Behavioral health coverage close to or on par with medical coverage after Affordable Care Act parity requirements

New study on individual and small-group insurance markets finds improved coverage for behavioral health conditions


RESEARCH TRIANGLE PARK, NC—A new RTI International study examines the individual small group insurance markets and finds that in 2014 when the ACA’s parity requirements went into effect, the proportion of plans with behavioral health coverage increased to be equal to or close to that of medical/surgical coverage. The study was published today in the July issue of the journal Health Affairs.

In 2013, before the ACA’s parity requirements took effect, all plans offered in-network coverage for medical care, but only 81 percent of plans explicitly mentioned they covered mental health conditions and 77 percent included substance use disorders. After the requirements took effect, all plans had in-network coverage for behavioral health conditions.

The proportion of plans with out-of-network coverage for all three conditions – mental health, substance use and medical/surgical conditions – fell after the requirements went into effect from 74 percent, 68 percent and 89 percent respectively to 61 percent. This design incentivized in-network care while out-of-network care became more expensive and less generous.

“The study’s findings are encouraging because people with behavioral health conditions tend to have high health care service use and expenditure. This study shows that because the ACA helped increase the scope and level of coverage, these services may become more affordable, allowing more access to care for those who need it,” said Alexander Cowell, PHD, senior research economist at RTI International and lead author of this paper. 

Another implication is that key provisions in the ACA – essential health benefits and parity requirements – may be important to the stability of the individual and small-group insurance markets. If these provisions were removed, the markets may become more unstable if insurers exclude some enrollees by limiting behavioral health coverage to reduce the cost of care and attract healthier enrollees.

The study collected data from 138 individual and small-group health plans from 2013 and 2014. The sample included at least one state from the four census regions, each type of insurance Marketplace, and diverse state population sizes and urban/rural designations.