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Does the Patient Protection and Affordable Care Act of 2010 cover people with ADHD?

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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:

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1. These marketplaces were first referred to as "Affordable Insurance Exchanges," but the federal government changed the name to "Health Insurance Marketplace" in Summer 2013.


Created: January 2014

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