What Is Mental Health Parity? How the Law Protects Your Therapy Coverage
Mental health parity is the legal principle that insurance has to cover mental health and substance use treatment on the same terms as physical health care — not a lesser, more restricted benefit. It’s the single most important piece of law behind almost everything else on this site, so it’s worth understanding directly.
The law itself
The Mental Health Parity and Addiction Equity Act (MHPAEA), signed in 2008, requires that group health plans and insurers that offer mental health or substance use disorder benefits provide them at parity with medical/surgical benefits — meaning comparable financial requirements (copays, coinsurance, deductibles) and comparable treatment limitations (visit limits, prior authorization requirements). The Affordable Care Act later extended parity requirements to most individual and small-group market plans by making mental health and substance use treatment one of the ten Essential Health Benefits.
What parity actually requires, concretely
If your plan’s medical/surgical benefits have no annual visit limit, it can’t cap your therapy visits at, say, 20 per year. If your specialist medical copay is $40, your therapy copay can’t be set at $75. If prior authorization for a medical/surgical service is applied to only 10% of claims, mental health prior authorization can’t be applied to 80% of claims for a comparable level of care. The law also requires “non-quantitative treatment limitations” — things like how medical necessity is determined, or how provider networks are built — to be comparably applied, which is a more subjective standard and a common area of enforcement disputes.
What parity does not require
Parity doesn’t require a plan to cover mental health care at all if it doesn’t already offer mental health benefits (though ACA plans are required to, separately, as an Essential Health Benefit). It also doesn’t guarantee unlimited coverage regardless of medical necessity — insurers can still deny a specific claim if they determine the specific treatment wasn’t medically necessary, as long as that determination process is held to the same standard as it would be for medical/surgical care.
How parity gets enforced
Enforcement falls to the Department of Labor for employer-sponsored plans, state insurance regulators for fully-insured plans, and the Department of Health and Human Services for other markets. In recent years, DOL and several state attorneys general have brought high-profile enforcement actions against insurers found to have parity violations, particularly around non-quantitative treatment limitations like overly restrictive medical necessity criteria or narrow mental health provider networks compared to medical networks.
What to do if you suspect a parity violation
If you notice your mental health benefit seems more restrictive than your medical benefit in a specific, comparable way — a higher copay, a stricter prior authorization process, a much narrower in-network therapist list than your medical specialist list — you can file a complaint with the Department of Labor’s Employee Benefits Security Administration (for employer plans) or your state insurance commissioner (for individual/fully-insured plans). Complaints like these are one of the main ways parity violations actually get identified and corrected.
Why this matters even if you never file a complaint
Understanding parity gives you a concrete standard to hold your insurer to in ordinary interactions — when you’re told a service isn’t covered, when a copay seems off, or when a prior authorization gets denied, “is this treated the same as a comparable medical service would be” is a legitimate and useful question to ask directly, and insurers are required by law to be able to answer it.
How to Check Whether Your Plan Follows Parity
Look at your plan documents for limits on therapy visits, higher copays for mental health than for medical care, or extra approval requirements that other services do not face. If something looks stricter for mental health, call your insurer and ask them to explain the difference in writing. You can also file a complaint with your state insurance department or the appropriate federal agency. General coverage information is available at HealthCare.gov.
Steps If a Claim Is Denied
Ask for the reason in writing, gather your provider’s notes, and file an internal appeal within the deadline on your denial letter. If the appeal fails, you may be able to request an independent external review.
Frequently Asked Questions
Does parity apply to every plan? It covers many plans but not all, and details vary.
Does parity mean unlimited therapy? Not necessarily, but limits must not be stricter than for medical care.
Who can help me? Your state insurance department and patient advocacy groups.
This article is general information about insurance and is not medical, legal, or financial advice. Coverage varies by plan and state, so confirm details with your insurer.