The journey to reclaiming control of your life from the clutches of addiction or mental health conditions can be daunting. Accessing that care can also be stressful. As healthcare costs for all services continue to rise, you might be looking for substance abuse treatment programs that are covered by your insurance. The Mental Health Parity and Addiction Equity Act (MHPAEA) helps remove some of the previous barriers to employer-funded insurance plans.1
Don’t let the cost of treatment or the thought of job insecurity keep you from getting the help you need. Call BlueCrest Health Group at 888.340.2214 now.
What Is Mental Health Parity?
Mental health parity means treating mental health treatments and substance use disorder treatments the same as physical health treatments in terms of insurance coverage. This means no extra costs or special limits for mental health care to make it more accessible for everyone. By providing equal coverage, mental health parity helps foster a fairer healthcare system and supports overall well-being. It’s a crucial step toward ensuring everyone gets the help they need without unnecessary obstacles.
What Is the Mental Health Parity Act?
The MHPAEA is a federal law that prevents group health plans and health insurance issuers offering group or individual health insurance coverage from imposing less favorable benefit limitations on mental health and substance use disorder benefits than on medical or surgical benefits.
In simpler terms, it mandates that insurers cannot place financial requirements or treatment limitations on mental health and substance use disorder benefits that are stricter than those applied to medical or surgical benefits.
Key Components of the MHPAEA
The MHPAEA is packed with provisions aimed at safeguarding your rights as you navigate your path to recovery. Some of its key components include:
- Equity in financial requirements – Insurers cannot set higher deductibles or co-pays for mental health and substance use disorder services than for medical or surgical services.
- Parity in treatment limitations – There should be no stricter limits on the frequency of treatment, number of visits, days of coverage, or other similar limits for mental health or substance use disorder services than for medical or surgical services.
- Same standards for out-of-network services – If a plan offers out-of-network coverage for medical or surgical services, it must offer the same for mental health and substance use disorder services. This means that you cannot be charged higher co-pays or deductibles for seeking treatment from out-of-network providers.
The Mental Health Parity and Addiction Equity Act helps deliver both mental health and substance use disorder treatment coverage on par with other medical conditions, making it easier for individuals to access the care they need.
Types of Health Plans Subject to MHPAEA Regulations
- Employer-Sponsored Health Plans. MHPAEA applies to most employer-sponsored health plans, including those provided by large employers (generally companies with more than 50 employees). These plans must offer mental health and substance use disorder benefits on par with medical and surgical benefits.
- Individual Health Plans. Individual health plans, whether purchased through the Health Insurance Marketplace or directly from an insurance company, fall under the rule. These plans must adhere to mental health parity standards to ensure equal treatment for mental health and substance use disorder services.
- Medicaid Managed Care Plans. Medicaid-managed care plans are required to comply with MHPAEA regulations. This means individuals on Medicaid receive mental health and substance use disorder benefits comparable to medical and surgical benefits.
- Federal Employees Health Benefits Plans. Federal employees and retirees who receive health coverage through the Federal Employees Health Benefits program are protected under MHPAEA. These benefits must include mental health and substance use disorder services at parity with medical and surgical benefits.
- Large Group Market Health Insurance. Health insurance issuers in the large group market must comply with MHPAEA requirements. This includes offering mental health and substance use disorder benefits that are no more restrictive than medical and surgical benefits.
What’s Not Affected by the MHPAEA?
- Small Employer Health Plans. Small employer health plans, typically those with fewer than 50 employees, are often not subject to the MHPAEA. Consequently, these plans might not offer the same level of mental health care as larger employer-sponsored health plans.
- Medicare. The Mental Health Parity and Addiction Equity Act (MHPAEA) does not apply to Medicare. This means those on Medicare may experience different rules concerning mental health and substance use disorder benefits compared to other health plans.
- State Medicaid Plans (CHIP). State Medicaid Plans, including the Children’s Health Insurance Program (CHIP), are not always bound by MHPAEA guidelines. These government health plans may have their own set of rules concerning treatment limits and benefits.
- Long-Term Care Insurance. Insurance plans specifically designed for long-term care are not influenced by MHPAEA. These types of health coverage typically focus on services like assisted living and nursing home care rather than mental health or substance use disorder services.
- Supplemental Health Insurance. Supplemental health insurance, which covers out-of-pocket expenses not included in your standard health insurance, also isn’t governed by MHPAEA. Therefore, they don’t need to provide mental health parity benefits.
- Medigap Plans. Medigap policies, also known as Medicare Supplement Insurance, are not subject to MHPAEA. These plans fill in gaps in Medicare but don’t usually cover mental health or substance use disorder services comprehensively.
Tips to Secure Coverage for Mental Health and Addiction Treatment
Navigating the complexities of insurance coverage and treatment can be overwhelming when you’re struggling with addiction or a mental health condition. To make the most of the protections offered by the MHPAEA, follow these steps:
- Understand Your Plan. Study your health insurance plan to understand what mental health and substance use disorder services are covered.
- Inquire About Compliance. If you’re unsure whether your plan complies with the MHPAEA, ask your insurer, plan administrator, or HR representative.
- Know Your Rights. If you believe your rights under the MHPAEA have been violated, file a complaint with the appropriate regulatory agency.
- Seek Treatment. Don’t let the cost of treatment keep you from seeking help. If your plan is not in compliance, there may still be options available to access affordable care.
At BlueCrest, we understand that seeking treatment can be intimidating and overwhelming, especially when it comes to navigating insurance coverage. That’s why our team is dedicated to helping you understand your options and access the care you need.
Contact BlueCrest Health Group to Verify Your Insurance Now
Don’t let financial concerns prevent you from getting the treatment and support you need. Our team at BlueCrest Health Group is here to assist you in verifying your insurance coverage and exploring options for affordable care.
Contact us online today or at 888.375.2861 to start your journey toward a happier, healthier life. Remember, help is just a call or click away.
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