The Patient Protection and Affordable Care Act of 2010 (ACA) (which may also be called the "Affordable Care Act, ACA," or even "Obamacare") does not specifically mention ADHD, but its protections should benefit people with ADHD.
Health Insurance in General:
In general, under the ACA, health insurance cannot now exclude, limit, or deny coverage to a child, based solely on a pre-existing condition. Insurers cannot limit lifetime coverage to a fixed dollar amount or remove coverage due to a mistake on an application.
In general, starting in 2014, insurance cannot discriminate against individuals of any age due to a pre-existing condition, nor impose annual dollar limits on coverage. Each State will have competitive marketplaces called Health Insurance Marketplaces1 where small businesses and individuals can purchase private insurance plans and ask questions. For example, marketplaces can tell consumers whether they are eligible for tax credits for private insurance or for programs like the Children's Health Insurance Program (CHIP). Note that health insurance obtained before March 23, 2010, may be a "grandfathered" plan that is exempt from providing some protections under the ACA.
Specific Coverage for Diagnosis and Treatment of ADHD:
Health plans offered in the Marketplaces and Medicaid state plans, will be required to offer essential health benefits in 10 categories including: (1) "prescription drugs" and (2) "mental health and substance use disorder services, including behavioral health treatment." Plans in each Marketplace will also offer differing levels of coverage. Each state will have the opportunity to set standards for plans offered in its Exchange. States that choose not to set their own standards will have those standards set by the federal government. Thus, prescription drug coverage will vary among states; and which conditions qualify for coverage under "mental health and substance use disorder services, including behavioral health treatment" will vary among states. Plans within each state can differ in the amount of coverage, if any, offered for ADHD. Thus, when shopping for insurance in a Marketplace, compare plans to determine whether, and what kind of, coverage is available for the diagnosis and treatment of ADHD.
See Key Features of the Law via the following links:
On August 24, 2010, the U.S. Department of Health and Human Services
announced the release of a new web tool, available for download at HealthCare.gov, that
will make it easier to search for insurance coverage options. “By
putting the power of information at your fingertips, HealthCare.gov is
helping American families everywhere to take control over their health
care and make the choices that are right for them,” said HHS
Secretary Kathleen Sebelius. For anyone seeking to understand the new
benefits under the Affordable Care Act, the website is an extremely
The Insurance Finder widget enables anyone with a
website or blog to embed a tool on their site that allows users to begin
the process of searching for insurance coverage options. After users
answer two questions (“select a state” and “which best
describes you”), they click on "next steps" and are redirected to
a page on HealthCare.gov that continues the process. Based on their
answers to specific questions, the coverage finder provides a
personalized list of coverage choices.
On July 22, 2010, the White House announced new federal regulations to strengthen
patients’ rights to appeal health insurance denials. That same
day, the National Health Council released the following
statement from its president, Myrl Weinberg:
People with chronic conditions make up the largest segment of users
of health care in this country. They require care and treatment that
will allow them to live the healthiest, most productive lives possible.
It is essential that they be able to obtain and retain coverage and care
that meet their individual health care needs.
The steps taken today by the Obama Administration will provide
patients with an understandable, predictable internal and external
appeals process. It’s the right thing to do. It's a fair solution
for patients—particularly those living with chronic diseases and
We are also pleased that $30 million has been allocated for
strengthening state-based consumer assistance offices. This is a
critical step to improving patient awareness of their rights.
On July 1, 2010, U.S. Department of Health and Human Services
Secretary Kathleen Sebelius announced the establishment of a new
Pre-Existing Condition Insurance Plan (PCIP). The plan will make
temporary coverage available to Americans who have been uninsured for at
least six months and who are unable to obtain health coverage because of
a pre-existing health condition. The PCIP will be in effect now through
2014, when the new health insurance exchanges are established.
Twenty-nine states plus the District of Columbia have decided to
administer the plan themselves, and twenty-one states elected to have
HHS administer their plans.
Posted July 5, 2010
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