Not long ago, insurance companies were allowed to deny substance use disorder patients the help they needed. Drug or alcohol dependency was considered a pre-existing condition. For millions, the Affordable Care Act (ACA), a law enacted in March 2010, was the first opportunity at mental and substance use disorder treatment. The ACA made addiction treatment insurance coverage possible with the hopes that of the 23 million Americans suffering from alcohol or drug addiction, more will seek the help they need. (1)
The ACA made health insurance available to everyone – even those with no or low-paying jobs. It also eliminated the insurance company’s ability to place a limit on the amount of money they would spend on an individual consumer.
What Is The Affordable Care Act?
President Barack Obama signed the Affordable Care Act into law in 2010. While designing the comprehensive health care reform law, the goal was to make health insurance more affordable for all Americans. They also wanted to expand the Medicaid program and lower the cost of health care.
One of the most significant changes took effect in 2014 when services for the insured included substance use disorder. More individuals battling drug and alcohol dependency are finally able to access the help they need.
According to a White House press release (2), “The ACA increases the number of people who will be eligible for health care under Medicaid in 2014. Some of whom may need intervention and treatment services for substance use disorders.”
Essential Health Benefits
Substance use disorder has always been considered a pre-existing condition. But the ACA eliminated that reasoning from why a person is denied coverage. The law mandated insurance companies cover ten categories of essential health benefits (3):
- Ambulatory patient services
- Emergency services
- Hospitalization (like surgery and overnight stays)
- Pregnancy, maternity, and newborn care (both before and after birth)
- Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
- Prescription drugs
- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)
Insurance companies must provide addiction treatment insurance coverage. In turn, they have lost the right to limit the amount of treatment made available to those battling drug or alcohol use disorder. The insurers cannot apply more stringent limits to substance abuse or mental health services than they do surgical or medical services. For example, the insurance company can’t mandate that you get approval before seeking substance use disorder treatment if they don’t require the same for medical and surgical procedures. The same is true for the financial side of coverage. Those seeking treatment for drug or alcohol addiction can’t pay a higher copayment or out-of-pocket amount than they would for a medical or surgical procedure.
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ACA And Addiction Treatment Availability
When you enter a California drug and alcohol rehab facility under ACA coverage, you are eligible for:
- Addiction evaluation
- Addiction treatment medication
- Alcohol and drug testing
- Anti-craving medication
- Brief intervention
- Clinic visits
- Family counseling
- Home health visits
Addiction treatment insurance coverage under the ACA also covers inpatient treatments like medical detox programs.
How To Obtain Addiction Treatment Insurance Coverage
Affordable Care Act open enrollment extends through mid-December. By entering your basic information at Healthcare.gov (4), you can discover how much money you can save on health insurance and obtain the coverage you need for addiction treatment insurance coverage.
All plans on the marketplace must cover mental and behavioral health inpatient services and substance use disorder treatment, although your specific health benefits will depend on the health plan you choose.
Am I Eligible For Addiction Treatment Insurance Coverage?
Eligibility for Marketplace health coverage requires that you live in the United States, are a U.S. citizen or national (or be lawfully present), and not be in prison. Coverage cost (5) under the ACA will be determined by five factors: the plan you choose, your age, income, location, and family size.
Treatment for substance use disorder has become more available for those in need. However, regulations under the ACA also mean people using drugs or alcohol may continue to shuffle in and out of treatment. Between 40 to 60 percent of people who’ve sought treatment for addiction or alcoholism relapse within a year, and treatment is expensive. (6)
According to The New Yorker (7), “a month of inpatient rehab can cost tens of thousands of dollars; in the past, this kind of treatment was mostly limited to the wealthy. The ACA made it easier for the owners of treatment centers to bill insurers, and rehab, suddenly democratic, fell within reach of the well-insured middle class and its children.”
Reach Out For Help Today
Although relapse is common, it isn’t inevitable. At Ocean Hills Recovery, patients and staff will work to create a custom treatment plan to meet their needs specifically. The drug and alcohol treatment center programs available to patients are evaluated until the right fit is made. For some, addiction treatment programs will be beneficial. For others, 12-step recovery or inpatient residential treatment can be partnered with holistic treatment options to create a personalized plan.
The Affordable Care Act put a spotlight on the need for substance use disorder treatment for everyone. Access to a quality drug rehab facility in California shouldn’t be reliant on a certain income or socioeconomic status. The ACA creates an opportunity for all to receive quality care when overcoming a drug or alcohol dependency.
Get Help with Addiction Treatment Insurance Coverage
The experienced staff at Ocean Hills Recovery can help you understand how your health insurance works with substance use disorder treatment. The ACA means you or your loved one don’t have to depend on subpar care or suffer through substance dependency. Contact the Ocean Hills Recovery team today to explore your treatment options.
About the author:
Nicole earned her doctoral degree in Psychology with an emphasis on marriage and family therapy at California School of Professional Psychology. Her doctoral thesis was a grounded theory study exploring the role of alienation and connectedness in the life course of addiction. She specializes in treating addiction and trauma. She is certified in DBT and EMDR, two of the most highly regarded evidence-based methods in psychotherapy. Dr. Doss is a strong LGBT advocate and provides open and affirming support to her LGBT clients.
Dr. Doss’s earlier education included graduating cum laude from the University of California, Irvine in June of 2007 with a Bachelor’s degree in Psychology. While there, she received honors recognition by Psi Chi and Golden Key honor societies.
Nicole has been working with alcoholics and addicts in our California drug and alcohol rehab center as an advisor and counselor for many years. She is passionate about providing quality counseling and care to her clients. Her main focus is on integrating the 12 Step and disease models of addiction with experiential therapeutic theory. She is married to Greg; they have two adorable sons together and an energetic yellow Labrador Retriever.