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Consumer Alert: Mental Health Insurance Coverage

Commissioner Miller is informing consumers about insurance coverage for mental health services. Mental health issues peak during the winter months, and nearly 10 million Americans experience seasonal affective disorder (SAD).

If you have health insurance, your insurance company will have a list of providers that are covered by your plan. Your primary care provider may be able to refer you to a mental health specialist who meets your needs. When insurance plans cover mental health benefits, those mental health services must be covered at parity with your medical coverage.

Under the Affordable Care Act, coverage under individual and small employer health insurance plans has been expanded to cover mental health and substance use disorders. Also, preventive services like depression and anxiety screenings are now covered by most plans at no additional cost.

If you purchased health insurance through the federal marketplace, your plan must cover inpatient care, outpatient care, emergency care, and prescription drugs for mental health and substance use disorder treatment, including behavioral health treatment. If you have a pre-existing mental or behavioral health condition, you cannot be denied coverage or be charged more when purchasing health insurance through the marketplace.

If you experience a life change - like a divorce, having a baby, or losing a job - you may be eligible for a Special Enrollment Period to enroll in health insurance through the federal marketplace at www.HealthCare.gov.

If you have questions regarding mental health insurance coverage, please contact our Consumer Services Bureau at 1-877-881-6388.