For years, people with behavioral health issues, their loved ones and advocates have pushed for a more equitable system, one in which substance use and mental health treatment is covered equally, or at parity with, other forms of medical treatment under health insurance plans. This work resulted in the 2008 passage of the Mental Health Parity and Addiction Equity Act, a federal law requiring many health insurance plans to follow parity rules, meaning that if they offer mental health and substance use disorders benefits, they must cover them equally to other medical benefits. The Affordable Care Act (ACA) has extended these protections to more health plans. New federal regulations were issued in late 2013 for private plans and proposed regulations came out last week for Medicaid.
NAMI surveyed nearly 3,000 behavioral health consumers (thanks to those of you who participated!) and analyzed 84 insurance plans in 15 states. The takeaway? While more consumers than ever should have access to health plans that require behavioral health parity as a result of the ACA and the federal parity law, consumers are often left without the treatment they so desperately need.
In addition to the high rate of substance use and mental health coverage denials, the survey’s highlight other common problems with parity implementation:
- Many insurance networks have far too few substance use and mental health providers
- Discriminatory drug tiering, when insurance companies make medication for certain conditions more costly for the consumer, creates barriers to needed for substance use and mental health disorders
- Consumers do not have enough information about behavioral health coverage to compare health plans and choose a health plan that meets their needs