Mental illness impacts 1 in 5 adults in the U.S., many of whom never seek medical care, according to the National Alliance on Mental Illness. The Affordable Care Act sought to improve that rate, giving scores of people access to health insurance that’s required to include treatments for things such as depression, anxiety and addiction.
With the increased access to mental health care comes greater focus when shopping for health insurance. Unfortunately, determining which plan will give you the most mental health coverage for the lowest cost can be difficult, leaving people in need frustrated during the annual open enrollment period. It doesn’t help that provider networks for mental health care tend to be far narrower than primary care, making it hard to find a psychiatrist that accepts a particular insurance plan. Add the need for certain prescription drugs to the mix, and it’s not surprising so many consumers give up and simply purchase the cheapest option.
“For consumers of health services in general, it’s hard to get the information we really need to make informed decisions,” says Ron Honberg, senior policy advisor at NAMI. “The more hoops people have to jump through at a time of crisis, the less likely it is for them to navigate those hoops.”
Under the ACA, all insurance plans have to cover mental health and substance abuse services to the same extent they cover medical services. But if the ACA’s individual mandate that requires every American to have health insurance or pay a fine is repealed, those frustrated consumers may exit the health care market altogether. That means they will forgo needed treatment, hurting themselves and further taxing the health care system.
[Read: What Do I Do if I Lose My Health Care Coverage?]
“Plans fill up, customer service lines get backed up and choosing the wrong plan in a rush could really hurt your health if you can’t afford your specialist or treatments next year,” says Lacie Glover, insurance writer at NerdWallet and former U.S. News contributor. “When mental health is what you really care about, you’re doing yourself a favor every minute you invest dissecting your health plan options.”
Frustration doesn’t have to be a foregone conclusion when shopping the health exchanges this open enrollment season, from Nov. 1 to Dec. 15. You can get the most cost-effective coverage for mental health and addiction treatment, granted you are willing to do the work.
Make Sure Your Doctors Are In-Network
Whether you are searching for a primary care doctor or a mental health provider, make sure the person or practice is covered by your insurance provider. That’s particularly important for people suffering from mental illness. It takes time to build trust with a doctor, and often that can’t easily be replicated with a new one. If your doctor matters to you, make sure he or she is part of the plan and is considered an in-network doctor. If your psychiatrist is out of network, for example, you’ll pay more, which may make the plan unaffordable.
“This is an especially important question if a child with a mental illness will be covered by the plan, as there is somewhat of a scarcity of child psychiatrists,” says Pamela Greenberg, president and CEO at the Association for Behavioral Health and Wellness.
If you’re shopping on behalf of a family member, it’s important to have a list of doctors, therapists and mental health providers, as well as the medicine he or she takes handy. And find out if he or she is willing to change plans to get the best deal on health insurance, Greenberg says.
[Read: How the Health Care Debate Is Impacting Medicare.]
Prescription Drugs Go Hand and Hand With Doctors
Insurance companies typically have formularies, or lists of drugs a health plan covers. Patients purchasing new prescription drug coverage with medicines that are considered Tier 2 or Tier 3 on the formulary will have a tougher time accessing them, Honberg says. Since drugs in these tiers are typically pricier, plans could require patients to try cheaper drugs first, even if they have failed for them in the past.
“Sometimes people try for years to find the medication that works for them, and they finally find it and change insurance, and it isn’t covered,” Honberg says. If you take a brand-name drug without a generic version, you need to make sure you won’t be on the hook for the full cost of it.
To make the process easier for consumers, the health care exchanges and marketplaces provide online tools to help narrow down the search. Most of the tools such as the plan finder and prescription drug coverage finder let you enter both the doctor and prescription drugs to find plans that cover both. With a shortage of mental health providers and limited insurance providers, a perfect match isn’t always obtainable. In that case, consumers have to make tough choices between having either their doctor or drugs covered. “It can be hard to prioritize, but doing the math on the difference in cost of a year’s worth of medication vs. the cost of the psychiatrist visits can help you compare,” Glover says.
[Read: How Does the Health Care Debate Affect Obamacare Open Enrollment?]
High-Deductible Plans May Not Be Best Option
The marketplace offers three types of plans for consumers, with different costs and options at each tier: bronze, silver and gold. Bronze plans are typically the cheapest, but they also have the highest deductibles. That means you’ll typically have to pay a couple of thousand dollars or more before the insurance kicks in. Silver and gold plans cost more, but they usually have lower deductibles and more coverage extras. Other expenses to consider include copayments and coinsurance. The details of plans will vary, so you must take the time to compare all of the different costs.
Thanks to the ACA, mental health and substance abuse services are considered essential health benefits and therefore have to be offered by every plan. It’s up to the states to determine how much and what treatments plans have to cover, says Nancy Kelley, program director for Expanding Coverage at the Missouri Foundation for Health. Every plan has to include mental/behavioral health inpatient and outpatient services, generic and specialty drugs and inpatient and outpatient services for substance abuse disorder.
Going into to the health insurance buying process armed with information about how to make an apple-to-apple comparison of the plan with an eye toward mental health coverage can go along way in making sure you make the best choice. It’s important to give yourself enough time and prepare for some frustrations along the way. “Some people will have one option, others may have dozens. No matter where you fall on the spectrum, look at every plan you can possibly afford closely and how it covers your treatment needs — even if there is just one, so you’ll know your costs ahead of time,” Glover says.
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How to Shop for Health Insurance With an Eye Toward Mental Health originally appeared on usnews.com
