Some Exchange Plans May Violate ACA Mental Health Parity Law

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Although the Affordable Care Act (ACA) mandates that the mental health benefits offered in health care plans are at parity with medical benefits, 25% of such plans offered on state insurance exchanges may be violating the law by not doing so.

Colleen L. Barry, PhD, MPP, of the Johns Hopkins Bloomberg School of Public Health in Baltimore, Md., and colleagues analyzed whether information presented to consumers looking for plans on the exchanges appeared to comport with the parity law. They looked at benefit brochures for two state exchanges — one large, one small, though not identified — during the first ACA enrollment period that ran between October 2013 and March 2014.

The larger state offered five times as many plans as the smaller state. More concerning, however, was that in the smaller state, more than half of the plans there appeared to violate the parity law, the researchers reported in the journal Psychiatric Services.

While more plans in the larger state appeared complaint, in some benefit brochures, seeing a behavioral health specialist had a different cost-sharing arrangements. For example, while seeing a general practitioner might cost a patient a $10 co-pay, seeing a mental health professional might require 20% coinsurance, which is typically higher than a co-pay.

Critics say that people with mental illness may shy away from such plans as a result.

“These disparities are prohibited under the law, but they do appear in plan brochures — and not in isolated instances," Barry said in a statement. "It suggests there's a need to better regulate what is being offered to potential enrollees.”

Some Exchange Plans May Violate ACA Mental Health Parity Law
Some Exchange Plans May Violate ACA Mental Health Parity Law

One-quarter of the health plans being sold on health insurance exchanges set up through the Affordable Care Act offer benefits that appear to violate a federal law requiring equal benefits for general medical and mental health care, according to new research led by the Johns Hopkins Bloomberg School of Public Health.

The law — known as mental health parity — was designed to eliminate discrimination in insurance coverage offered for people with mental illness and addiction problems. The federal law first required parity for group health insurance policies in 2010 and was extended to insurance products offered on state exchanges with the implementation of Obamacare last year.

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