The ACA, also known as “Obamacare,” requires that health insurance providers cover addiction treatment and recovery programs. It means that by signing up for medical insurance, one can receive financial assistance in recovering from drug and alcohol addiction.
How much is Obamacare? How much does it cover? And what are the Affordable Care Act pros and cons?
What is Obamacare?
The Patient Protection and Affordable Care Act (PPACA), more commonly known as the Affordable Care Act (ACA), was passed into law in March 2010 by President Barack Obama. The ACA was put into place to make healthcare coverage available to a wider range of people.
The Law Accomplishes This By
- Forbidding insurance providers from denying someone coverage because of age, a pre-existing condition, or other factors
- Charging the same rates regardless of these factors
- Offering discounts and subsidies for low-income families
The ACA also improved the quality and healthcare provided by requiring providers to include a number of essential healthcare benefits in every plan.
The Ten Essential Health Benefits Covered by Obamacare Insurance Include:
- Outpatient care
- Emergency room visits
- Inpatient care (hospital stays)
- Maternity and newborn care
- Mental health and substance use disorder services (includes behavioral health treatment, counseling, and psychotherapy)
- Prescription drugs
- Rehabilitative and habilitative services and devices to help someone who has a chronic condition or has been severely injured, i.e., physical and occupational therapy, speech-language pathology, psychiatric rehabilitation, etc.
- Laboratory tests
- Preventive services, i.e., counseling, screenings, vaccines, etc.
- Pediatric services (includes dental care and vision care for kids)
Affordable Care Act Insurance and Addiction Treatment
In the past, addiction was thought to be a moral defect representing a lack of self-control; anyone addicted to alcohol or drugs was either a “bad person” or a “weak-willed.” Either way, this line of thought made it easy for coverage providers to deny coverage for addiction treatment and rehabilitation.
While the choice to use a substance for the first time is the individual’s own, a person cannot control how their brain reacts to a substance. Obamacare reflects this philosophy in its mandate that all health insurance providers must cover mental health and substance abuse treatments with the same level of coverage as any other physical disease or illness.
The ACA means addicts no longer have to pay entirely out-of-pocket to enter a drug and alcohol rehab facility.
What Does ACA Cover in Addiction Treatment
Substance abuse treatment includes many therapies and approaches. Obamacare insurance aims to cover the essential health benefits and treatments. Therefore the coverage will be limited to the most effective and vital elements of addiction treatment.
The Covered Services Include:
- Inpatient and residential treatment
- Halfway houses
- Partial hospitalization programs
- Individual counseling (CBT, MET)
- Intensive Outpatient Programs (IOP)
- Medication Group counseling
- Assertive Continuing Care (ACC)—often used to help adolescents
- Mutual help groups
Speaking about the Affordable Care Act pros and cons, ACA will not cover many additional therapies like art therapy, yoga for addiction, or acupuncture. For these services, the patient will need to pay out of pocket.
Many rehabilitation centers accept Health Insurance Marketplace plans. If there is a specific place one wants to go for inpatient rehabilitation or a particular center of counseling one would like to attend for outpatient treatment, speak with a Health Insurance Marketplace agent, who can provide additional information about the best options. Another good resource for government-mandated treatment facilities is SAMHSA.
How Much is Obamacare?
The answer will depend on a particular plan. There are four “metal” categories for plans developed under the ACA.
The bronze plans offer the most inexpensive monthly premiums but cover less than the others. Like any plan, the higher the premium, the better the coverage.
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A Bronze plan may be the best option for someone who was a relatively healthy individual before their addiction and wants to attend a lower-cost rehab facility.
The Silver Plan of Affordable Care Act insurance is an excellent choice for low-income individuals seeking to enter a rehabilitation facility who may need coverage for medical services other than addiction treatment now or later on.
An Obamacare Gold or Platinum plan would be a good fit for those who can afford higher premiums and are require medical services and treatments on a fairly regular basis.
The type of Obamacare plan will determine what rehab centers one can go to. If one already has a place or two in mind, ask the facilities what kinds of health plans they accept, and choose a plan accordingly.
- If one has an EPO (Exclusive Provider Organization) plan, insurance will only cover rehab facilities considered to be “in-network.” Otherwise, one must pay the total price for the treatment.
- If one has an HMO (Health Maintenance Organization) plan, ACA will typically only cover rehab centers that are “in-network”; these plans are more geared toward providing prevention and wellness services and would not offer any additional coverage for rehab.
- If one has a POS (Point of Service) plan, out-of-pocket costs for rehab are significantly lower if the facility is an “in-network” provider. However, insurance will cover out-of-network treatment providers if an in-network provider submits a referral for the patient to attend an out-of-network facility.
- If one has a PPO (Preferred Provider Organization) plan, while rehab costs much less if the patient attends an “in-network” facility, patients can also choose an out-of-network rehab center (without a referral) if they are willing to pay a little more.
Who Is Eligible for the ACA?
Everyone is eligible for Affordable Care Act insurance as this was one of the primary goals of the ACA—to make it accessible to everyone. Many people who have coverage with a private provider, either self-purchased or through their employers, can keep their coverage if they so choose. However, those who are not currently insured have two choices:
- Get the minimum essential coverage through the Health Insurance Marketplace
- Pay a “shared responsibility fee” on their federal taxes for each month they go without insurance. Exemptions from this fee are available but must be applied for.
How To Get Cheaper Health Insurance?
When one applies through the federal Health Insurance Marketplace, the website automatically calculates what savings one may be eligible for, such as Medicaid, tax credits, or specific plans to reduce premiums and out-of-pocket costs. If one wants to see what kinds of low-cost plans or other forms of assistance may be eligible for before filling out an application, go to https://www.healthcare.gov/lower-costs/.
How To Apply For It on the Exchange?
If one lives in a state that does not have its own health insurance exchange set up, one can visit the HealthCare.gov website to apply for health insurance.
Some states currently have their exchanges and, therefore, different application sites. Links to the different state exchanges may be found at “The marketplace in your state.”
Using Obamacare Insurance To Pay For Rehab
So can one use ACA insurance to pay for rehabilitation? The simple answer to this question is yes.
It is unrealistic to expect most Americans, especially addicts, to have the means to receive treatment out-of-pocket and to be motivated enough to seek treatment if it costs thousands or tens of thousands of dollars to do so.
Applying for health plans can be a tedious process. However, an addicted person will spend more on addiction than what one would pay for health insurance. Therefore, put the money toward something that will enhance the quality of life, not destroy it, and take advantage of the plan’s benefits to get help with addiction.
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- Substance Abuse and Mental Health Services Administration(SAMHSA) https://www.samhsa.gov/
- HealthCare.gov, The 'metal' categories: Bronze, Silver, Gold & Platinum. https://www.healthcare.gov/choose-a-plan/plans-categories/
- HealthCare.gov, Saving money on health insurance: Income levels & savings. https://www.healthcare.gov/lower-costs/
- HealthCare.gov, The Marketplace in your state. https://www.healthcare.gov/marketplace-in-your-state/