Some Exchange Plans May Violate ACA Mental Health Parity Law

the Psychiatry Advisor take:

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.”