If you have health insurance, there’s good news. Since alcohol use disorder and substance use disorder are both recognized as diseases by the American Medical Association, the Affordable Care Act (ACA) now requires that some of your substance use disorder treatment will be covered, no matter your insurance plan.1 This includes private health plans or a plan through your employer, “Obamacare” plans sponsored by your state, or public insurance like Medicare or Medicaid.
While all plans now must include substance use disorder care as part of the benefits covered, each plan has different rules about which benefits are included, and what the patient’s share of the cost will be.
Substance Use Treatment and the Law
Healthcare insurance providers are required to offer coverage for substance use disorders and mental health issues under the Affordable Care Act of 2010, which stated that this kind of treatment is included as ‘Essential Health Benefits.'2 The Mental Health Parity and Addiction Equity Act, passed in 2008, mandates that coverage for mental health and substance use benefits be equal to coverage for medical and surgical benefits.3 Combined, these two laws establish that insurance companies must cover mental health and substance use under all insurance plans, and that plans must do so in a way that’s comparable to the coverage they offer for physical medical issues.4 Mental health issues and substance use disorders must be taken just as seriously as heart disease or cancer and any restrictions on coverage must be comparable to restrictions on other diseases. These laws also prevent insurance companies from refusing to provide coverage for pre-existing conditions, including substance use. Both public and private insurance companies must comply with these laws.
The Affordable Care Act requires all Americans to have health insurance—either through Medicaid/Medicare, through the Healthcare Exchange, or through a private insurance company.
Navigating treatment options can be challenging
Sponsored by the government, Medicaid and Medicare are insurance programs for which you can apply if you meet certain qualifications. Medicare is available to adults over the age of 65 or to some adults on Social Security Disability, while Medicaid may be available to low-income adults, families, children, and the elderly. After the Affordable Health Care Act was passed, 30 states expanded Medicaid options so that it’s now available for low-income adults.
All state Medicaid and Medicare programs are required to cover some treatments for substance use disorder. To receive these benefits, you must select a treatment facility that accepts Medicare or Medicaid, and you may be required to pay a copayment or to meet a deductible before your coverage kicks in. Benefits often include the initial assessment, some form of detoxification at an inpatient or outpatient facility, medication, and partial hospitalization, but your specific coverage depends upon your state.5 Contact Medicare or Medicaid for more information.
Healthcare Exchange/Public Insurance (Obamacare)
The Health Insurance Marketplace—what many people refer to as "Obamacare"—is an exchange where you can apply for health insurance organized by your state. Depending on your income level, you may be eligible for federal credits to help with the price of this insurance.
Healthcare.gov, the Federal Government’s health care website, says all marketplace plans must cover mental health and substance abuse services as one of 10 “Essential Health Benefits.”6 This coverage includes:
- Behavioral treatments like psychotherapy and counseling
- Mental and behavioral health inpatient services
- Substance use disorder treatment
Pre-existing medical conditions—including substance use or mental health issues—must be covered, and yearly or lifetime dollar limits are not allowed for these Essential Health Benefits.7
Benefits vary from state to state and based on the plan you choose in the marketplace, but all state insurance plans offered by the Healthcare Exchange cover some benefits for substance use disorder treatment, and many include the initial assessment, detoxification, and outpatient care. You may be responsible for copayments or a deductible to receive this care, so contact your insurance company for more details.
If you receive health insurance coverage from your employer, or you purchase your insurance without any help from the government, you have private insurance. Except in the case of selected "grandfathered" plans, all insurers must cover some benefits for substance use disorder under the Affordable Care Act of 2010. Benefits may include assessment, detoxification, medication, inpatient and outpatient services, and ongoing therapy. Like public plans, copayments and deductibles may apply based on your specific plan.
To find out how extensive your substance use disorder treatment benefits are, contact your health insurance company or your employer’s human resources department. They can give you specific information about your deductibles and copayments, which treatment providers accept your plan, and estimates for your out-of-pocket expenses.
If worries about money are stopping you from seeking treatment, get information about free substance use treatments, grants, financial aid, and other resources that can help with payment so you can get the treatment you need.What are my options?
In most cases, your health insurance will cover at least some of the costs of your substance use disorder treatment. To find a facility that accepts your insurance, contact your insurance provider, or check out the Substance Abuse and Mental Health Services Administration’s (SAMSHA) Behavioral Health Treatment Services Locator. In addition to showing treatment services, this site also provides payment information, sliding scale fees, and options for payment assistance.
If worries about money are stopping you from seeking treatment, please review the section When You Have No Insurance for information about free substance use treatments, grants, financial aid, and other resources that can help with payment so you can get the treatment you need.