Drug Abuse & Insurance Coverage

Monday, March 24th, 2014

Is drug abuse covered by insurance policies? It’s a popular question, and one that’s been thrown into the spotlight with the Affordable Care Act. The general answer is yes. Substance abuse is covered by insurance policies, though that doesn’t necessarily mean that every single policy will cover it. However, there are a great many policies that do, which means that if you have a drug addiction, you have insurance options available to contribute to the cost of your treatment.

Understanding Insurance for Drug Abuse Treatment

Parity Act

Part of the big change brought in by Obamacare is the implementation of parity between coverage for mental health and physical health. Basically, if an insurance policy covers three days of hospitalization due to a broken foot, they have to cover three days of hospitalization due to a mental health disorder. All insurers must offer coverage for mental health treatment that is on par with their coverage for physical health treatment. It’s important to note that the parity act does not outright require an insurer to cover drug abuse; the equivalent form of treatment for physical ailments will determine the type of equal coverage available.

Health Insurance Marketplace

Here’s the good news: the Affordable Care Act lists substance use disorders as one of the ten elements of essential health benefits. That means that all health insurance offered on the Health Insurance Exchanges or through Medicaid to eligible candidates must include services for drug abuse. An insurer cannot refuse to take you on due to a pre-existing condition, including addiction.

The Affordable Care Act is still in its early days, so it remains to be seen exactly what the definition of substance abuse services will be. The Department of Health and Human Services is working to decide which services must be covered by insurance policies. Because there is no blanket method of drug abuse treatment that works for everyone, it isn’t a clear-cut case.

Even though there are still some kinks to iron out, the introduction of substance abuse services is a big step forward for addiction treatment. More people should now have access to treatment because more health care providers stand to be reimbursed for their services. Electronic Health Records will allow health care providers to access and monitor an individual’s medical history, so they can provide better care. With your consent, doctors can then share that information between each other when needed.

Why are these changes so important?

Drug abuse treatment takes time, often 30 days or longer in a residential program. Many insurers are still hesitant to cover this length of time, so addiction professionals are trying raise awareness about the quality of services that should be covered as a minimum. By expanding coverage for all Americans and increasing access to basic substance abuse services, the future becomes brighter for treatment. Too many people suffer from addiction without seeking help because they think it’s unaffordable. With these changes, these same people are able to reach out and start their journey to recovery.