What is Mental Health?
Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make choices. Mental health is important at every stage of life, from childhood and adolescence through adulthood.
Over the course of your life, if you experience mental health problems your thinking, mood, and behavior could be affected. Many factors contribute to mental health problems, including:
• Biological factors, such as genes or brain chemistry
• Life experiences, such as trauma or abuse
• Family history of mental health problems
Mental health problems are common, but help is available. People with mental health problems can get better and many recover completely.
Early Warning Signs
Not sure if you or someone you know is living with mental health problems? Experiencing one or more of the following feelings or behaviors can be an early warning sign of a problem:
• Eating or sleeping too much or too little
• Pulling away from people and usual activities
• Having low or no energy
• Feeling numb or like nothing matters
• Having unexplained aches and pains
• Feeling helpless or hopeless
• Smoking, drinking, or using drugs more than usual
• Feeling unusually confused, forgetful, on edge, angry, upset, worried, or scared
• Yelling or fighting with family and friends
• Experiencing severe mood swings that cause problems in relationships
• Having persistent thoughts and memories you can't get out of your head
• Hearing voices or believing things that are not true
• Thinking of harming yourself or others
• Inability to perform daily tasks like taking care of your kids or getting to work or school
Mental Health and Wellness
Positive mental health allows people to:
• Realize their full potential
• Cope with the stresses of life
• Work productively
• Make meaningful contributions to their communities
Ways to maintain positive mental health include:
• Getting professional help if you need it
• Connecting with others
• Staying positive
• Getting physically active
• Helping others
• Getting enough sleep
• Developing coping skills
Health Insurance, Mental Health Services, and Addiction Services
• Help is available, if you have:
o Been denied coverage
o Reached a limit on your plan (such as copayments, deductibles, yearly visits, etc.)
o Have an overly large copay or deductible
• You may be protected by Mental Health and Substance Use Disorder Coverage Parity laws that require most health plans to apply similar rules to mental health benefits as they do for medical or surgical benefits. See the different types of insurance below for more information about the protections that may apply for you, and to receive assistance information. There are federal and state agencies who can provide assistance.
Does the Affordable Care Act require insurance plans to cover mental health benefits?
• As of 2014, most individual and small group health insurance plans—including plans sold on the Marketplace—are required to cover mental health and substance use disorder services. Medicaid Alternative Benefit Plans also must cover mental health and substance use disorder services.
• These plans must have coverage of essential health benefits, which include 10 categories of benefits as defined under the health care law. One of those categories is mental health and substance use disorder services. Another is rehabilitative and habilitative services.
• Additionally, these plans must comply with mental health and substance use parity requirements, as set forth in the Mental Health Parity and Addiction Equity Act (MHPAEA)—meaning coverage for mental health and substance abuse services generally cannot be more restrictive than coverage for medical and surgical services.
How do I find out if my health insurance plan is supposed to be covering mental health or substance use disorder services in parity with medical and surgical benefits? What do I do if I think my plan is not meeting parity requirements?
• In general, for those in large employer plans, if mental health or substance use disorder services are offered, they are subject to the parity protections required under MHPAEA. And, as of 2014, for most small employer and individual plans, mental health and substance use disorder services must meet MHPAEA requirements.
• If you have questions about your insurance plan, you might first look at your plan’s enrollment materials, or any other information you have on the plan, to see what the coverage levels are for all benefits. Because of the Affordable Care Act, health insurers are required to provide you with an easy-to-understand summary about your benefits including mental health benefits, which should make it easier to see what your coverage is.
• More information also may be available via the Mental Health and Addiction Insurance Help consumer portal prototype and with your state Consumer Assistance Program (CAP). Additional, helpful information on what you can do to better understand the parity protections you have is available online at https://store.samhsa.gov/product/Know-Your-Rights-Parity-for-Mental-Health-and-Substance-Use-Disorder-Benefits/SMA16-4971.
Does Medicaid cover mental health or substance use disorder services?
• All state Medicaid programs provide some mental health services and some offer substance use disorder services to beneficiaries, and Children’s Health Insurance Program (CHIP) beneficiaries receive a full-service array. These services often include counseling, therapy, medication management, social work services, peer supports, and substance use disorder treatment.
• While states determine which of these services to cover for adults, Medicaid and CHIP requires that children enrolled in Medicaid receive a wide range of medically necessary services, including mental health services. In addition, coverage for the new Medicaid adult expansion populations is required to include essential health benefits, including mental health and substance use disorder benefits, and must meet mental health and substance abuse parity requirements under MHPAEA in the same manner as health plans.
Does Medicare cover mental health or substance use disorder services?
• Yes, Medicare covers a wide range of mental health services.
• Medicare Part A (Hospital Insurance) covers inpatient mental health care services you get in a hospital. Part A covers your room, meals, nursing care, and other related services and supplies.
• Medicare Part B (Medical Insurance) helps cover mental health services that you would generally get outside of a hospital, including visits with a psychiatrist or other doctor, visits with a clinical psychologist or clinical social worker, and lab tests ordered by your doctor.
• Medicare Part D (Prescription Drug) helps cover drugs you may need to treat a mental health condition. Each Part D plan has its own list of covered drugs, known as formulary.
• If you get your Medicare benefits through a Medicare Advantage Plan (like an HMO or PPO) or other Medicare health plan, check your plan’s membership materials or call the plan for details about how to get your mental health benefits.
• If you get your Medicare benefits through traditional Medicare (not a Medicare Advantage plan) and want more information, visit https://www.medicare.gov/Pubs/pdf/10184-Medicare-and-Your-Mental-Health-Benefits.pdf. To see if a particular test, item or service is covered, please visit the https://www.medicare.gov/coverage.
What can I do if I think I need mental health or substance use disorder services for myself or family members?
• Here are three steps you can take right now:
o Learn more about how you, your friends, and your family can obtain health insurance coverage provided by Medicaid or CHIP or the Health Insurance Marketplaces by visiting HealthCare.gov
o Find out more online about how the law is expanding coverage of mental health and substance use disorder benefits and federal parity protections by visiting https://aspe.hhs.gov/report/affordable-care-act-expands-mental-health-and-substance-use-disorder-benefits-and-federal-parity-protections-62-million-americans
o Find help in your area with the Behavioral Health Treatment Services Locator at https://findtreatment.samhsa.gov/ or the Find a Health Center locator at https://findahealthcenter.hrsa.gov/
What is the Health Insurance Marketplace?
• The Health Insurance Marketplace is designed to make buying health coverage easier and more affordable. The Marketplace allows individuals to compare health plans, get answers to questions, find out if they are eligible for tax credits to help pay for private insurance or health programs like the Children’s Health Insurance Program (CHIP), and enroll in a health plan that meets their needs. The Marketplace Can Help You:
o Look for and compare private health plans.
o Get answers to questions about your health coverage options.
o Get reduced costs, if you’re eligible.
o Enroll in a health plan that meets your needs.
In Texas, mental health encompasses an individual's emotional, psychological, and social well-being, influencing thoughts, feelings, actions, stress response, interpersonal relationships, and decision-making. Mental health issues can arise from biological factors, life experiences, and family history, but recovery is possible with appropriate help. Warning signs of mental health problems include changes in eating or sleeping habits, withdrawal from social activities, mood swings, and persistent negative thoughts. Maintaining positive mental health involves seeking professional help if needed, staying connected with others, and developing healthy lifestyle habits. Health insurance coverage for mental health services is mandated by the Affordable Care Act (ACA) for most insurance plans, including those on the Marketplace, small group plans, and Medicaid Alternative Benefit Plans. These plans must offer mental health and substance use disorder services and adhere to the Mental Health Parity and Addiction Equity Act (MHPAEA), ensuring parity between mental health/substance use and medical/surgical benefits. Texans with Medicare also have access to mental health services under various parts of the program. If individuals believe their plan is not meeting parity requirements or need mental health services, they can consult their plan's summary, the Mental Health and Addiction Insurance Help consumer portal, or state Consumer Assistance Program (CAP). For more information or to find treatment services, resources like HealthCare.gov, the Behavioral Health Treatment Services Locator, and the Find a Health Center locator are available.
