The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires that health insurance plans provide equal coverage for mental and physical illnesses.
A recent National Council on Behavioral Health report outlines that over 40 million Americans received mental health care through their employers in 2020. This is an increase from 35.6 million in 2019. The report also found that nearly 30% of all employer-sponsored health plans include substance use disorder treatment coverage, up from 29% in 2019.
The report shows that the private industry had made significant strides toward parity in mental health coverage since 2010, when only 25% of plans covered mental services and substance use disorder treatment. The increase in coverage is due to more employers offering benefits such as flexible spending accounts, health savings accounts, and consumer-directed plans, which allow employees to pick their providers and treatments with no pre-authorization required by their employer or insurer.
The report also showed that among large companies (those with more than 1,000 employees), less than half offer mental health coverage compared to two-thirds who provide medical coverage (though a third of these large companies offer both).
Major Causes of Mental Health in America
Mental health disorders are more common than cancer and diabetes, with more than 40 million Americans suffering from various conditions. According to the Centers for Disease Control and Prevention (CDC), approximately one in five adults in the United States experience mental illness in a given year. This makes the Mental Health Services a significant part of the health care industry in the United States.
The industry includes establishments that provide mental health services, including counseling and psychotherapy, psychiatric treatment, and substance abuse services. This industry excludes facilities that provide mental health services exclusively to residents of long-term care facilities.
Impact of Covid-19 On Mental Health
While COVID-19 has had various impacts on work arrangements and job security throughout 2020, it has also directly increased stress levels and mental strain among many workers. The stress caused by these changes can lead to increased depression and anxiety among Americans across all demographics and employment statuses.
For example, some Americans have been forced to take unpaid leave because their employers could not accommodate them under COVID-19’s new rules. Others have resorted to working from home due to their employer’s inability to provide them with accessible child care services or transportation options for getting to work on time.
Mental health issues can arise from other conditions, including cancer, heart disease, chronic pain, and substance misuse. Mental Health Services are essential to many people with these conditions.
The Affordable Care Act (ACA) expanded access to mental health services by requiring most insurance plans to cover behavioral health care at parity with medical/surgical benefits (the same copays and deductibles). This means that if your doctor prescribes a medication for depression, you can’t be charged more than if you were taking a drug for high blood pressure.
Mental Health Coverage Is Increasing
The number of people covered for mental health services has continued upward despite a year of setbacks for the U.S. economy and a national pandemic that has resulted in millions losing their jobs and health insurance.
According to a report by the Kaiser Family Foundation, 39.5 million Americans received mental health and substance use disorder benefits through their employer-sponsored health insurance plans in 2020, up from 36.6 million in 2019 and 33.3 million in 2018.
As part of its annual Employer Health Benefits Survey, Kaiser found that 19 percent of employers offered at least one plan with mental health benefits this year, compared to 14 percent last year. Of those employers offering such coverage, 38 percent offered only one plan, while 56 percent offered more than one plan with mental health benefits.
Kaiser also found that most employers are still offering behavioral health coverage even though they may not consider it sufficient. The report said that when employers were asked how they would describe the level of coverage they currently offer employees who need mental healthcare services, only 13 percent said adequate; 22 percent said sufficient; 21 percent said limited but sufficient; 18 percent said inadequate, and 26 percent declined to answer.
The increased number of people covered for mental health issues can be attributed to a rise in the number of avenues for help that can lead to better outcomes for people with mental health problems.
One such avenue is employer-sponsored coverage for mental health services.
Increased Employer Coverage for Mental Health
Recent research by AHIP found that 41 million Americans received mental health services through their employer in 2020 — up from 29 million in 2018 and just 12 million in 2013. Another study found that 38% of employers offer employees access to at least one type of behavioral health benefit, which includes both traditional medical services and complementary therapies like yoga or meditation classes.
The survey also found that most companies offer comprehensive coverage plans or partial plans that cover medication only. Employers are also increasingly offering telehealth services as part of their benefits package so employees can get help at home instead of going to a clinic or doctor’s office. In addition to the employer coverage, more insurance companies were covering mental health services in 2020 than ever before, and the percentage of workers who took advantage of these plans increased.
According to a report released by the National Alliance on Mental Illness (NAMI), 40 percent of Americans with private insurance had access to mental health coverage in 2020.
The number of Americans with private insurance increased, jumping from 330 million people in 2019 to 341 million in 2020. The percentage of workers who took advantage of these plans also increased from 23 percent in 2020 to 26 percent in 2021 — an increase of 3 million people.
However, the NAMI report also revealed some troubling trends related to access for those who need it most: People with Medicaid or Medicare were less likely than those with private insurance to have access to mental health services through an employer plan; those without any insurance at all were even less likely than that, and men were less likely than women.
NAMI also found that 15.4% of adults with private insurance reported an unmet need for treatment due to cost. Of those adults who reported having unmet needs, more than half had been diagnosed with a mental illness, and nearly one-third had been diagnosed with a substance use disorder.
Mental Health Coverage Is Hotter Than Ever
In addition to the jump in mental health coverage options from employers, another trend stood out: More companies are offering telemedicine treatments for mental health conditions like depression, anxiety, and post-traumatic stress disorder (PTSD). Telemedicine allows patients to receive treatment remotely through video chats with doctors or other providers.
The use of telemedicine for mental health issues is growing rapidly and is now available in many areas around the country. According to the Mental Health Network, an organization that provides telehealth services, more than 1,000 licensed psychiatrists and psychologists are now providing telemedicine services.
Impact of Increased Coverage of Mental Health Treatment
A report by the Society for Human Resource Management (SHRM) notes that the increase in mental health benefits can be attributed to employers’ desire to assist employees with mental health conditions, along with a growing awareness of the importance of mental wellness.
According to the survey, employees are more likely than ever to use their employer-sponsored mental health coverage. A study by the National Council for Behavioral Health shows that greater than 90 percent of employers provide some mental health coverage, with nearly one-third offering full coverage for all employees.
The study also found that employee assistance programs (EAP) were the most common form of employer-sponsored behavioral health care coverage, followed by medical insurance, prescription drug plans, and dental plans.
The findings come at a time when Americans increasingly turn to their employers for help with mental health issues. According to a National Institute for Mental Health survey, roughly half of adults with depression or anxiety conditions have sought help from an EAP in the past year. And more than 70 percent of people who have received treatment for substance use disorder say they did so through an EAP.
These numbers provide evidence that more employers realize that giving financial support for patients’ care can help improve overall employee productivity and reduce turnover costs — especially among high-performing employees who would be unlikely to leave their jobs without such support.
Mental health coverage is an important benefit for employees because it allows them to seek treatment without worrying about whether or not they can afford it.
The above findings are encouraging, but there is still room for improvement. For example, many employers still do not offer mental health benefits at all, which means that their employees might have to pay out-of-pocket for treatment.
In addition, some companies may offer limited coverage options or restrict how often they allow employees to use these benefits. This can make it difficult for workers who need regular care to access the services they need to stay healthy and productive at work (and beyond).
Healthcare Solutions Team is a wholly-owned subsidiary of the National General Insurance Group and Allstate Insurance Company