Are you, or some you know, struggling with addiction. It can be difficult to know where to turn. Perhaps you want things to get better and you’re ready to take the next step towards healing, but you’re wondering: Does my insurance through the marketplace help with drug and alcohol treatment? How much will I have to pay? Does The Affordable Care Act require insurance companies to cover children with addiction issues?

Here, we’ll explore:

  • Government statistics on addiction in the U.S.
  • How The Affordable Care Act has changed insurance planning.
  • Obamacare coverage for adults with Substance Use Disorder (SUD).
  • Obamacare coverage for children with substance abuse issues.
  • Treatment options requiring prior authorization.
  • Possible out-of-pocket expenses.

Addiction asks no questions and only takes hostages. It can affect individuals of any sex, age, race, nationality, sexual orientation, gender expression or religion. And if left to its own devices, addiction can rip families apart.

Addiction in the United States

According to reports of the Center for Disease Control (CDC), starting around age 12, a shocking 10% of individuals have used unlawful substances within the last month. The government organization responsible for reporting on addiction trends, known as SAMHSA, announces that:

  • More than 20 million people meet the criteria for a chemical dependency disorder
  • This amounts to nearly 1 in 12 adults within the U.S.
  • 7.7 million people are living with a mental disorder that co-exists with chemical dependency issues

Based on these statistics, there is a high likelihood that you or a loved one will face a situation ravaged by addiction at some time in life. Understanding what your insurance covers is one of the most important steps on the road to recovery.

SAMHSA projects that the 2014 allocation of chemical dependency costs were:

  • nearly 18% for private insurance
  • 20% for Medicaid coverage
  • about 15% for additional Federal funds
  • 45% at the state and local levels
  • 5% for Medicare coverage

How The Affordable Care Act Has Changed Insurance Planning

The 2010 Affordable Care Act (ACA), also called health care reform or “ObamaCare,” made certain demands of insurances on what they are required to cover in substance abuse treatment. This Act holds many provisions to decrease healthcare costs, improve the quality and extend coverage in particular areas.

The ACA has:

  • increased the amount of people covered by Medicaid and private insurance.
  • extended substance abuse coverage under Medicaid and private insurance.
  • changed the relationships between substance abuse professionals, payers  and addiction patients through coordinating care, integrated care and mutual savings and liability.

With its requirement that all Americans, with very few exceptions, have health insurance or suffer a monetary consequence, the ACA attempts to help distribute the costs and help individuals with little to no means to pay for life-saving operations or other medical attention.

Through the 2008 Mental Health Parity and Addiction Equity Act, commonly referred to as the Parity Act, the ACA will extend behavioral health coverage for nearly 62.6 million individuals before 2021.  With the aid of this Act, the ACA dramatically affects substance abuse treatment In the U.S.

Obamacare Rehab Coverage for Adults

Most addiction facilities accept insurance plans from the Health Insurance Marketplace. The ACA has prompted providers to build innovated approaches to offer high quality, but with lower costs. This entails bundling packages of services.

For states compliant with ACA, insurance providers typically cover:

  • Regular assessments for substance dependency or abuse.
  • Medically supervised detoxification.
  • Short- or long-term residential treatment at select facilities.
  • Outpatient support and resources.
  • Medications to promote abstinence from mood-altering substances.
  • Family interventions.
  • Sobriety maintenance and relapse prevention support programs.

Under ACA, all insurance plans must include:

  • Chemical dependency treatment as deemed medically necessary.
  • In-patient services addressing behavioral and mental health.
  • Some form of addiction counseling that varies with each insurance plan.

Obamacare Coverage for Children

The ACA has also impacted substance abuse treatment for adolescents. Many of the outpatient treatment options usually covered by insurance plans through the market place include:

  • One-on-one counseling to address personal issues or trauma.
  • Group and family therapy.
  • “Day treatment” during the school day.
  • Case management.
  • Psychiatric evaluations and medication management.

Prior Authorization

Prior authorization means that the addiction treatment must be considered medically necessary, and this requirement is dependent upon the specific plan you have. In prior authorization, a medical evaluation and professional recommendations are obtained and sent to your insurance company that tell you how much they will cover.

Out-of-pocket Expenses

This is the amount of money you’ll be responsible for, in addition to what your insurance covers. This may include:

  • Co-payments
  • Deductibles
  • Additional fees from the select facility

It is important to know what kind of insurance plan you have in order to move forward with treatment.

Questions and Concerns

Insurance coverage, out-of-pocket expenses, and any restrictions are dependent upon your specific plan. We at Adrugrehab.org understand that this can be a difficult road to maneuver, and we are here to help you choose the treatment that’s right for your situation. We provide a free, 24/7 national helpline staffed with licensed counselors offering confidential referrals. Give us a call, and let us extend a helping hand!