Establishing Principles for Parity in Medicare Coverage

This week, Medicare Rights joined the Legal Action Center and the Center for Medicare Advocacy to release “Parity Principles to Optimize Medicare Coverage of Mental Health and Substance Use Disorder Care.” This one-page document explains the need for and outlines necessary steps toward ensuring that older adults and people with disabilities have access to the full range of care and services they need.

Currently, Medicare has gaps in coverage when it comes to behavioral health and substance use disorder treatments, including missing treatment options and provider types, that force beneficiaries to go without care, seek other coverage, or pay out of pocket. This is partly due to Medicare not being subject to the Mental Health Parity and Addiction Equity Act of 1996 (Parity Act). The Parity Act requires health insurers to treat mental health and substance use disorder care benefits like medical and surgical benefits, without higher costs, caps, or other restrictions. While this has not eliminated discrepancies in coverage, it has reduced them. Applying the Parity Act to Medicare is an important step in improving coverage.

The Parity Principles document lays out how Congress could bring all aspects of Original Medicare, Medicare Advantage, and Part D prescription drug coverage into alignment with the Parity Act and explains how doing so would help fill in coverage gaps and expand access to care. The Parity Principles avoid piecemeal approaches that could leave some people with Medicare without options for the specific care they need.

These reforms are more critical than ever. Mental health concerns and overdose deaths have been exacerbated by the COVID-19 pandemic, highlighting the urgent need for better treatment coverage and access. At Medicare Rights, we urge Congress to take swift, comprehensive action to fill these gaps and keep people with Medicare from falling through the cracks in the system.

Read more about the need for greater coverage of mental health and substance use disorder care in Medicare.

Read more from the Legal Action Center on gaps in substance use disorder treatments in Medicare.