Mental health is an essential benefit


All Marketplace plans cover mental health and substance abuse services as essential health benefits.




1. Mental and behavioral health services are essential health benefits


Coverage for mental health and substance abuse services cannot be more restrictive than coverage for medical and surgical services.

All plans must cover:


  • Behavioral health treatment, such as psychotherapy and counseling
  • Mental and behavioral health inpatient services
  • Substance use disorder (commonly known as substance abuse) treatment

Your specific behavioral health benefits will depend on your state and the health plan you choose.


2. Pre-existing mental and behavioral health conditions are covered


Marketplace plans can’t deny you coverage or charge you more just because you have any pre-existing condition, including mental health and substance use disorder conditions.
Coverage for treatment of all pre-existing conditions begins the day your coverage starts.


3. Parity protections for mental health services


Marketplace plans must provide certain "parity" protections between mental health and substance abuse benefits on the one hand, and medical and surgical benefits on the other.

This generally means limits applied to mental health and substance abuse services can’t be more restrictive than limits applied to medical and surgical services.

Write your comment