Mental health parity law requires most health plans that cover mental health and substance use disorder treatment to cover it on terms no more restrictive than medical and surgical care. That means similar copays and deductibles, similar visit limits and no extra hoops, like stricter prior authorization, just because the care is for your mental health. The main federal law is the Mental Health Parity and Addiction Equity Act (MHPAEA), and Pennsylvania has its own parity protections too.
Knowing your rights can help you get the treatment you need and push back when a plan treats your care unfairly.
What Is the Mental Health Parity Law?
According to the Centers for Medicare & Medicaid Services (CMS), the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act was enacted in 2008. It built on the Mental Health Parity Act of 1996, which stopped plans from setting lower annual or lifetime dollar limits on mental health benefits than on medical benefits. MHPAEA kept those protections and added new ones, including extending parity to substance use disorders.
One key detail: the law does not require plans to cover mental health or substance use care. It says that if a plan does cover it, the coverage must be on par with medical care. The Affordable Care Act (ACA) filled much of that gap by making mental health and substance use disorder services an essential health benefit in non-grandfathered individual and small-group plans.
Which Plans Must Follow Parity Rules?
CMS lists the main types of coverage subject to MHPAEA:
- Large employer group health plans
- Large non-federal government employer plans
- Individual health insurance, including Marketplace plans
- Medicaid managed care plans and CHIP
Small employer group plans are not directly covered by MHPAEA, but CMS notes that parity requirements apply to them indirectly through the ACA’s essential health benefit rules. HealthCare.gov confirms that all Marketplace plans cover mental health and substance use services as essential health benefits and cannot deny coverage or charge more because of a pre-existing mental health or substance use condition.
What Parity Requires in Practice
The U.S. Department of Labor breaks parity into three main areas:
Financial Requirements
Copays, coinsurance and deductibles for mental health and substance use care must be similar to those for medical care. A plan generally cannot charge a higher copay for a therapy visit than for comparable medical office visits.
Treatment Limits
Limits on the number of visits or days of care cannot be more restrictive for mental health benefits than for medical or surgical benefits.
Care Management Rules
These are sometimes called nonquantitative treatment limitations. They include prior authorization, medical necessity criteria and provider network rules. The Department of Labor notes that most health plans cannot require preauthorization for all mental health and substance use disorder treatment.
Signs Your Plan May Be Violating Parity
The Department of Labor’s guide, Understanding Your Mental Health and Substance Use Disorder Benefits, describes situations that may signal a parity problem, such as a plan that:
- Requires preauthorization every three months for medications prescribed for mental health conditions
- Has a much less complete network of mental health providers than medical providers
- Requires preauthorization or concurrent review for all mental health benefits, only approving a few days at a time
- Refuses to cover mental health treatment because you did not complete a previous treatment
- Requires your mental health treatment plan to be updated and resubmitted every six months
These are red flags, not automatic violations. Parity is judged by comparing how a plan handles mental health benefits with how it handles similar medical benefits.
How to Use Your Parity Rights
- Ask for information. The Department of Labor says you can request the information your plan uses to make decisions about copays, limits, medical necessity and prior authorization, and plans must generally respond within 30 days.
- File an internal appeal. You usually have 180 days from the plan’s decision to appeal in writing, and plans generally must respond within 60 days.
- Request an external review. If your internal appeal is denied, you can ask for an independent external review no later than four months after the final denial. A decision is generally due within 45 days.
- Get help. The Department of Labor’s Employee Benefits Security Administration offers free help with employer plans, and your state insurance department can help with state-regulated plans.
Where the Federal Rules Stand in 2026
In September 2024, federal agencies issued a new rule strengthening parity requirements for care management rules like prior authorization. On May 15, 2025, the Departments of Labor, Health and Human Services and the Treasury announced they would not enforce the portions of the 2024 rule that are new compared with the earlier 2013 rule until a final decision in related litigation, plus 18 months. The core law still applies: the agencies stated that MHPAEA’s statutory obligations, as amended in 2021, remain in effect, and the 2013 rule and existing guidance still stand.
Mental Health Parity in Pennsylvania
Pennsylvania adds its own protections. The Pennsylvania Insurance Department explains that parity means your plan must provide the same level of coverage for mental health and substance use disorder treatment as for medical services, and that Pennsylvania’s Act 106 requires minimum coverage for alcohol and drug treatment in many group plans. In a 2024 consumer alert, the department noted that Pennsylvania’s Health Insurance Coverage Parity and Nondiscrimination Act requires equitable access to covered mental health and substance use services. It urged consumers to watch for higher behavioral health copays, stricter visit limits or prior authorization, and denials of residential substance use treatment as not medically necessary, and to appeal and contact the department’s Bureau of Consumer Services if needed. For details on state rules, read does insurance cover rehab in Pennsylvania.
Frequently Asked Questions
Does the mental health parity law require my plan to cover therapy?
Not by itself. MHPAEA applies when a plan covers mental health benefits. However, the ACA requires non-grandfathered individual and small-group plans to cover mental health services as an essential health benefit.
Does parity apply to substance use disorder treatment?
Yes. MHPAEA extended parity protections to substance use disorder benefits, including rehab programs like partial hospitalization and intensive outpatient care.
Can my plan require prior authorization for mental health care?
Yes, but the rules for requiring it must be comparable to those for similar medical care, and most plans cannot require preauthorization for all mental health and substance use treatment.
Does parity mean my care will be free?
No. You may still owe copays, coinsurance and deductibles. Parity means those costs should not be higher or more restrictive than for similar medical care.
Get Mental Health and Addiction Treatment in Lancaster, PA
At The Ranch Pennsylvania Outpatient Services, we accept many plans from carriers including Aetna, Blue Cross Blue Shield, Cigna, Magellan and UnitedHealthcare. We offer mental health treatment, including a partial hospitalization program and an intensive outpatient program, as well as addiction treatment programs. Coverage varies by plan, and our admissions team verifies benefits before treatment. Learn how to check your coverage or verify your insurance now. Our admissions team is available 24/7, and calls are free and confidential.
