An Employee Benefit Research Institute survey found that 39% of health plan participants were unsure whether mental health services were covered in the same way as medical care, despite plan sponsors improving their mental health coverage offerings in recent years.
Coverage Gap Persists Despite Legal Protections
Only 46% of survey respondents reported that their health plan covers mental health care and other services the same way. According to Paul Fronstin, EBRI’s director of health benefits research, parity means having the same cost sharing between employer and plan participant, including identical deductibles, copayments, and restrictions on the number of visits. Fronstin noted that if people believe there are restrictions or higher costs for mental health care than other services, that “may be a deterrent to [them] getting that care when they need it.”
Federal law has addressed mental health coverage through several legislative acts. The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 prevents group health plans and health insurance companies from imposing less favorable benefit limitations on mental health or substance use disorder benefits compared to medical/surgical benefits. The Patient Protection and Affordable Care Act of 2010 built on this by requiring coverage of mental health and substance use disorder services as essential health benefits. The Consolidated Appropriations Act of 2021 amended requirements for plans to provide comparative analyses of nonquantitative treatment limitations to federal secretaries.
Three Barriers to Awareness and Access
Christin Kuretich, vice president of supplemental products at Voya, identified three reasons knowledge about mental health benefits lags behind offerings: provider shortages, high-deductible health plans, and incomplete reimbursements to mental health providers. She noted that since COVID, “we’ve lost mental health clinicians in the field” as therapists, social workers, and counselors experienced burnout.
High-deductible plans shift costs to employees; the minimum annual deductible for family coverage in 2025 in an HDHP plan is $3,300, with families potentially facing deductibles up to $6,000. Additionally, many mental health providers do not accept insurance due to inadequate reimbursement rates, limiting employees’ ability to use coverage.
Generational Demand Divergence
Mental health diagnoses among the population younger than age 65 with employment-based coverage increased to 18.5% in 2020 from 14.2% in 2013, according to EBRI research. Interest in mental health benefits shows generational differences: according to a Voya Financial Consumer Insights & Research survey conducted in April, 67% of Generation Z and 59% of Millennials said mental health benefits would increase their likelihood of staying with their employer, compared to 43% of Generation X and 31% of Baby Boomers.
This article is an AI-assisted summary. All facts and figures are drawn from the original report: https://www.plansponsor.com/participants-lack-awareness-of-mental-health-coverage-despite-improved-offerings/