Anxiety and Health Insurance

Anxiety disorders are a family of mental health conditions, which includes generalized anxiety disorder (GAD), panic disorder, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), social phobia or other specific phobias. According to the National Institute of Mental Health, anxiety disorders affect about 40 million Americans age 18 and older over the course of a year. Characterized by lasting at least six months or longer, they are known to usually occur with other mental or physical illnesses.

Each type of anxiety has its own particular symptoms, all of which are centered around an excessive, irrational fear and dread. Some may experience panic attacks, while others feel internal pressure to count their movements, the effects of which can cause a person to be unable to function socially, or interfere with performing normal activities. Whether you are being treated for a continual state of heightened worry or following self-imposed rituals, anxiety disorders usually lead people to regular medication and professional help.

Treatment for anxiety disorders has been heavily reliant on medication and therapy, which can get very costly. Regardless of the millions of Americans affected by this family of mental disorder, solutions continue to develop and research is always being conducted to find a truly effective method to treat anxiety. The condition varies in all patients, though a person may spend half of their life switching medications, experimenting with new therapies, and it may or may not help them reach normalcy.

 

How Anxiety Disorders Affect Insurability: Past and Present

PRESENT

Health Reform & Mental Health Care

The federal health care law passed in March 2010 provides people with mental illness better access to care through essential health benefits that include prescription drugs and psychotherapy. The Affordable Care Act makes mental health care more available to a greater number of people by requiring it as a benefit through all health insurers in state exchanges. Additionally, no one can be denied for coverage due to having a pre-existing condition. Those who have OCD or any other anxiety disorder cannot be turned down by an individual health insurance company or have restrictions such as elimination riders and exclusion periods placed on their policy. Private plans in some states also include mental health care as a benefit, depending where you live.

For older patients, those with Medicare no longer experience the coverage gap, or doughnut hole, that once left many elderly Americans sick because they could not afford to pay for their prescriptions. The Medicare coverage gap provision of the PPACA cuts the amount a person pays for their brand name drugs in half when in this gap occurs. The doughnut hole is when Medicare Part D would stop coverage between $2,930 and $4,700 in cumulative medication expenses.

 

PAST

Before the Affordable Care Act, anxiety-related conditions were evaluated by insurers based on level of treatment, severity and risk level. If a person was using a medication to regulate their anxiety disorder, they would likely experience an increased rate when applying for health insurance coverage, or potentially be declined. Many individuals lost their ability to receive health insurance if they were using an expensive brand name prescription drug for treatment. Those who frequently changed medications would also be considered a higher risk. Certain health insurance companies might also have declined coverage to someone who has been institutionalized for their mental condition within a specific time frame.

Anxiety disorders and poor emotional health can lead to further health problems if not treated, including high blood pressure, headaches, shortness of breath, change in appetite, upset stomach and other digestive problems, back and chest pain, and insomnia. Constant stress is an easy way to weaken the immune system, which obviously leads to other illnesses. Without feeling your anxiety disorder is under control, your risk increases of getting more sick.

Because of this, it was important to note that insurers would increase rates if were not as emotionally stable or healthy as possible. The 2012 underwriting guidelines below evaluated risk level based on other criteria, your medical history and your health status. Your premium could increase solely because you took a costly medication, or multiple medications; all of which were important to consider before applying for health insurance prior to the laws changing.

 

Coverage Alternatives for Anxiety Disorders

You have other health insurance options besides the private individual market, even though no insurer can turn you down. However, if there are zero health plans in your area that cover the benefits you need, other options may be available. Keep in mind, your health will never get in the way of getting insured or having access to certain benefits. If you are employed at a larger company, they may offer you health insurance there. Also, if you have a very low income, there are public programs available through the state health department for individuals of various ages and conditions. The importance lies in getting some sort of coverage to help pay for necessary medical treatment and maintaining your health.

 

Employer-Sponsored Benefits

Obtaining coverage through the workplace is a highly common way to get health insurance for a fairly reasonable cost, often similar to what you pay for an individual plan. Companies with over 50 employees are required by the ACA to offer their workers a health benefit, though they only have to cover preventive care. Group coverage is offered through the same private insurers that you would purchase individual health plans from, but your employer may have chosen a more robust plan than your individual options provide in certain cases. Always read the schedule of benefits and find out what is covered before you enroll. There is a waiting period before your benefits kick in, which is usually a good time to buy a month-to-month individual health plan.

Medications and therapy may be covered as long as you have a benefit and use an in-network provider. Many group plans are HMOs, and others are POS or PPO, which provide the option of using non-network care, so make sure you are aware of your plan’s network restrictions prior to receiving care. All health plans also have a formulary, which will list the approved medications for coverage. Some prescriptions drugs may not be on the list, particularly brand names that are very expensive. The formulary is another very important document to reference from your health plan, as well as the provider and benefit lists.

 

Medicaid & CHIP

Medicaid is a government-sponsored program for low-income families and children, and the Children’s Health Insurance Program (CHIP) is its slightly higher income counterpart. The Medicaid program bases eligibility on income and falling under a certain category of needy persons, and will not discriminate against your anxiety disorder in the application process. If approved, members have access to a full health insurance plan through Medicaid providers and community clinics. Prescription coverage is also offered through both Medicaid and CHIP, as well as any additional health needs.

Income guidelines vary by state, age, and category. In most states, to be an adult between 18 and 64 covered by Medicaid, you must have children or a disability to qualify, though other states have expanded their eligibility. Check your state’s guidelines and find out more about the program from your local Department of Health and Human Services. CHIP is available for children under age 19 whose family income is between 200 and 300 percent of FPL, and they will be served by Medicaid providers for care.

 

Resources

Individual Health Insurance Quotes

Medicaid Information

NIMH: Anxiety Disorders