Your rights under the Mental Health Parity and Addiction Equity Act (MHPAEA)
Your health plan cannot:
- Charge higher copays or coinsurance for therapy than for comparable medical visits
- Cap your therapy sessions when no comparable cap exists on physical therapy or specialist visits
- Require more burdensome prior authorization for mental health care than for equivalent medical care
- Maintain a narrower network of mental health providers than medical providers
- Apply separate, stricter deductibles to mental health services
What Is Mental Health Parity?
Mental health parity is the legal requirement that health insurance plans cover mental health and substance use disorder (MH/SUD) services at the same level as medical and surgical services. In other words, your plan cannot impose more restrictive limits on mental health care than it does on comparable medical care. This protection comes from two main federal laws: the Mental Health Parity and Addiction Equity Act (MHPAEA) and the ACA.
What the Law Requires
Under parity law, health plans that cover mental health and substance use disorder services cannot impose:
- Higher copays or coinsurance for MH/SUD services than for comparable medical services
- More restrictive visit limits (e.g., capping therapy at 20 sessions per year when there is no comparable cap on physical therapy)
- Different deductibles or out-of-pocket maximums that apply only to mental health care
- More burdensome prior authorization requirements for mental health care than for medical care (this is a key area of enforcement)
- Narrower in-network provider standards for mental health providers than for medical providers
What Counts as a Mental Health or Substance Use Disorder Benefit?
Parity applies broadly to:
- Outpatient psychotherapy and counseling (individual, group, family therapy)
- Inpatient psychiatric hospitalization
- Partial hospitalization programs (PHP) and intensive outpatient programs (IOP)
- Substance use disorder treatment: detox, residential rehab, outpatient treatment
- Medication-assisted treatment (MAT) for opioid and alcohol use disorder (buprenorphine, methadone, naltrexone)
- Psychiatric medications prescribed by a psychiatrist or other prescriber
- Applied Behavior Analysis (ABA) therapy for autism spectrum disorder
- Eating disorder treatment
Parity Violations: What to Watch For
Parity violations are more common than many people realize. Signs your plan may be violating parity:
- Your plan requires prior authorization for every mental health visit but not for comparable medical visits
- Your plan has a very limited network of in-network therapists or psychiatrists compared to the breadth of the medical network
- Your plan is applying a session limit to therapy but not to physical therapy
- Your claim for inpatient psychiatric care was denied while comparable medical inpatient stays are routinely covered
- Step therapy requirements for psychiatric medications that do not exist for comparable medical conditions
How to Assert Your Parity Rights
If you believe your plan is violating mental health parity:
- Request a parity analysis from your insurer. Under federal rules, plans must disclose their non-quantitative treatment limitations (NQTLs) and how they compare to medical/surgical coverage upon request.
- File an internal appeal. If a mental health claim is denied, file a formal appeal with your insurer citing the MHPAEA. Include documentation from your provider about medical necessity.
- File a complaint with your state insurance department. State regulators enforce parity at the individual plan level.
- File a complaint with the U.S. Department of Labor (DOL) if your employer plan is violating parity. The DOL oversees ERISA-governed employer plans.
Mental Health Coverage and the ACA
The ACA designated mental health and substance use disorder services as one of ten essential health benefits that all individual and small group marketplace plans must cover. Combined with MHPAEA, this means marketplace plans in 2026 are required to cover MH/SUD services and to cover them at parity with medical care. If you are concerned about your mental health coverage, a licensed broker can help you find a plan with strong MH/SUD benefits. Call (713) 575-9904.