The Affordable Care Act (the “ACA”, which is more popularly referred to as “Obamacare”) is slowly but surely approaching its goal of assuring that everyone in the United States has access to and is covered by a comprehensive health care plan. The ACA treats substance abuse disorders as one of ten essential elements of healthcare, and all ACA-approved plans include some form of drug rehab in their coverage provisions. The good news, therefore, is that if you have health insurance through an ACA-established insurance exchange and you are enrolling in a rehab program for drug addiction or alcoholism, your insurance will provide reimbursements for your rehab care. Likewise, private health insurance that complies with minimum ACA standards will also provide reimbursements for that care.
The Affordable Care Act and Drug Rehab Coverage
Insurance coverage for any health-related issues is rarely straightforward, however, and the specifics of your ACA insurance coverage for drug addiction or alcoholism rehab will vary as a function of several factors. For example, drug and alcohol rehab is covered under treatment for mental and behavioral health disorders. In all likelihood you will not receive 100% coverage of all costs for your rehab. Further, the total reimbursement will likely be limited. You will also incur co-pay charges and deductibles, but some portion of your rehab costs will be compensated by your ACA health care coverage.
Additional ACA coverage limitations may also apply. The total number of days of treatment for any specific addiction diagnosis will be limited. You or your primary care physician might also be required to present an addiction care treatment plan to your insurance carrier for pre-approval before you begin a rehab program to qualify for insurance reimbursements. The ACA will not cover every aspect of your rehab, but unlike the time before enactment of the ACA, you are at least entitled to some coverage for treatment. The out-of-pocket costs and expenses that you incur will ultimately cost you far less than your addiction habit would cost if you were to continue on the path of substance abuse.
On a more positive note, the ACA’s emphasis on mental health treatment makes it easier for an alcoholic or drug addict to get medical and rehab treatment before a substance abuse situation is desperate. Prior to enactment of the ACA, alcoholics and drug addicts had to have private health insurance or Medicaid coverage to qualify for reimbursement for rehab treatment. ACA health care coverage allows all addicts to seek and receive treatment at any point in their illness, including well before their illness reduces them to public aid. The provisions of the ACA treat addiction like the disease that it is. ACA-covered parties can receive addiction prevention, early intervention, medical screenings, education services, and other psychotherapy and behavioral therapy to break their cycles of addiction before all chances of recovery are lost.
Even strong proponents of the ACA will admit that it is far from a perfect solution for drug and alcohol addiction therapy. Substance abuse and addictions of all forms impose hundreds of billions of dollars in direct and indirect costs on the American public every year. The ACA’s rehab coverage philosophy aims to reduce this cost.
If you have questions or concerns over whether your health insurance coverage will reimburse your costs for drug or alcohol rehab, please contact the Last Resort Recovery Center near Austin, Texas, at 512-360-3600. Our staff can provide a confidential review of your insurance coverage and can advise you on the amounts and limits of your coverage for drug- and alcohol-related care.