Does My Insurance Cover Mental Health and Substance Abuse?

If you have individual or small group coverage, there are some benefits you can count on being covered by your insurance. The Affordable Care Act requires all Marketplace plans to cover ten “essential health benefits,” two which broaden your access to mental health services:

  1. Preventive services
  2. Mental health and substance use disorder services.

Which services count as “preventive?”

There’s a lengthy list of preventive services that are now covered under the Affordable Care Act, which you can explore on www.hhs.gov. Among those that relate to mental health include depression screenings for adults and behavioral assessments for children of all ages. Preventive services are completely covered by most health plans with no copay.

What mental health and substance use disorder services are covered?

According to healthcare.gov, the following mental and behavioral health services are included as part of this essential health benefit:

  • Behavioral health treatment, such as psychotherapy and counseling
  • Mental and behavioral health inpatient services
  • Substance use disorder treatment

The specific services covered by your plan will vary based on which plan you selected. If you’re a Blue Cross Blue Shield of Michigan or Blue Care Network member, here’s how to find out what’s covered under your plan:

  1. Log into your account at bcbsm.com
  2. Hover over “My Coverage” in the blue bar at the top of the page
  3. Select “Medical” from the drop down

If I have an HMO, do I need a referral to get mental health services?

Blue Care Network members needing mental health services can call 1-800-482-5982, 24 hours a day, seven days a week. A care manager will be there to listen to your needs and arrange for services. You do not need a referral from your primary doctor. For information on what you should do when you call to make an appointment, visit bcbsm.com.

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For more health insurance tips visit bcbsm.com/101 or follow the hashtag #Covered101 on our social channels. If you have a specific question, please submit your query online through our Customer Action Center

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