Mental Health Parity in Georgia

Behavioral health parity means that if your health insurance covers mental health and substance use care at all, it must cover that care and services at the same level as physical health care.

For example, if your plan covers a generic medicine for diabetes with a $10 co-pay, it must cover a generic medicine for a mental health condition with the same $10 co-pay. If your plan covers ongoing visits for a chronic physical condition, it must also pay for ongoing visits for chronic conditions like depression, anxiety, or substance use disorder.

When health insurance plans do not follow parity rules, Georgians end up paying more, waiting longer, or skipping mental health care altogether.

Federal Law: Together, the Mental Health Parity and Addiction Equity Act of 2008 and the Affordable Care Act (2010) require that most health plans to cover mental health and substance use disorder (MH/SUD) care just as fully as other medical care.

Parity rules apply to:

• Copays, coinsurance, and deductibles
• How many visits are covered
• Prior authorization and other approval and paperwork rules
• Which providers are in network and/or how long you have to wait for an appointment
• Rules for deciding what care is "medically necessary"

If a plan offers strong coverage for physical health but weaker coverage for MH/SUD care, it may be violating federal or state parity laws.

In 2022, Georgians for a Healthy Future (GHF) and a coalition of partners worked with state lawmakers to pass House Bill 1013, the Georgia Mental Health Parity Act. This law:

• Requires many private health insurance plans and all Medicaid health insurers in Georgia to follow the federal parity law and rules
• Gives state agencies better tools to check whether insurers are complying and impose consequences if they are not
• Strengthens protections for consumers who need their health insurance to pay for MH/SUD treatment

The law is an important step toward making sure the benefits people are promised on paper match the benefits they receive in real life.

GHF is working with state leaders, insurance companies, and community partners to make parity real for Georgians. Our work includes:

• Evaluating and sharing whether insurance companies are following the law–– have you seen our Mental Health Parity Dashboard?
• Monitoring and sharing how state agencies enforce the law–– have you seen our Mental Health Parity Dashboard?
• Educating Georgians about their insurance rights and how to use them–– check out GeorgiaMentalHealth.org for more information!
• Identifying barriers that still prevent people from getting MH/SUD care
• Lifting up stories from Georgians who have faced coverage problems

Without strong enforcement and ongoing advocacy, Georgians will continue to face unnecessary hurdles when they seek help.

Parity protects your right to get mental health and substance use (MH/SUD) treatment without extra barriers. That means your health plan should:

• Cover mental health and substance use treatment at the same level as physical health care
• Use similar copays, coinsurance, and other out-of-pocket costs for MH/SUD and physical health services
• Apply the same rules for approving or denying care regardless of whether its physical or mental health care, such as prior authorization or visit limits
• Offer access to mental health and substance use providers similar to other medical providers (For example, if none of your in-network mental health providers are taking new patients, but half of other medical providers are, that might be a parity problem!)

If something about your MH/SUD coverage feels unfair or harder to use than other medical benefits, it could be a parity problem.

Parity in Practice

What coverage looks like when plans follow the law and when they do not.

If you think your health insurance plan is not following parity rules, you can:

• Ask your insurer for written explanations of denials or limits on mental health or substance use care
• File an appeal with your health plan
• If you have private insurance, contact the Georgia Office of Insurance and Safety Fire Commissioner to file a complaint.
  • Check out the Resource Library at GeorgiaMentalHealth.org for a video about how to file a complaint with Georgia's Office of Insurance.
• If you have Medicaid, visit the Georgia Department of Community Health's Mental Health Parity page to file a complaint.
• Reach out to GHF to share your story.

You are not alone, and you deserve clear answers about your coverage.

Related resources:

• Cover My Mental Health
• National Alliance for Mental Illness, Georgia (NAMI, Georgia): Understanding Mental Health Parity

• Parity means fairness. If an insurance plan covers mental health and substance use care at all, they must be covered on equal terms with physical health care.
• Federal and state laws protect your rights. The Mental Health Parity and Addiction Equity Act and Georgia's Mental Health Parity Act work together to require fair coverage.
• Problems still exist. Many people in Georgia still face higher costs, denials, or delays when they seek MH/SUD care.
• GHF is taking action. We work with partners across the state to monitor compliance, push for better enforcement, and support people who are navigating coverage issues.
• You have a voice. If your plan is not treating mental health and substance use care fairly, you can get help, file complaints, share your story, and help make the system better for everyone.

Think Your Plan Isn't Following Parity Laws?

You have the right to equal mental health coverage. Here's what you can do: