Does Health Insurance Cover Addiction Treatment?

health insurance

Anytime you’re considering inpatient or outpatient admission for treatment — from heart surgery to pain therapy to medically assisted drug detox — it’s natural to worry about the financial aspects of treatment.

At The Outpatient Treatment Center, we encourage anyone who is dealing with substance abuse or addiction to reach out for professional help regardless of their financial situation. Admissions counselors can help you understand the many options for covering treatment, and putting off seeking help because of financial worries often only makes the situation worse. Instead of fretting about finances and possibly leaving yourself open for more dangerous use — or health or legal issues — take action to find out more about treatment now.

It’s also a good idea to educate yourself about what types of treatments are covered under your health insurance policy. As of 2017, the Affordable Care Act does ensure that if you have an approved plan, you have access to coverage for both mental health and substance abuse treatment.

Addiction Treatment Coverage and the Affordable Care Act

The Affordable Care Act puts some requirements on insurance plans and what they cover. Prior to the ACA, insurance companies were allowed to offer policies that didn’t include certain types of coverage; often, plans would sell policies with so-called medical-only coverage, so if someone needed treatment for behavioral or chemical dependency diagnoses, they didn’t have any coverage to assist with payment.

Now, any insurance that is sold via the state or federal marketplaces must comply with the ACA regulations. That means that the plan must offer coverage for behavioral health, mental health and substance use disorder treatments. That can include inpatient and outpatient services as well as individual or group counseling, among other options.

The ACA also mandates that preexisting mental health and chemical dependency issues must be covered. That means that if you were treated before, regardless of when, and you have an ACA-approved health insurance plan, the plan can’t deny coverage based on your previous treatment.

Will Medicare or Medicaid Cover Substance Abuse Treatment?

In some cases, Medicare or Medicaid will pay for substance abuse treatment, with some caveats. Medicare coverage kicks in if documentation shows that the treatment is medically necessary. The treatment also has to be conducted in an inpatient or outpatient facility that is certified by Medicare.

Health Insurance Cost - Addiction Treatment

Understanding Protections Under the MHPAEA

In 2008, the federal government passed the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). Under that act, any health insurance plan that included mental health or substance abuse coverage had to do so with equality to the other coverages under the plan. The act stopped insurers from offering coverage for addiction or mental health treatment while limiting that coverage in ways that they didn’t limit medical coverage.

This requirement is still present under the ACA — in fact, insurers are allowed even less room for limitation. Coverage for essential health benefits can’t be capped via lifetime or annual maximums. This is an important considering when dealing with chronic illnesses — which addiction can be. While treatment, education and the development of strong coping mechanisms may lead to a healthy, stable future, drug or alcohol addiction is not something that can be cured and it’s reassuring to know that you always have help covering necessary treatment.

Finding Out About Your Insurance Coverage

If you or someone in your family is struggling with a substance abuse disorder, don’t sweep it under the rug because you’re worried about the financial aspect. Ignoring a problem rarely helps anyone, and acting now to find out about your insurance coverage and what options you have for treatment can actually provide some peace of mind.

Here are some steps you can take now to find out if substance abuse treatment is covered under your plan.

  • Sign into your insurance policy’s web portal and look for a section on benefits to read about your coverage
  • Review any welcome package or other policy documentation that was sent to you when you signed up for the insurance
  • If appropriate, speak to the benefits specialist in your employer’s HR department
  • Call your insurance provider and ask to speak with a benefits specialist or case manager

In addition to your health insurance plan, you might look into coverage from employer-sponsored funds, a health savings plan and community assistance programs. Substance abuse counselors are usually aware of some of these programs and can provide literature or contact information for applications.

If you’re not sure where to turn or what questions to ask first, simply call The Outpatient Treatment Center. Our admissions counselors are ready to take your call, and we’re experienced in assisting patients with all types of financial situations and insurance coverage. We can work with your insurance company to verify benefits and help you understand what treatment might be covered. Call Now (844)211-7944.