Does Insurance Cover Addiction Treatment Centers?

It is possible to find addiction treatment centers that your insurance will cover. You may also find a low-cost center for which your insurance will provide at least partial coverage. Many Americans are suffering from substance abuse disorders and need help paying for treatment. There are centers which are affordable and covered by your insurance, as a substance use disorder is a serious issue and a complex brain disease which requires treatment.

Affordable Care Act

The Affordable Care Act, which was signed March 23, 2010, has made some major changes to the way addition treatment can be obtained by those who need it. First and foremost, according to the ONDCP, “the ACA includes substance use disorders as one of the ten elements of essential health benefits,” meaning that “all health insurance sold on Health Insurance Exchanges or provided by Medicaid” in 2014 must cover substance abuse treatment as part of services for patients.

As stated by HealthCare.gov, “your specific behavioral health benefits will depend on the state you live in and the particular health plan you choose.” This also means that:

• “Services include behavioral health treatment, such as psychotherapy and counseling.”
• Inpatient services are available to patients.
• You cannot be denied based on preexisting conditions.
• “Marketplace plans can’t apply yearly or lifetime dollar limits on coverage of essential health benefits.”
• Generally, services for mental health, including substance abuse services, cannot be any more restrictive or limited than those of medical and surgical services.

These are the essential terms of insurance service as it applies to substance use treatment. Addiction treatment centers can be either inpatient or outpatient-based, and depending on the state you live in and your health plan, you can find out what services will be covered.

Affordable Addiction Treatment Centers

Certain addiction treatment centers are more affordable than others and some will be more covered by your insurance plan. Depending on what you need, there are also treatment centers that can be affordable on their own. According to SAMHSA, there are low-cost and even free treatment centers available, but finding them can be difficult.

SAMHSA states that facilities that are “all free” make up 4% of the total substance abuse treatment facilities. The highest number of facilities (37.8%) are “partial free with a sliding fee scale.” Depending on your needs, you may want to consider one of these facilities. Especially if your insurance provider is paying for all or some of your treatment, you will probably have better luck with one of these facilities.

HealthCare.gov states that “all Marketplace insurance plans cover mental health and substance abuse services as an essential health benefit.” But what they cover and how much of it will depend on specific criteria, not just limited to the needs of the patient. When you are discussing your needs with your insurance provider, make sure to remember that your treatment is covered and, if you need to attend an addiction treatment center, you should be given assistance by your insurance provider.