Rehab Under Obamacare: The Costs of Recovery with the Affordable Care Act

recovering with obamacare

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The Affordable Care Act, also known as “Obamacare,” requires that health insurance providers cover addiction treatment and recovery programs.

This means that by signing up for health insurance, one can receive financial assistance in recovering from drug and alcohol addiction.

What is the Affordable Care Act, AKA 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 insurance providers to include a number of basic healthcare benefits in every plan.
The 10 essential health benefits covered by Obamacare include:

  1. Outpatient care
  2. Emergency room visits
  3. Inpatient care (hospital stays)
  4. Maternity and newborn care
  5. Mental health and substance use disorder services (includes behavioral health treatment, counseling, and psychotherapy)
  6. Prescription drugs
  7. 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.
  8. Laboratory tests
  9. Preventive services i.e. counseling, screenings, vaccines, etc.
  10. Pediatric services (includes dental care and vision care for kids)
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What Does the Affordable Care Act Mean for Those Seeking Addiction Treatment?

In the past, addiction was thought to be a moral defect representing a lack of self-control; anyone who was addicted to alcohol or drugs was either a “bad person” or a “weak-willed.” Either way, this line of thought made it easy for insurance 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 his or her 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 completely out-of-pocket if they want to enter a drug and alcohol rehab facility.

What Does the Affordable Care Act Mean for Those Seeking Addiction Treatment

What elements of drug and alcohol addiction treatment do insurance plans under the ACA cover?

Inpatient and residential treatment

  • Inpatient treatment centers
  • Half-way houses

Partial hospitalization programs

Individual counseling

  • Cognitive Behavioral Therapy (CBT)
  • Contingency Management (CM)
  • Motivational Enhancement Therapy (MET)

Intensive Outpatient Programs (IOP)

Medication

  • To help a person detox
  • To reduce withdrawal symptoms
  • To help maintain sobriety/prevent relapse

Group counseling

Assertive Continuing Care (ACC)—often used to help adolescents

Mutual help groups

  • 12-Step fellowships (Alcoholics Anonymous, Narcotics Anonymous)
  • Peer support communities (Recovery community centers, Recovery high schools)
  • Case or care management

How to find a rehab center that accepts plans from Marketplace providers under the Affordable Care Act?

Many rehabilitation centers accept Health Insurance Marketplace plans. If there is a specific place one wants to go for inpatient rehabilitation or a specific counseling center one would like to attend for outpatient treatment, speak with a Health Insurance Marketplace agent, which can provide the additional information about best options.

Another good resource for government-mandated treatment facilities is https://www.samhsa.gov/.

How does paying for rehab work with the ACA?

There are four “metal” categories for plans developed under the Affordable Care Act.

The bronze plans offer the most inexpensive monthly premiums but cover less than the others. Like any insurance plan, the higher the premium the better the coverage.

  • Bronze—

Monthly premium: lowest
Coverage: own 40% | insurance 60%

  • Silver—

Monthly premium: lowest
Coverage: own 40% | insurance 60%

  • Gold—

Monthly premium: lowest
Coverage: own 40% | insurance 60%

  • Platinum—

Monthly premium: lowest
Coverage: own 40% | insurance 60%

An Obamacare Bronze plan may be the best option for someone who was a relatively healthy individual before his or her addiction and wants to attend a lower-cost rehab facility.

An Obamacare Silver Plan is a great 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 one has will determine what rehab centers one can go to. If one already has a place or two in mind, ask the facilities what types of insurance 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 full price for the treatment.
  • If one has an HMO (Health Maintenance Organization) plan, insurance will typically only cover rehab centers that are “in-network”; these plans are more geared toward providing prevention and wellness services, and so would not provide 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 “Obamacare” as this was one of the major goals of the ACA—to make health insurance accessible to everyone. Many people who have insurance 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:

1) get the minimum essential coverage through the Health Insurance Marketplace

2) pay a “shared-responsibility fee” on their federal taxes for each month they go without coverage. Exemptions from this fee are available but must be applied for.

How can one 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 that can 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 does one apply for health insurance on the exchange?

If one lives in a state that does not have its own health insurance exchange set up, one can visit https://www.healthcare.gov/ to apply for health insurance.

The following states currently have their own exchanges and therefore, different application sites. Links to the different state exchanges may be found at https://www.healthcare.gov/marketplace-in-your-state/.

Why should one use Obamacare insurance to pay for rehab?

The simple answer to this question is: because one can.

It is unrealistic to expect most Americans, especially addicts, to

1) have the means to receive treatment out-of-pocket

2) to be motivated enough to seek treatment if it costs thousands or tens of thousands of dollars to do so.

Applying for health insurance can be a tedious process, however addicted person will spend more on addiction than what one would paid for health insurance. Put the money toward something that will enhance the quality of life, not destroy it, and take advantage of plan’s benefits in order to get help with addiction.

View Sources
  1. https://www.samhsa.gov/
  2. https://www.healthcare.gov/lower-costs/
  3. https://www.healthcare.gov/
  4. https://www.healthcare.gov/marketplace-in-your-state/

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