Addiction and Mental Health Health Insurance Parity

Posted on February 3rd, 2014
Posted in News

The White House recently announced that it has made the final changes to an existing law that will bring parity to health care coverage. The existing law, from 2008, required that large group plans include equal coverage for mental health, addiction and medical and surgical care. The law left several loopholes, and did not include any requirements for individual plans, or for small group plans. With what is being called the final rule, the Obama Administration hopes that barriers to getting help for addiction and mental health disorders will finally be lifted.

The 2008 Law

In 2008, congress passed the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, or MHPAEA. The law applied to large group health care plans, meaning those with 100 or more employees. It did not apply to smaller groups or plans purchased by individuals. What the law did for those in large groups was require benefits for mental health care and addiction support to be on par with benefits for medical and surgical care. It did not set any minimum levels of care, but simply required equality between the three types of care.

MHPAEA made some important changes to how insurance companies treated addiction and mental health, but there were limitations. People in smaller groups and individuals were not impacted by the law. The law also allowed for large groups to be exempt if making the required changes to an insurance plan increased costs too significantly. The exemption could last for one or two years.

The Final Rule for Addiction and Mental Health Parity

The Obama Administration announced the so-called final rule for the MHPAEA to ensure that all people have affordable access to mental health care and addiction support. The rule is designed to break down all barriers to equality of care. It includes smaller groups and individual plans as well as larger insurance groups, so that now more people should get access to benefits for mental health and addiction.

The new rule also ensures that the equality applies to all levels of care, in both inpatient and outpatient settings. It also requires insurance companies be more transparent so that compliance with the law is guaranteed. The parity now applies to all aspects of care, including limits on the type of facility where care is received, limits on geographic location for care, and limits on the number of visits covered.

There are several ways in which the final rule will make it easier for patients to get addiction and mental health care. Previously, limits were placed on such care, which were not placed on traditional medical care. For instance, many plans required that a doctor review inpatient addiction care every single day. The same was not usually true for inpatient care while recovering from surgery. Now, if a patient does not require daily review for recovering in the hospital after surgery, he will not require that review for inpatient mental health or addiction care either.

The law is still imperfect, however. It does not require that insurance plans of any size or type include mental health and addiction care coverage. It simply requires equality with medical coverage, if a plan includes mental health and addiction at all. In other words, insurance plans are not required to have any benefits for addiction and mental health care.

Although not perfect at removing all barriers to mental health care and addiction support, the final rule and the MHPAEA as a whole have made huge strides in helping people to get the care they need. It has reduced financial barriers, so that most people with insurance will now have to pay much less out of pocket for care. Experts also hope that it will help to reduce the stigma associated with mental health and addiction by placing them on equal ground with less stigmatized conditions.

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