ACA-compliant kids health insurance plans in Madison, Wisconsin typically cover these mental health services.

Does Kids Health Insurance Typically Cover Mental Health Services?

The Affordable Care Act (ACA) requires health insurance plans to cover certain mental health services for kids, ages ​zero to 18. All kids covered under ACA-compl​iant health insurance in Wisconsin receive the following benefits1 –

  • Diagnostic evaluations and assessment
  • Treatment planning
  • Referral services
  • Medication management
  • Prescriptions based on the plan’s pharmacy benefit
  • Inpatient care
  • Partial Hospitalization / Day Treatment
  • Intensive Outpatient Treatment
  • Services at a Residential Treatment Facility
  • Individual and family, therapeutic group, and provider-based case management services
  • Crisis intervention

Unless you have an emergency, it’s best to call your insurance company before using services because some treatments may require prior authorization. Also, for kids, their coverage may vary depending on the health insurance plan. In Wisconsin, your insurance company will appoint a Mental Health / Substance Use Disorder Designee who will authorize the services. It’s important to note that Mental Health Services will be covered in the same manner as other health services. That means that you’ll pay coinsurance, copays and other out-of-pocket costs for services and medications depending on your specific plan. It’s also important to note mental health treatment for kids must be provided by an in-network provider in order to be covered by health insurance.


In addition, kids covered by ACA-compliant health insurance receive preventive health services at no cost that include –

  • Autism screening for children at 18 and 24 months
  • Behavioral assessments at least annually through age 17
  • Developmental screening for children under age three
  • Depression screening for adolescents
  • Alcohol and drug use assessments for adolescents

Unity's new plans for sale today are ACA-compliant and include a wide range of covered mental health care for children. Browse our selection of medical plans and get a quote right now. Have more questions about kids health insurance coverage in Wisconsin? Give our friendly and knowledgeable customer service representatives a call at 800.362.3310.