Behavioral Health Coverage In The Individual Market Increased After ACA Parity Requirements

As of January 1, 2014, the Affordable Care Act designated mental health and substance use services as an essential health benefit in Marketplace plans and extended parity protections to the individual and small-group markets. We analyzed documents for seventy-eight individual and small-group plans i...

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Bibliographic Details
Published in:Health Affairs 2018-07, Vol.37 (7), p.1153-1159
Main Authors: Cowell, Alexander J., Prakash, Shivaani, Jones, Emily, Barnosky, Alan, Wedehase, Brendan
Format: Article
Language:English
Subjects:
Access
Addictions
Computer networks
Datasets
Drug use
Equity
Health behavior
Health care policy
Health insurance
Health services
Insurance coverage
Market shares
Markets
Medicine
Mental disorders
Mental health
Mental health care
Mental health services
Parity
Patient Protection & Affordable Care Act 2010-US
Substance abuse
Substance use
Surgery
Task forces
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Summary:As of January 1, 2014, the Affordable Care Act designated mental health and substance use services as an essential health benefit in Marketplace plans and extended parity protections to the individual and small-group markets. We analyzed documents for seventy-eight individual and small-group plans in 2014 (after parity provisions took effect) and sixty comparison plans in 2013 (the year before parity provisions took effect) to understand the degree to which coverage for mental health and substance use care improved relative to medical/surgical benefits. The results suggest that plan issuers did what the provisions required them to do. Although in 2013 a lower proportion of plans covered mental health or substance use care, compared to medical/surgical care, in 2014 the proportions were the same. If essential health benefit requirements were to be removed and mental health and substance use coverage becomes similar to that in 2013, as many as 20 percent of the plans in our sample would not cover these conditions. To determine whether increases in behavioral health coverage will result in improved access to behavioral health services requires complementary data on the size of provider networks and use of services.
ISSN:0278-2715
1544-5208
DOI:10.1377/hlthaff.2017.1517