Although there’s much controversy surrounding the law, the Affordable Care Act is creating real changes in the coverage of addiction recovery services.
Nearly 23 million Americans suffer from drug or alcohol addiction, but only two million are currently receiving treatment. In many cases, this is due to a lack of treatment options or the inability to afford these services.
But with the provisions made under President Obama’s Affordable Care Act (ACA), more Americans will have access to health care plans that cover addiction treatment programs.
Parts of the health care law have been gradually implemented since the legislation passed in 2008. But most of the major provisions took effect in 2014 – such as when people began receiving health insurance coverage through the marketplace.
Although there’s much controversy surrounding the law (and endless efforts to repeal), the fact of the matter is that the Affordable Care Act is creating real changes in the coverage of addiction recovery services.
Does The Affordable Care Act Cover Addiction Services?
In short, yes. The Affordable Care Act does cover addiction recovery services such as rehab and detox.
Under the Affordable Care Act, ten essential health benefits must be offered at no dollar limits on every health plan.
Addiction treatment – as well as mental health services – are covered under these benefits, allowing many individuals who previously did not have access to these services to go to rehab and receive the treatment they need.
But there are some restrictions.
What’s Covered Under The Affordable Care Act?
Under the ACA, addiction is no longer considered a pre-existing condition for insurance purposes. Additionally, coverage for addiction treatment must be as complete as it is for any other procedure. Some of the services covered include:
- Clinic visits
- Family counseling
- Brief interventions
- Home health visits
- Addiction evaluations
- Anti-craving medication
- Alcohol and drug testing
- Addiction treatment medication
Previously, many addicts only received treatment services once they hit rock bottom because, at that point, it was necessary.
Now, the Affordable Care Act treats addiction like any other disease: with prevention, early intervention, and several options when it comes to care. This means more medical screenings, educational campaigns, and community prevention activities centered around drug and alcohol addiction.
Although insurance policies cover many addiction-related services, there are still out-of-pocket costs on most plans. The amount you owe depends on your plan, which is why it’s so important to check with your insurer about doctors in your network, treatment coverage, allowed dollar amounts and the allowed number of times you can use a service.
Parity Protections For Addiction Services
The Paul Wellstone and Pete Domenici Mental Health Parity And Addiction Equality Act of 2008 (MHPAEA) is a federal law that prevents group health plans and health insurance issuers that provide mental health or substance abuse benefits from imposing less favorable benefit limitations on those benefits than on medical and surgical benefits.
MHPAEA initially applied to group health plans and health insurance coverage. It was amended by the Affordable Care Act to apply to individual health insurance coverage, the marketplace exchange, and Medicaid insurance programs.
In other words, limits applied to mental health and substance abuse services can’t be more restrictive than limits applied to medical and surgical services.
The kinds of limits covered by the parity protections include:
- Financial: Deductibles, copayments, coinsurance and out-of-pocket limits
- Treatment: Limits to the number of days or visits covered
- Care management: Requirements to get authorization of treatment before receiving the service
What The Affordable Care Act Doesn’t Fix
The Affordable Care Act significantly improves the substance abuse landscape by providing addicts with greater access to addiction treatment programs. However, the Act doesn’t ensure high-quality services and care for those struggling with substance abuse disorders.
Some research shows that nearly 90% of people who enter addiction treatment programs in the United States aren’t receiving evidence-based treatment, the type of therapy that’s proven to be the most effective.
Instead, they receive “treatments” rooted in the idea that addicts are weak and narcissistic, and therefore, they must accept that they’re powerless over their addiction.
Many treatment programs reject scientific evidence, which is detrimental to treating such a deadly disease.
The quality of care and treatment is one of the most important factors in recovery. Scientists have identified best practices for treating addiction – a combination of behavioral, pharmacological and psychological therapies.
Many experts argue that insurance plans should only cover programs that offer these services to avoid addicts receiving inadequate treatment for their disease.
Despite the challenges, the Affordable Care Act and its associated regulations are making a tremendous difference, especially among populations disproportionately affected by substance abuse.
One of the most important changes may come from its larger philosophical changes as President Obama’s health care reform act defines addiction as a medical issue rather than the result of poor morals or a criminal justice problem.
This is helping remove the stigma around mental health and substance abuse and may even pave the way for greater changes in the future.
The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.