Millions of Americans have drug addictions that require treatment, but until recent years, drug rehab and other treatments often resulted in high out-of-pocket costs, making them inaccessible for many. In fact, only approximately 11 percent of the nearly 22 million Americans who need substance use treatment receive it, according to the Substance Abuse and Mental Health Services Administration’s (SAMHSA) latest National Survey on Drug Use and Health. Improvements in substance abuse healthcare have been made which means you may have access to more treatment options under current laws.
Is drug addiction a pre-existing condition?
Drug addiction is a pre-existing condition. In the past, insurance companies used this as a reason to deny people health insurance. Therefore, when someone was going through drug addiction treatment, they typically had limits on what would be covered. Now, thanks to the Affordable Care Act (ACA), or Obamacare, most health insurance companies can no longer use a pre-existing condition as a reason to deny someone healthcare coverage.
The reason it’s most insurance companies and not all of them is that there are still grandfathered health insurance plans, which do not offer ACA protections like coverage for those with pre-existing conditions. If you are on one of these plans and you want the protections offered by Obamacare, you can switch to a Marketplace plan during Open Enrollment or when you qualify for a Special Enrollment Period once your grandfathered plan ends.
Is treatment for drug addiction covered under Obamacare?
Yes. One of the provisions of Obamacare is that insurance plans must cover 10 categories of essential health benefits. One of these is mental health and substance use disorder services. Coverage for treatment of all pre-existing conditions, substance use disorder or otherwise, is effective the day your plan starts. In addition, plans offered in health insurance Marketplaces can’t put a maximum coverage amount on substance use disorder services.
Marketplace plans must also have parity protections for mental health and substance abuse services. This means that plans cannot apply stricter limits to mental health and substance abuse services than they do to medical and surgical services. For example, you can’t be forced to get authorization before receiving treatment or be limited to a certain number of visits for your mental health and substance use disorder treatments if comparative rules aren’t set for medical and surgical services. The same applies to financial aspects such as copayments and out-of-pocket maximums.
What sort of drug addiction treatment is covered by Obamacare?
The exact type and amount of substance use disorder treatment coverage depend on your state and your plan. In most cases, counseling, outpatient services, medication, and inpatient rehab are covered by insurance on at least a partial basis.
You can find a treatment center via this SAMHSA tool. Make sure to double check with your health insurance company to ensure your chosen healthcare provider or facility is covered and to understand what types of services are included in your plan.