If you are looking into rehabilitation for yourself or a loved one with a drug/alcohol problem, you may be wondering: will health insurance cover treatment? The cost of treatment is always aÂ top concern, and unfortunately it prevents too many people from getting the help they need.
Health Insurance & Treatment
The unfortunate thing about insurance is that many people find it difficult to understand and navigate through. But don’t let thisÂ prevent youÂ from getting the help you so desperately need.Â You may be eligible for treatment through or outside of your provider, andÂ substance abuse treatment may even be part of your coverage without you knowing about it!
The Mental Health Parity and Addiction Equity Act
Until theÂ Mental Health Parity Act (MHPA)Â of 1996, access to mental health (including addiction) treatment was extremely limited because healthcare providers were not required to cover it. The ActÂ mandatedÂ that benefits for mental health be equal to any other coverage, but most insurers circumvented these requirements through deductibles and out-of-pocket expenses.
In 2008, theÂ Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) remedied these loopholes by requiringÂ both insurers andÂ group plans to mental health benefits equally to surgical and medical benefitsÂ with regard to:
- Out-of-pocket maximums
- Limitations on all benefits
What You Should Know About the MHPAEA
- Only applies to plans ofÂ employers with 50+ employees
- Requires parity forÂ bothÂ annual limitsÂ andÂ lifetime benefits
- Includes out-of-network benefits
- ONLY APPLIES TO INSURERS WHO OFFER BOTH:
- Medical & Surgical Benefits
- Mental Health & Substance Abuse Treatment Benefits
The Patient Protection & Affordable Care Act
The Patient Protection and Affordable Care Act (the “ACA,” commonly referred to as “Obamacare”) went into effect in 2010. In 2014, its government Health Insurance Exchange launched, stipulating that plans soldÂ on the exchange include 10 essential benefits The category of “Mental Health and Substance Use Disorders” is one of those ten, which means any plan obtained through the exchange must offer benefits in this area.
What You Should Know About the ACA
- The ACA also expands Medicaid eligibility, giving low-income addicts more access to treatment
- ONLY APPLIES TO THESE HEALTHCARE PLANS:
- Plans sold on the healthcare exchange
- Medicaid plans
- DOES NOT stipulate the length of treatment, only that the aforementioned plans must provide itÂ â€” most of these plans will only cover residential treatment for 30 days
Options Outside of Insurance
Many people may be surprised to learn that addiction treatment is part of their benefits. It is always worthwhile to do your homework and know the facts â€” insurance almost never wants to pay for treatment, but don’t accept NO for an answer if you can!
Unfortunately, there are still those who cannot access treatment, even with the help that the MHPAEA and ACA provide. Outside of insurance, you may still have options for getting treatment and recovering from addiction. Explore some of these alternatives:
- Sliding ScalesÂ â€“ ManyÂ treatmentÂ centers offer sliding scalesÂ for lower-income patients, basing your out-of-pocket cost on your income.
- Scholarships/SubsidiesÂ â€“ Believe it or not, some will actually offer to “scholarship” (subsidize) part or all of your stay.
- Non-Profits â€“ Non-profit organizations are another avenue to explore. Religious groups run their own cost-free rehabilitation programs all across the country.
- State-Run TreatmentÂ â€“ There are also free or low-costÂ facilities run by the federal, state or local governments. They are especially widespread in areas where addiction is a major public health problem.
- FinancingÂ â€“Â Finally, there are financing options availableÂ in the form of debt, credit, etc.