Parity in mental health benefits typically affects what aspect of plan design?

• A. MH/SUD benefits receive no parity with medical benefits.
• B. Parity requires higher copays for MH/SUD.
• C. Medical management and cost-sharing parity with medical/surgical benefits for MH/SUD benefits.
• D. Parity applies only to inpatient MH care.

Answer: (C)

Parity in mental health benefits means plans must treat MH/SUD benefits on the same footing as medical/surgical benefits. The key idea is that how care is managed and what patients pay should be comparable between mental health/substance use benefits and medical/surgical benefits. Medical management parity ensures rules like prior authorizations, step therapy, and utilization review for MH/SUD aren’t more restrictive than those for medical care. Cost-sharing parity means deductibles, copays or coinsurance, and out-of-pocket maximums for MH/SUD should be no worse than for medical/surgical benefits. This broad approach covers more than just inpatient care, spanning outpatient and other MH/SUD services as well. The other options misstate the concept by implying no parity, higher cost-sharing for MH/SUD, or restriction to inpatient care only.