What Is Parity?
Parity, mentioned in both the Mental Health Parity and Addiction Equity Act of 2008 and in the Affordable Care Act is a concept that is often misunderstood. In an effort to relieve some of this confusion, today we are going to breakdown what parity is and is not, who it applies to and what the purpose of parity is.
What Is Parity?
Parity is defined as equal or equivalent, at symmetry, not favoring one over another, or fairly matched.
What Does Parity Do?
Parity makes sure that if mental health or substance use disorder benefits are being offered, they are being offered equal to medical/surgical benefits.
To help understand this, here are a couple examples if your insurance plan is offering mental health or substance use disorder benefits:
- If your health insurance plan offers out of network medical/surgical benefits, it must then provide out of network mental health and substance abuse benefits.
- If there is not a limit on the number of days or number of visits on medical/surgical benefits, there can’t be a limitation on mental health or substance use disorder benefits.
What Doesn’t Parity Do?
The Mental Health Parity and Addiction Equity Act of 2008 and the Affordable Care Act do not require employers to offer mental health or substance use condition benefits.
Who Does Parity Apply To?
Parity applies to a couple different groups based on the implementation date of the Mental Health Parity and Addiction Equity Act of 2008 and the Affordable Care Act.
The Mental Health Parity and Addiction Equity Act of 2008, effective October 3, 2009, states that health insurance benefits for people who receive insurance through their employer, who insure over 50 people, and choose to offer both mental health or substance use condition benefits must be on parity with the medical/surgical benefits. Parity is also applicable to Medicaid Managed Care Plans. Medicaid Managed Care and Medicaid Managed Care benefits vary from state to state. For more information on Medicaid in your state use healthcare.gov’s insurance and coverage finder.
Through the Affordable Care Act, an estimated 40 million Children’s Health Insurance Program (CHIP) enrollees will have parity as of 2010. Like Medicaid, CHIP and CHIP benefits vary from state to state. For more information on CHIP check out healthcare.gov.
Starting January 1, 2014 the Affordable Care Act also expands parity to people purchasing small employer group insurance plans (employers who have 2- 50 employees) through the State Health Insurance Exchanges and to the newly eligible Medicaid recipients through the Medicaid benchmark health plans. The Affordable Care Act also will extend parity to individual insurance plans.
What’s the Purpose of Parity?
The purpose of parity is to address the discrimination and inequality that historically has existed in insurance policies regarding mental health or substance use disorder benefits.
Can you simply tell me what the significant difference is particularly for people seeking detoxification/Treatment @ a hospital or treatment program/rehabilitation center? I am an addictions counselor who formerly worked in a hospital setting and have experienced many clients have their treatment terminated prematurely or denied treatment due to the policies and conditions of their insurance policy.
As I wrote in an op-ed in The Washington Post almost 11 years ago to the day, the biggest discriminator in health care for the mentally ill remains the federal government through it’s Medicaid “Institutes for Mental Disease” (IMD) exclusion. Medicaid will pay for long-term inpatient care for anyone 18-65 who has a disease in any part of the body other than the brain. If it’s in the brain, Medicaid won’t reimburse states. And that is why states kick people with mental illness out of hospitals and put them in jails. See op ed here
http://www.treatmentadvocacycenter.org/index.php?option=com_content&task=view&id=575&Itemid=196
Medicaid is exempt from parity because it is an entitlement program and not an insurance company. So, If you’re medically indigent there is no parity.
Even with health care reform if you’re an addict, expect JAIL not treatment and you won’t be disappointed. One day we will leave the dark ages of Behavioral Health, but I don’t see it in my lifetime.
There is parity all right, very few people get any coverage at all. My friend’s son is bi-polar and drug addicted and getting him any behaviour health support is nearly impossible.
Its sad but true that majority of the people who need behavioral health services are turned away or denied because of the fine lines held in manage care contracts. I would love to see the day when substance abuse cases are viewed and treated medically rather than locking one up for using drugs. Most of the persons who are forced into recovery by these drug courts are from a low socio-economic status and want to avoid jail time. How is this beneficial to their recovery? In my opinion it does more harm than good for the wellness of that individual.