Eating disorder treatment and Obamacare — what has changed?
Heather Larson
As many as 20 million women and 10 million men suffer from an eating disorder at some time during their life, according to the National Eating Disorders Association (NEDA).
Eating disorders may include:
- Anorexia nervosa.
- Bulimia nervosa.
- A binge-eating disorder.
- Any condition characterized by abnormal or disturbed eating habits.
An eating disorder is classified as a mental illness. Prior to January 1, 2014, certain insurance plans limited mental health benefits so those with eating disorders couldn’t get the care they needed. However, all health plans under the Affordable Care Act must now include mental health coverage as one of 10 essential benefits.
Other benefits include children being able to remain on their parents policies until age 26. According to eating disorder experts, young men and women are particularly susceptible to eating disorders.
Also, more people may be covered if their state expanded Medicaid under the Affordable Care Act.
What kind of treatment do patients with eating disorders need?
Although each person’s case varies, typically a person who seeks treatment for his or her eating disorder may require a number of specialists. They need an initial examination and ongoing monitoring by a physician (internist, pediatrician or other medical professional) throughout the course of their treatment, says Dr. Allegra Broft, assistant professor of psychiatry at Columbia University Medical Center in New York City.
Outpatient treatment may include individual and/or group psychotherapy visits and nutritional counseling, Broft says. Eating disorders can affect nearly every organ of the body, she says, and other types of specialists may need to become involved at times, such as an endocrinologist or a gastroenterologist. If a patient needs to be hospitalized or placed in a residential care facility, that adds more medical personnel.
“Despite the fact that eating disorders have the highest mortality rate of any psychiatric diagnosis, lack of insurance coverage for them has often been a barrier to care for those seeking treatment,” says Claire Mysko, a spokeswoman for the National Eating Disorders Association (NEDA) in New York City. “Although eating disorders can be treated successfully, some insurance companies have refused payment for much-needed care.”
Under Obamacare, 10 states now require coverage for anorexia and bulimia on the same basis as other mental health conditions. Eighteen states only require eating disorder coverage in certain health plans like state employee and group health plans. However, the remaining states have no laws requiring coverage of eating disorders.
How Obamacare will help eating disorder treatment
Don Silver, author of “The Best Obamacare Guide,” says the ACA, also known as Obamacare, has many parts that may benefit people with eating disorders. These benefits include:
- People with preexisting conditions can no longer be denied coverage. Previously, many insurers would deny coverage to eating disorder sufferers, and classified their condition as preexisting.
- Children can remain on their parents’ health insurance policies until age 26. Mysko says teens and young adults represent a very high-risk demographic for eating disorders.
- More people may be able qualify for Medicaid (currently available in 23 states). If you live in one of these states, to qualify for Medicaid your income must be 138 percent or less of the poverty level. In 2014 the income maximums are $16,105 for an individual and $32,913 for a family of four.
What Obamacare doesn’t do for eating disorder treatment.
According to Silver, insurance coverage those with eating disorders varies across the country. Each state adopted its own benchmark plan that may include or exclude coverage for eating disorders, and the exact benefits may differ. That benchmark plan is used to determine the benefits of policies sold in that state. Other components, Silver says, that may negatively impact eating disorder patients are:
- Annual out-of-pocket limits under Obamacare generally only apply to in-network coverage. The 2014 in-network limits are $6,350 for an individual and $12,700 for a couple or family. However, you may feel that the medical providers in your network won’t provide the right treatment for you and may want to use an out-of-network provider.
Silver says some policies do provide some out-of-network care. But they usually come with a higher deductible and lower percentage of payment than in-network coverage. This out-of-network coverage also has a higher out-of-pocket limit, usually a known dollar amount, which is in addition to the in-network deductible and out-of-pocket limits – and these costs can quickly add up.
- People seeking government benefits under Obamacare may be automatically placed in Medicaid instead of getting a subsidy for private insurance. Whether you qualify for Medicaid depends on your income level, how many are in your family and your state. It’s generally more difficult to find medical providers under Medicaid since almost half of all doctors don’t accept Medicaid patients, Silver says. Health-care consulting firm Merritt Hawkins conducted a survey of Medicaid acceptance rates which found that just 45.7 percent of physicians are now accepting Medicaid patients in the U.S.’s largest 15 cities.
“The bottom line is people have to do their homework and research not only an insurance policy’s costs, benefits and exclusions, but also the network of doctors, hospitals and other providers that are covered (in-network) under the policy,” Silver says.
