Ensure consumer protections in all health plans

In 2023, two bills were introduced in the U.S. House that would expand telehealth-only plans and association health plans (AHPs). As introduced, these bills did not include critical protections for individuals with mental health and substance use disorders (MH/SUD).[1][2][3]

Telehealth-only health plans would limit – or fail to cover altogether – in-person MH/SUD services. While telehealth is a critical delivery mechanism for MH/SUD services that should be covered at parity with in-person services, restricting in-person services through telehealth-only plans will limit access to critical in-person care. Key levels of care (e.g., inpatient) are fundamentally in-person services, while other services may be most effectively delivered in-person (due to the nature of the service or the needs/preferences of the individual). These “excepted benefits” plans should not be expanded.[4]

AHPs are offered by organizations like trade associations or professional groups and are exempted from ACA standards, such as requiring coverage of MH/SUD services and preventing discrimination against individuals because they have (or previously had) an MH/SUD.[5] AHPs also threaten to raise premiums and undermine the stability of higher-quality health plans that serve the majority of Americans by peeling off younger and healthier enrollees who are less expensive. Similarly, short-term limited duration plans, which do not have to follow ACA rules or MHPAEA, should be defined as plans lasting three months or less. These plans offer inadequate coverage and should not be allowed to undermine full-year plans.

Congress should reject any health plans that do not offer strong MH/SUD coverage, are allowed to discriminate against individuals with MH/SUDs, or are not subject to MHPAEA.