Health insurance plans, from private individual and group coverage to the Medicare program, have long imposed barriers that limit access to needed behavioral health care for both mental and substance-use disorders, with far-reaching and often tragic results. No comparable barriers limit access to needed care for other illnesses.
Does parity mean I will get good mental health coverage?
However, parity doesn't mean that you will get good mental health coverage. Comprehensive parity requires equal coverage, not necessarily "good" coverage. If the health insurance plan is very limited, then mental health coverage will be similarly limited even in a state with a strong parity law or in a plan that is subject to federal parity.
Why is it so hard to enforce mental health parity?
Enforcing mental health parity is complex partly because a patchwork of federal and state entities are responsible for enforcement and the onus is largely on consumers to file individual claims of discrimination. NAMI strongly supports efforts to address these issues and achieve mental health parity in all forms of health coverage.
What if I don’t follow the rules for Mental Health Parity?
If you feel that mental health parity rules aren’t being followed by your plan, you can reach out to your state’s department of insurance. If your plan is regulated under state law, the staff may be able to provide you with assistance. Was this page helpful?
Which health insurance plans do not comply with Federal Parity?
Health plans that do not have to follow federal parity include: Medicare (except for Medicare's cost-sharing for outpatient mental health services do comply with parity). Medicaid fee-for-service plans. “Grandfathered” individual and group health plans that were created and purchased before March 23, 2010.
Does parity apply to Medicare?
The California Mental Health Parity Law and the federal MHPAEA do not apply to Medicare plans.
Is Mental Health Parity a federal law?
The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is a federal law that generally prevents group health plans and health insurance issuers that provide mental health or substance use disorder (MH/SUD) benefits from imposing less favorable benefit limitations on those ...
What does parity mean in mental health?
Mental health parity describes the equal treatment of mental health conditions and substance use disorders in insurance plans.
Who enforces Mental Health Parity?
CMS has enforcement jurisdiction over MHPAEA in the individual and fully insured group markets in states where it has enforcement authority and over non-federal governmental group health plans, such as plans sponsored by state and local governments for their employees.
What does Mental Health Parity law require?
Mental Health Parity Specifically, the Medicaid Parity Rule includes the following compliance requirements: Aggregate lifetime and annual dollar limits. Financial requirements (FR) such as copayments, coinsurance, deductibles, and out-of-pocket maximums.
When did Mental Health Parity go into effect?
The Mental Health Parity and Addiction Equity Act (federal parity law) was enacted in 2008 and requires insurance coverage for mental health conditions, including substance use disorders, to be no more restrictive than insurance coverage for other medical conditions.
Which is the best example of mental health parity?
Which is the BEST example of mental health parity? Your insurance covers medical and mental illnesses equally.
What is the purpose of the Mental Health Parity Act and its amendments?
Federal Parity Amendment The law, otherwise known as the Mental Health Parity Act of 1996 (Public Law 104-204), prohibits group health plans that offer mental health benefits from imposing more restrictive annual or lifetime limits on spending for mental illness than are imposed on coverage of physical illnesses.
What are the federal regulations that require parity?
The Mental Health Parity and Addiction Equity Act (the Federal Parity Law ) was passed in 2008 and requires health insurance plans to cover behavioral health benefits and physical health benefits equally.
Who benefits from Mhpaea?
The MHPAEA is beneficial for those who may need the most intensive treatment and financial protection. To comply with specific requirements of the law, therefore, health plans need to pay close attention to the benefits they offer. Protections under the MHPAEA include financial requirements and treatment limitations.
How is Mhpaea funded?
MHPAEA applies to plans sponsored by private and public sector employers with more than 50 employees, including self-insured as well as fully insured arrangements. MHPAEA also applies to health insurance issuers who sell coverage to employers with more than 50 employees.
Are grandfathered plans subject to mental health parity?
These “grandfathered” plans are exempt from certain requirements of the ACA, including EHB and parity. MHPAEA. Grandfathered self-insured small group plans will not be subject to MHPAEA.
Why is mental health parity so complex?
Enforcing mental health parity is complex partly because a patchwork of federal and state entities are responsible for enforcement and the onus is largely on consumers to file individual claims of discrimination. NAMI strongly supports efforts to address these issues and achieve mental health parity in all forms of health coverage.
What is mental health parity?
Parity is the basic idea that mental health and addiction care are covered at the same level as care for other health conditions. State and federal laws have attempted to address discriminatory practices in health insurance by creating requirements around parity. In 1996, the Mental Health Parity Act ...
How many people have mental health issues?
About one in five adults in the U.S. has a mental health condition, and nearly 20 million people aged 12 and older have a substance use disorder. NAMI successfully fought for passage of a federal parity law in 2008 called the Mental Health Parity and Addiction Equity Act that was intended to improve coverage for mental health ...
What is NAMI insurance?
NAMI supports establishment and enforcement of laws and policies that ensure parity between mental health and physical health services in all forms of insurance coverage.
When was the Mental Health Parity and Addiction Equity Act passed?
In 2008, Congress passed the Mental Health Parity and Addiction Equity Act (MHPAEA) requiring comprehensive standards for equitable coverage of mental health and substance use disorder treatment and coverage of medical/surgical treatment.
Is parity achieved in mental health?
Despite these laws, the promise of true parity has not been achieved, and many people with mental illness are still being denied the care that they need and deserve. People with mental health conditions struggle to find a mental health care provider in network or getting treatment approved by their health plan.
Does insurance cover mental health?
As such, it is critical for health insurance to provide comprehensive coverage of mental health and substance use disorder services. Yet, too often, health insurance covers mental health care differently than other kinds of medical services, creating barriers to affordable, accessible mental health care and reinforcing a stigma around mental ...
What are the exceptions to the MHPAEA requirements?
Except as noted below, MHPAEA requirements do not apply to: Self-insured non-Federal governmental plans that have 50 or fewer employees; Self-insured small private employers that have 50 or fewer employees;
What is MHPAEA insurance?
MHPAEA originally applied to group health plans and group health insurance coverage and was amended by the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the “Affordable Care Act”) to also apply to individual health insurance coverage.
What is the MHPAEA?
Introduction. The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is a federal law that generally prevents group health plans and health insurance issuers that provide mental health or substance use disorder (MH/SUD) benefits from imposing less favorable benefit limitations on those benefits ...
When is the MHPAEA regulation effective?
MHPAEA Regulation. A final regulation implementing MHPAEA was published in the Federal Register on November 13, 2013. The regulation is effective January 13, 2014 and generally applies to plan years (in the individual market, policy years) beginning on or after July 1, 2014.
How to contact MHPAEA?
If you have concerns about your plan's compliance with MHPAEA, contact our help line at 1-877-267-2323 extension 6-1565 or at [email protected]. You may also contact a benefit advisor in one of the Department of Labor’s regional offices at www.askebsa.dol.gov or by calling toll free at 1-866-444-3272.
What is self funded group health plan?
The insurance that is purchased, whether by an insured group health plan or in the individual market, is regulated by the State’s insurance department. Group health plans that pay for coverage directly, without purchasing health insurance from an issuer, are called self-funded group health plans. Private employment-based group health plans are ...
Does MHPAEA apply to small group health plans?
MHPAEA does not apply directly to small group health plans, although its requirements are applied indirectly in connection with the Affordable Care Act’s essential health benefit (EHB) requirements as noted below. The Protecting Affordable Coverage for Employees Act amended the definition of small employer in section 1304 (b) ...
When was the Mental Health Parity Act passed?
This Mental Health Parity Act of 1996 passed as an attachment to an appropriations bill. However, research indicates that health plans circumvented the law by tightening restrictions on other mental health benefits--on the number of hospital days and outpatient visits for mental health services.
What are the issues with mental health insurance?
The key issues are: Discrimination in health insurance coverage for mental health and substance abuse has existed despite the passage of other anti-discrimination legislation. Legislation is needed to reverse this arbitrary discrimination. Voluntary measures have not worked to end discrimination.
What is federal parity?
Federal parity is expanded to The Mental Health Parity and Addiction Equity Act is expanded to apply to health insurance plans offered to small businesses and individuals and to newly eligible Medicaid recipients.
What is the national campaign for mental health?
Successful legislative campaigns such as the national campaign for mental health parity include reaching out to and being willing to work with business and insurance plan groups as well as legislators whose interests are closely aligned with these groups. Bipartisan support is a necessity in most states.
Why is mental health important?
Mental health is essential to leading a healthy life and to the development and realization of every person's full potential. Yet mental illness and substance-use disorders are leading causes of disability and premature mortality in the United States.
When was the parity law signed into law?
This is OUR responsibility. Brief Summary of the Parity Law. The parity law was signed into law on October 3, 2008.
When was the Metal Health America policy position adopted?
The Metal Health America Policy Position and Call to Action was adopted in September 2006, before the passage of the Mental Health Parity and Addiction Equity Act in 2008. However, as will be outlined in this toolkit, there are still gaps in mental health and substance abuse parity and the principles of the policy statement are still relevant.
History of Mental Health Parity
The first mental health parity rules took effect in 1998, under the Mental Health Parity Act (MHPA). This law, signed by President Bill Clinton in 1996, prohibited large-group (employer-sponsored) health plans from having lower dollar caps (the maximum they would pay) for mental health benefits than they had for medical or surgical benefits.
Mental Health Parity and the Affordable Care Act
Under the MHPA and MHPAEA, group health insurance plans were not required to cover mental health care, and mental health parity rules did not apply to small-group plans or individual/family plans.
Ongoing Gaps in Mental Health Coverage
The MHPA, MHPAEA, and ACA have made substantial improvements in terms of access to mental health coverage. But there are still people who struggle to access mental health and substance use treatment, even on plans that are regulated under mental health parity laws .
Summary
For more than a quarter of a century, various mental health parity rules have applied to at least some health plans in the United States. And over time, these provisions have increasingly targeted some of the worst gaps in coverage that previously prevented people from obtaining mental health and substance use treatment.
A Word From Verywell
If you have health coverage in the United States, you likely have coverage for mental health and substance use treatment. And although coverage specifics vary greatly from one plan to another, various rules have been put in place over the last couple of decades to ensure that mental health benefits are covered the same as medical/surgical benefits.
What is mental health parity?
The first step to understanding mental health parity is knowing what laws and rules are involved. The federal Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 is the law that most people think of when it comes to parity. However, that's only ONE of the many state and federal laws that address health insurance coverage ...
When did Medicare eliminate copayments for mental health?
The Medicare Improvements for Patients and Providers Act eliminated Medicare's discriminatory copayment requirements for mental health care effective January 1, 2010.
What is the federal mental health parity and addiction equity act?
Federal Mental Health Parity and Addiction Equity Act. Employer group plans with 50 or more employees (fully-insured and self-funded) that include mental health services for either inpatient care, outpatient care, or prescription drugs as part of their medical plan.
Do state parity laws apply to Medicaid?
State parity laws do not apply to them either. Some fee-for-service Medicaid plans also do not have to comply. Self-funded non-federal governmental health plans may opt-out of the MHPAEA, and therefore are not required to provide equivalent MH/SUD coverage.
Is Medicare Part B the same as Medicare Advantage?
coinsurance for mental health/substance use treatment must be the same as for medical/surgical treatment. Medicare Advantage plans must be “actuarially equivalent” to original Medicare.
Does Medicare cover psychiatric care?
Medicare still has a 190- day lifetime limit on inpatient psychiatric care that does not exist for inpatient medical care. For Medicare Advantage plans, since the law requires actuarial equivalency, these insurers can still apply specialty co-pays for mental health treatment.
What is Part B in psychiatry?
Part B covers partial hospitalization in some cases. Partial hospitalization is a structured program of outpatient psychiatric services provided to patients as an alternative to inpatient psychiatric care. It’s more intense than the care you get in a doctor’s or therapist’s oce. This type of treatment is provided during the day and doesn’t require an overnight stay.
What is an appeal in Medicare?
An appeal is an action you can take if you disagree with a coverage or payment decision by Medicare, your Medicare health plan, or your Medicare drug plan. If you decide to file an appeal, ask your doctor, health care provider, or supplier for any information that may help your case. Keep a copy of everything you send to Medicare or your plan as part of the appeal.
Does CMS exclude or deny benefits?
The Centers for Medicare & Medicaid Services (CMS) doesn’t exclude, deny benefits to, or otherwise discriminate against any person on the basis of race, color, national origin, disability, sex, or age in admission to, participation in, or receipt of the services and benefits under any of its programs and activities, whether carried out by CMS directly or through a contractor or any other entity with which CMS arranges to carry out its programs and activities.
Can you get help with Medicare if you have limited income?
If you have limited income and resources, you may be able to get help from your state to pay your Medicare costs (like premiums, deductibles, and coinsurance) if you meet certain conditions.
Does Medicare cover alcohol abuse?
Medicare covers one alcohol misuse screening per year for adults with Medicare (including pregnant women) who use alcohol, but don’t meet the medical criteria for alcohol dependency. If your health care provider determines you’re misusing alcohol, you can get up to 4 brief face-to-face counseling sessions per year (if you’re competent and alert during counseling). You must get counseling in a primary care setting (like a doctor’s oce).
Does Medicare cover opioids?
Counseling and therapy services are covered in person and by virtual delivery (using 2-way audio/video communication technology). Talk to your doctor or other health care provider to find out where you can go for these services. For more information, visit Medicare.gov/coverage/opioid-use-disorder-treatment- services.
Can mental health problems happen to anyone?
Mental health conditions, like depression or anxiety, can happen to anyone at any time. If you think you may have problems that affect your mental health, you can get help. Talk to your doctor or other health care provider if you have:
