Traditionally, insurance providers and employers have covered treatment for mental health and substance use conditions differently than treatment for other medical conditions. Coverage for mental health care and substance use disorders had its own (usually higher) cost-sharing structure, more restrictive limits on the number of inpatient days and outpatient visits allowed, separate annual and lifetime caps on coverage, and different prior authorization requirements than coverage for other medical care. Altogether, these coverage rules made mental health and substance use benefits substantially less generous than benefits for other health conditions.
Over the past decade, Congress has enacted several laws to end this inequity. As a result, nearly all insured Americans are now entitled to receive their mental health and substance use benefits at the same level as their benefits for other medical care. Enforcing those rights, however, has not been consistent, and many patients are left to fend for themselves. The following brief provides an update to a previously published brief on, now with a focus on enforcement.
– Health Affairs