What parity means in plain terms
"Parity" means equal treatment. If your plan charges a $30 copay for a medical office visit, it generally should not charge a $60 copay for a comparable therapy visit. If it lets you see a medical specialist without prior approval, it should not demand prior approval for routine outpatient therapy without a comparable reason.
The main federal law is the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). CMS explains that it bars plans that offer mental health and substance use disorder benefits from setting financial requirements, such as copays and coinsurance, or treatment limits, such as visit caps, that are more restrictive than those applied to substantially all medical and surgical benefits in the same category.
What the federal law covers
CMS describes several protections that matter for someone starting therapy:
- Benefits are compared within six classifications, including outpatient in-network and outpatient out-of-network. If a plan covers medical care in a classification, it must cover mental health care there too.
- Deductibles and out-of-pocket maximums must be combined, so a plan cannot make you meet a separate deductible just for mental health.
- Nonquantitative limits, such as prior authorization, step therapy, network standards and how out-of-network payment rates are set, must be designed and applied no more strictly for mental health than for medical care.
- Plans must perform and document comparative analyses of those nonquantitative limits and make them available to regulators on request, a requirement added by Congress in 2020.
What it does not do
MHPAEA does not by itself require a plan to cover mental health care at all. It sets rules for plans that do. CMS notes that the Affordable Care Act fills much of that gap by making mental health and substance use services one of ten essential health benefits in non-grandfathered individual and small-group plans. Parity also does not set a price for therapy or guarantee that a particular therapist is in network.
Which plans are covered
According to CMS, the federal parity rules apply to private employer plans and state and local government plans with more than 50 employees, and to individual-market coverage. Small-employer plans are covered indirectly through the essential health benefit rules.
Who enforces the rules depends on how the plan is funded. CMS explains that insurance purchased from an insurer is regulated by the state's insurance department, while self-funded employer plans (where the employer pays claims directly, often with an insurance company handling administration) are regulated by the U.S. Department of Labor. Your plan administrator or HR office can tell you which kind you have, and it is worth asking, because it decides where you complain.
Medicare and Medicaid are public programs rather than group health plans, but CMS notes that Medicaid managed care plans must meet certain parity requirements. Mental Health Care With Medicaid or the Healthy Michigan Plan and Does Medicare Cover Therapy for Anxiety and Depression? cover those programs.
Michigan's own parity law
Michigan wrote parity into state law in 2024. The statute, MCL 500.3406hh, took effect on April 2, 2025. It requires an insurer that issues or renews a health insurance policy in Michigan to provide coverage for mental health and substance use disorder services, and it adopts the same core tests as federal law: copays, coinsurance, deductibles, out-of-pocket maximums and visit limits must be no more restrictive than for medical and surgical care, and nonquantitative limits must be comparable and applied no more strictly. The law also says benefits must meet all applicable federal parity requirements.
Michigan's Department of Insurance and Financial Services (DIFS) described the change as requiring health insurers to cover mental health and substance use treatment at the same level as physical health services. Because the law applies to insurance policies, people in self-funded employer plans should look to the federal rules and the Department of Labor.
The 2024 federal rule and its status
In September 2024, the U.S. Departments of Labor, Health and Human Services and the Treasury issued new MHPAEA rules that added data collection requirements and more detail on comparative analyses. In May 2025, the three departments announced they would not enforce the parts of that rule that are new compared with the 2013 rule while they reconsider it, until a court case challenging it is decided plus 18 months.
As of November 2026, that non-enforcement policy is the latest primary statement this guide could confirm. The departments also stressed that MHPAEA's statutory obligations, including the 2020 comparative analysis requirement, continue to apply. In practice, the core protections described above still stand.
Signs a plan may not be following parity
- A higher copay or coinsurance for therapy than for a comparable medical specialist visit
- A cap on therapy visits with no similar cap on medical visits
- Prior authorization for routine outpatient therapy when comparable medical visits need none
- A separate deductible that only applies to mental health
- A network so thin that you cannot find an in-network therapist within a reasonable time, while medical networks are much fuller
None of these is automatically a violation, because plans can have legitimate reasons. But each is worth asking about in writing.
What to do if you think a plan is out of line
- Ask the plan in writing to explain the limit and how it compares with the rules for medical care.
- File an internal appeal of any denial within the deadline on your notice.
- For state-regulated insurance, contact DIFS at 877-999-6442 (Monday through Friday, 8 a.m. to 5 p.m.) or file a complaint online, and ask about a free external review after a final denial.
- For self-funded employer plans, CMS points people to a Department of Labor benefits advisor at 1-866-444-3272.
- CMS also runs a parity help line at 1-877-267-2323, extension 6-1565.
If you are using a Blue Cross plan, Using Blue Cross Blue Shield of Michigan for Therapy explains where to look up your mental health benefits. Knowing your rights can make it easier to start therapy for anxiety or depression without being surprised by the bill.