content

New Insurance Policies Must Cover Mental Illness

People with depression, severe anxiety, eating disorders and other psychological conditions have often found themselves shut out of the private insurance market. But that will change under far-reaching provisions of the Affordable Care Act.

The federal law prohibits insurers from rejecting applicants with pre-existing conditions — a practice that made it nearly impossible for people with chronic mental health conditions to buy policies on their own.

Mental health coverage offered through the individual market also was notoriously skimpy or nonexistent. Now, anyone who buys a plan through the new online marketplaces will find mental health services covered as one of 10 “essential health benefits” and no lifetime limits on services that will be reimbursed.

In Illinois, it’s estimated that nearly 725,000 previously uninsured residents will be eligible to buy coverage through the state’s insurance marketplace; of those, nearly 156,000 are expected to have a serious mental illness or serious psychological distress, according to the National Association of State Mental Health Program Directors.

Colleen Burns, special counsel for health policy to Gov. Pat Quinn, called the change good news. “Historically, if you bought a health insurance plan on the individual market it’s unlikely that mental health services would have been covered much — if at all,” she said.

Meanwhile, all new insurance policies for individuals and small businesses that are sold outside the marketplaces must incorporate mental health coverage as of Jan. 1. A federal parity law prohibits insurers from charging higher rates, providing a narrower range of services, or otherwise imposing more stringent limits on mental health services in new policies.

New financial incentives, such as penalties for hospital readmissions, also give medical providers fresh incentives to focus on mental health care.

Advocate Health Care, one of Chicago’s largest health care systems, is responding with a plan to make psychiatrists available in emergency rooms 24/7, either in person or through telepsychiatry, said Dr. Lee Sacks, chief medical officer.

The plan will be tested this year at Advocate Christ Medical Center in Oak Lawn, Advocate Trinity Hospital in Chicago, Advocate South Suburban Hospital in Hazel Crest and Advocate BroMenn Medical Center in Normal in central Illinois, then rolled out to all Advocate hospitals in 2015. Also, Advocate will start routinely providing behavioral health services to patients on its medical and surgical units after an analysis found that up to 40 percent of these patients have issues such as depression or anxiety.

“A lot of this has been ignored in the past,” Sacks said. “Our goal will be to help people recover and get back to a full life more quickly.”

Other providers are looking at hiring psychologists, social workers or other mental health professionals to work alongside internists and family physicians in clinics or medical offices. Last month, the Department of Health and Human Services committed $50 million to expand mental health services at about 200 community health centers across the country.

Judith Graham

Related Topics

Mental Health The Health Law