Medical care for substance abuse, also referred to as substance use disorder, is one of the essential benefits health plans must provide to comply with provisions of the Affordable Care Act (ACA). Policies sold in the health insurance marketplace as well as individual and small group policies sold outside of the exchanges, must provide coverage for substance abuse care effective January 1, 2014.
Coverage for substance abuse screening and treatment is required of all health plans to meet the minimum essential coverage requirements of the ACA. Public health plans, such as Medicaid and TRICARE, and almost all large group policies meet this requirement. Most Americans will find their health insurance policy falls into one of these groups.
Some non-compliant policies have been grandfathered under the ACA. These are polices that were issued prior to March 23, 2010. Insurers are also allowed to continue policies issued between March 2010 and October 2013, although they may not provide coverage for substance abuse care.
If you are unsure about your coverages, contact your health insurance provider. You will find the customer service number on your insurance card. If your policy does not cover substance abuse treatment, it does not meet minimum standards under the ACA and you are eligible to enroll in a plan through a health care exchange. You can access the marketplace through Healthcare.gov.
Finding a health plan with substance abuse coverage
All plans offered in the exchanges are Qualified Health Plans (QHP); they must offer substance abuse treatment. Premiums for a QHP may be higher than you are currently paying for health insurance, but you will have expanded coverage and generally lower out-of-pocket costs. If your annual income is 138 percent to 400 percent of the Federal Poverty Level, you may be eligible for tax credits and cost-sharing reductions. Cost sharing is the amount you pay in deductibles, co-payments and co-insurance.
Your application for health insurance cannot be rejected because you have a history of substance abuse. When applying for health insurance in the marketplace, you will be asked about your tobacco use; it’s a simple yes/no “Do you use tobacco products?” question. The ACA does allow insurance companies to charge higher rates for tobacco users. This will be the only health question you will be asked during the application process.
Screening and counseling for alcohol abuse is considered preventive care and must be fully covered. You will not have to pay a deductible, co-pay or co-insurance for these services if you have a QHP. Depending on the plan you select, you may or may not have to get a doctor’s referral or pre-authorization for treatment.
Gillian Burdett is a freelance writer covering all things home and living. Her work can be found on Examiner.com.