Addiction Equity Act: What You Need to Know

The Addiction Equity Act is part of the Mental Health Parity and Addiction Equity Act (MHPAEA), designed to protect individuals who have mental or behavioral health conditions. The act prevents medical insurance companies from offering less favorable insurance benefits for mental and behavioral health conditions than they do for physical health needs and services. Knowing about the act can help you monitor your benefits to ensure you’re not discriminated against because of a certain type of condition. 

WhiteSands Treatment is recognized as the best addiction treatment center in Florida, specializing in behavioral and mental health care. We advocate for patients’ rights. The need for access to high-quality mental and behavioral healthcare is tremendous. This act protects people’s benefits to ensure that they are fair. 

Our rehab center provides a full range of treatment programming, including inpatient rehab, outpatient treatment, medical detox, and aftercare. We offer dual diagnosis treatment for individuals who have a substance use disorder and mental health conditions such as anxiety or depression. Our licensed clinicians also prescribe medication-assisted treatment to patients who can benefit from this type of treatment.

A substance use disorder is a serious chronic condition, but it can be managed effectively with treatment that supports abstinence and relapse prevention. We can help you put drug and alcohol abuse in your past. We can also help you determine how much coverage your insurance plan entitles you to maximize your benefits and obtain the best-quality support for your recovery journey. 

Overview of the Addiction Equity Act

The Addiction Equity Act (MHPAEA) states that insurance providers cannot offer less favorable insurance benefits for mental health and behavioral health conditions than they do for physical health conditions or surgeries. This federal law ensures that people who have a substance use disorder, for example, are entitled to the same level of coverage for their disorder as the company offers for other types of health conditions. In short, it prevents insurance companies from discriminating against people who have mental or behavioral health conditions. The law disallows companies from providing more favorable coverage for medical or physical health conditions than the coverage they provide for mental and behavioral health conditions.

Key Provisions of the Addiction Equity Act

Key provisions of the Addiction Equity Act target important benefit protections, treatment limitations, and financial requirements. Although each insurance provider and plan is different, the provisions of this act outline the necessity of providing equitable coverage for mental and physical health care. Once an insurance provider elects to offer coverage for mental and behavioral health (and it must, in order to participate in the federal health insurance marketplace), it becomes subject to the requirements of this act. 

How the Addiction Equity Act Impacts Insurance Coverage

This act affects health insurance coverage because it prevents insurance providers from offering less favorable benefits for mental and behavioral health care. This means that either insurance companies have to scale up their coverage of mental and behavioral health coverage or scale down their coverage of medical/surgical coverage to be in compliance with federal law. While the law impacts insurance companies financially, it also positively impacts patients who need mental or behavioral health care because it helps prevent discrimination based on a health condition and the need for treatment. 

Comparing Coverage for Addiction and Other Medical Conditions

Historically, it has been difficult for people who have mental health or behavioral health to access high-quality treatment. Substance abuse disorders have been notoriously undercovered until the passage of the Affordable Care Act. It was easier to obtain insurance coverage for a physical health condition than it was for a behavioral health condition like alcoholism. Today, it’s well known in the medical community that addiction can be managed–with treatment! Addiction is a complex condition that requires multi-type treatment. The passage of new laws supports access to and insurance coverage for behavioral health treatment. 

Challenges in Enforcing the Addiction Equity Act

Health insurance companies risk penalties for failing to comply with the MHPAEA, but that doesn’t mean they always comply. Insurance regulators don’t always catch or enforce laws that prevent insurance providers from unfairly cutting benefits or providing less favorable benefits for mental and behavioral health conditions. As a mental health and behavioral health care advocate, WhiteSands Treatment routinely helps clients evaluate their insurance plans and determine the coverage levels for treatment. We see the challenges for clients and help them obtain the fair benefits they deserve so they can get the treatment they need. 

Understanding Your Rights Under the Addiction Equity Act

If you have a substance use disorder or dual diagnosis, your medical insurance provider must offer you fair coverage of your condition if it offers mental and behavioral health benefits as part of its plans. In other words, it can’t provide better benefits for your heart or gastrointestinal tract than it does for your behavioral and mental health. You have rights. Although many clients aren’t aware of their rights under the MHPAEA, WhiteSands Treatment is. We can help you obtain the coverage you are entitled to so that you get the help you need to achieve lasting recovery. 

How the Addiction Equity Act Affects Treatment Providers

Treatment providers like WhiteSands Treatment’s clinicians understand that individuals have more than physical health care needs. One in six people, for instance, can expect to endure depression at least once in their lifetime. People have mental and behavioral health care needs, too. Treatment providers understand the need for whole-person health care. Insurance providers have a business model that requires them to cut costs where they can. They should not be able to cut their costs by cutting out or down on mental and physical health benefits. We are happy about the protections that federal laws now offer to people who have substance abuse disorders or other mental health and behavioral health conditions. 

WhiteSands Treatment’s Approach to the Addiction Equity Act in Its Programs​

WhiteSands Treatment helps people who have a mental health or behavioral health condition. We know that the need for quality treatment is profound. Without insurance benefits to cover the costs of this treatment, many patients would be unable to afford treatment, resulting in suffering and increased deaths. We offer comprehensive care to support clients where they need us. 

If you have questions about your insurance coverage, you can rely on WhiteSands Treatment’s insurance specialists for help. We can help you navigate your insurance to maximize your benefits. We routinely evaluate insurance plans to ensure that providers comply with acts like the Addiction Equity Act. We look out for our patients in various ways; helping them keep tabs on their health insurance company is just one of them. 

If you are struggling with an addiction to drugs or alcohol, it’s time to call WhiteSands Treatment at 877-855-3470 or contact us online and get the help you need to achieve long-term recovery. Treatment works. We combine many treatment approaches to help clients develop strategies to create a relapse prevention plan that works. We look forward to helping you protect your health and future.

If you or a loved one needs help with abuse and/or treatment, please call the WhiteSands Treatment at (877) 855-3470. Our addiction specialists can assess your recovery needs and help you get the addiction treatment that provides the best chance for your long-term recovery.