Does My Insurance Cover Alcohol Abuse?

Monday, March 17th, 2014

Alcohol abuse falls into the category of mental health and substance abuse services, which is one of 10 ‘essential health benefits’ laid out by the Affordable Care Act. These essential benefits must be covered by all health insurance plans in the Health Insurance Marketplace.

Thanks to the Mental Health Parity and Addiction Equity Act, all plans, even those not in the Marketplace, are required to treat alcohol abuse on par with physical health. In short, yes, alcohol abuse should be covered by your insurance.

What is the Marketplace?

The Health Insurance Marketplace is a government initiative put in place to ensure that Americans have access to health insurance, and, in turn, health care. It is set up for people who don’t have coverage, and people who have coverage but are looking for better options. The private plans offered in the marketplace are required to cover substance abuse services. You cannot be denied coverage or pay a higher premium because of pre-existing conditions, which includes substance use disorders like alcohol abuse. Enrolment in the Marketplace can be done over the phone, online, or in person.

What Alcohol Abuse Services are Available?

The parity act expanded mental health and substance use disorder benefits to 62 million Americans. There are many new, relevant services available to people with alcohol abuse.

Preventative services

Free depression screenings are available to adults, which is pertinent for those with alcoholism. Depression and alcoholism often co-exist, so screening can open up new avenues of treatment.

Parity

The parity act works to maintain equality between physical health coverage and mental health coverage. In the marketplace, limits applied to medical and surgical health services must be the same for mental health services. That includes limits to the number of visits covered, deductibles, copayments, and care management.

It’s important to note that the parity law does not translate to unlimited care or therapy sessions. Alcohol abuse services will be offered on par with physical services, so check with your policy about any restrictions.

What About Medicaid and Medicare?

Medicaid

State Medicaid programs do provide some level of mental health care that covers substance abuse treatment. That could include counseling, therapy, medication management, social work services, peer support, and substance abuse treatment. The exact services available to you depend on your state.

Medicare

Medicare does cover some mental health services that could extend to alcohol abuse treatment. This could include inpatient mental health care services, outpatient services, and medications. Again, different types of plans offer different benefits.

The best way to find out whether or not your insurance policy covers alcohol abuse treatment is to ask. The Affordable Care Act has made it a requirement that health insurers provide you with an easy-to-understand summary about your health benefits. Contact your insurer or, if you are insured through employment, your benefits administrator, for full details on your level of coverage.

Lack of insurance or finances shouldn’t prevent you from seeking alcohol abuse treatment. In the event that insurance doesn’t meet all of your needs, talk to your treatment facility about payment plans or other ways you can afford treatment. Everyone deserves to live a healthy life, no matter what their insurance policy.