Tag Archives: Insurance

ADHD Treatment: Money Matters

Money Matters

This article is part of the series: Find Treatment and Support. You may want to start there.

Money Matters – The Affordable Health Care Act and Mental Health – Find Health Insurance – Low-Income Help – Social Security Income and Social Security Disability

Need help paying for medication?
See: Lower costs for Prescription Medications

Money matters

The Cost of Not Treating ADHD by Steven Kurtz – “We’re already paying the cost, and our kids are too.” “Many kids with ADHD, and other conditions, just find their problems compounding as they get older. And they are less and less responsive to treatment. Kids with untreated ADHD often become adults with untreated ADHD, and with that comes a whole host of adult-sized problems.”

How much does it cost to test for ADHD? Consumer Reports – $700 to $1600 was the average assessment cost. – “About one-third of the parents in the survey reported that the costs of treating their child for ADHD were covered completely by their child’s health plan, with two-thirds of respondents reporting half to all treatment costs were covered by insurance.”

Managing the Costs of ADHD – by Chris Taylor – “Many parents are caught in a financial vise. They want to spend whatever it takes to ensure a successful future for their child, but don’t want to bankrupt the family. Some tips: Work the public school system, be an insurance Ninja,  and plan your budget early.”

Lowering ADHD Costs: Health Insurance and Treatment Help by Jane Lehto – “Insider tips on lowering ADHD costs by getting your insurance company to pay for medication, treatment, and other therapies.”

How to Finance ADD/LD Treatment – Expert tips for reducing the financial burden brought on by ADHD by Lois Gilman “Flexible Spending Arrangement (FSA), Use a medical tax deduction, Thoroughly analyze insurance plans…”

The Affordable Health Care Act and Mental Health

The Affordable Care Act has new regulations to make sure that mental health treatment is covered to the same extent as physical care. Therapies for depression, anxiety, and substance abuse — which often come along with ADHD — are among a core set of 10 services called “essential health benefits” that must be covered with no out-of-pocket limit. Included in these are prescription medications, which are usually a major component of ADHD treatment. Knowing that a pre-existing condition won’t exclude you from getting affordable insurance is also a bonus. So is the option of keeping children on their parents’ policies until they’re 26. (1)

Before health reform, one out of five people who bought their own insurance had no mental health benefits. This change is long overdue. One drawback may be that by placing the primary care physician is at the center of treatment, Doctors may decide to treat ADHD themselves by just prescribing medication, rather than referring to a specialist. With the high rate of mental health issues and Learning Disabilities so commonly associated with ADHD, however, a complete diagnosis and a holistic treatment plan may be beyond the expertise of primary providers. (2) They may not appreciate the value of parent training to managing behavior or family therapy to educate and help all members of the family.

The news for low-income families is not as good. “In 2012, the Supreme Court gave states the choice of whether to join the Medicaid expansion or not. Unfortunately, almost half of the states have decided not to do so. That means that 6 to 7 million Americans won’t enjoy this enhanced access.”(3) Even with Medicaid, finding a physician will be difficult. “Under the present Medicaid reimbursement rates, physicians are paid only about $45.00 for a basic visit, while $75 per visit is the break-even point for most private practices. So the physician has to take a $30 loss for every Medicaid patient that he or she sees and has increased paperwork to even get the reimbursement.” (4)

Find Health Insurance

Find Health Insurance at HealthCare.gov – You may qualify for Medicaid or lower subsidized rates.

Find Insurance for young adults – May be covered under parents’ plans or be subsidized.

Enroll in Medicaid or
Are you eligible for Children’s Health Insurance Program (CHIP)? Note: Make sure to enter your state for correct information.

Low-Income Help

Find low cost and or government sponsored clinics
– Nationwide
A searchable directory of mental health treatment facilities and support services from SAMHSA.gov

Alternatively, let your fingers do the walking. Check the Community Pages in your local phone book under Mental Health for local federally funded clinics. They accept Medicaid, Medicare, most insurances and will adjust their rate according to your income. (Note: Some areas do not consider adults with ADHD (alone) as qualified for treatment. Others will treat if it’s in combination with another mental disease or disorder). Children’s clinics, however, deal with ADHD concerns on a regular basis.

Or, use Google. I had good results using the words community mental health with city, county, and/or state

The Department of Vocational Rehabilitation is another possible way to go. You do, however, have to prove you are not employable or under-employed due to your ADHD or combination of disabilities. I know quite a few people who got a lot of help through DVR a number of years ago (including paying for a diagnosis for ADHD,) but their funding has been hit. – Find your state’s Voc-Rehab services

Clinical trials don’t cost a thing and you may even be reimbursed for your time.
(There’s no guarantee you’ll get the drug being tested, but you can often get a free evaluation for ADHD.) For a listing of current studies, see the National Institute of Mental Health.

2-1-1 is an Information and Referral service to help people connect with important community services and help them find help in their community more easily. Call 2-1-1 or Search for a 2-1-1 Call Center. Available in many states, 2-1-1 can help you find organizations that may assist with a broad range of needs. You may find help paying for medications or financial assistance with other essential needs such as food, clothing, rent and utility assistance, child care, employment supports, services for older adults, etc.

Social Security Income and Social Security Disability Income

Supplemental Security Income, or SSI, provides monthly income for those who cannot work due to a disability such as depression, bipolar disorder or other mental disorders. You must meet strict eligibility criteria to qualify.

SSI benefits- ALL Mental Illnesses

The basics of SSDI – “Social Security Disability Insurance (SSDI) is available to any worker who has a “disability” as defined by the federal government and who has paid into the Social Security system for a specified amount of time, depending on their age. In order to qualify as “disabled,” an SSDI applicant must show that he is almost completely unable to work at any job whatsoever.”

Apply for SSDI

Social Security Disability and ADHD – This article focuses primarily on children. – They need to show a MARKED inability to succeed in school and strong documentation is required. Adults must be unable to earn more than $960 per month gross (with that inability also caused by MARKED impairments. Most importantly, to win disability benefits from the Social Security Administration based on attention deficit, or ADHD, a person must have measurable functional deficits, in the context of school or work performance.


SSI / SSDI Outreach, Access and Recovery – SOAR

Help for the homeless with mental illnesses, a process where eligible individuals can have their disability case expedited. SOAR’s online training course is about 16 hours long, but it leads you through all the steps to help clients apply for SSI or SSDI. – To be eligible you must be at least 18, diagnosed with a serious mental illness, and homeless or at risk of becoming homeless. The SOAR process is designed to have a decision for disability claims within 90 days.

• “Image courtesy of Luigi/FreeDigitalPhotos.net” Modified on Canva.com

References

(1) “The Affordable Care Act: Good for ADHDers”
by Katherine Ellison – www.additudemag.com/adhdblogs/19/10545.html
(2) “An Update on How the U.S. Affordable Care Act Impacts Mental Health Care”
By John M. Grohol, PSY.D. – http://psychcentral.com/blog/archives/2013/11/01/an-update-on-how-the-u-s-affordable-care-act-impacts-mental-health-care/
(3) “Affordable Care Act : Will It Impact Your ADHD Child’s Treatment?” http://newideas.net/adhd-affordable-care-act-impact
(4) “One of the Best Things to Happen to People With ADHD? Obamacare” by Dennis Thompson Jr. http://www.everydayhealth.com/news/obamacare-best-thing-happen-people-with-adhd/

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