The last thing you want to think about when you’re trying to get treatment for a substance use disorder for yourself or for someone you love is how much it’s going to cost. Figuring out the financial aspects of treatment—from what’s covered, to which hoops you may need to jump through to get it—can add another layer of stress to an already-stressful process. In this section, we’ve tried to make it easier, offering information about how insurance coverage for substance use treatment usually works.
The Affordable Care Act (ACA) opened up insurance options for many Americans and created some benefits for those seeking treatment for an addiction. “Mental health services and addiction treatment” is classified as one of 10 Essential Health Benefits (or EHBs) defined in the ACA,1 which means it must be covered by all plans with no dollar limits. Insurance companies can no longer deny coverage for pre-existing conditions, and mental health and substance use disorder care must be treated in the same way as benefits for other physical health issues. This means costs for doctors visits—for mental health treatment or a physical issue—must be the same, and any caps on your coverage must be the same for both types of treatment.
If you have health insurance, it can still be overwhelming to figure out exactly how it works and exactly what’s covered. In Treatment Options Covered by Insurance, we walk you through the basics of what to ask your insurance provider to find out what substance use treatment benefits are available with your plan—including questions about copayments and deductibles so you’ll know what you have to pay. We also provide an overview of each stage of treatment and what insurance companies generally cover.
If you do not have health insurance, you’re probably eligible for coverage, whether it’s through Medicare/Medicaid, the Affordable Care Act Health Exchange, or a policy offered by your employer. The Insurance Options section provides a rundown on what’s available, and what each kind of insurance covers when it comes to treatment for substance use.
If for some reason insurance is not an option, there are many resources available to help you finance a substance use treatment program, from scholarships and loans to sliding scale programs and payment plans. There are even free community resources that can provide treatment. Learn more about what’s available in the section When You Have No Insurance.
Nothing should stand in the way of seeking treatment for a substance use disorder. There are always options, and there are many organizations ready to offer information and assistance. Use this information as a starting point to find the financial resources you need to start treatment—and start the journey toward recovery.