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The Affordable Care Act (ACA) offers plans that cover addiction treatment.
About 21 million Americans suffer from addiction, yet most don’t get the help they need.
In 2018, only 11 percent of patients with a substance use disorder (SUD) received treatment. Another 1 in 5 people said they didn’t know where to look for help.7
The Affordable Care Act (ACA) is a good place to start. The ACA offers Americans access to affordable health insurance plans.6 These plans cover some of the costs of addiction treatment.8 For example, rehabilitation and detox programs.
Under the ACA, there are 10 essential health benefits that must be offered at no dollar limit:5
Select mental health services, addiction treatment, and rehabilitative services and devices are all essential health benefits the ACA covers. And, because of financial assistance with premiums, 4 out of 5 people can find plans for just $10 or less per month.9
Like with any insurance plan, though, the ACA has some restrictions. Call an ACA representative or visit their website for more information.
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By law, all ACA plans must cover behavioral health treatment, mental and behavioral health inpatient services, and substance use disorder (SUD) treatment. Your specific benefits will depend on your state and plan of choice.4
Some addiction services the ACA covers include:
You might also be able to find mental health, medical, and surgical services from certain health care providers. To find coverage that includes the benefits you’re looking for, compare health insurance packages online.4
Not all addiction treatment services are covered under ACA health insurance plans. Different plans offer varying coverage benefits.
Generally, ACA plans are categorized into metal tiers that determine cost distribution:9
Various factors play into how you pick your plan. These include your monthly income, your health status, and how often you need care.
If you can’t afford any ACA plans, you might qualify for state-based insurance through Medicaid. Your ACA application will help determine if you qualify. It takes into account your household income and family size, among other factors.9
If you can’t afford an ACA plan and don’t qualify for Medicaid, explore other options at free clinics and community health centers in your area.9
Not everyone is covered under the ACA. If you aren’t a U.S. citizen, don’t live in the U.S., are incarcerated, or are already covered by Medicare, you might not be eligible for coverage.2
ACA coverage is designed to make healthcare more affordable for every U.S. citizen, regardless of their income. This means that almost anyone who is a legal resident and isn’t already covered by Medicare can apply for a health insurance plan under the ACA.9
The ACA offers subsidies, also known as premium tax credits, that lower costs. Only Americans who have incomes between the federal poverty level (FPL) and 4 times the federal poverty level are eligible for ACA tax credits.1, 9 FPL also depends on family size.1
The ACA sponsors insurance plans that you can find on the health insurance marketplace. These plans offer addiction treatment coverage that are comparable to private insurance plans.
Here are some quick tips for choosing an ACA-sponsored plan:
Fortunately, if you or someone you know is struggling with substance use issues or addiction, help is available. There are both inpatient and outpatient rehab centers located all over the country.
Finding a rehabilitation center that accepts ACA can be challenging. To find one, follow these steps:
If you don’t like the center you chose, find a new rehab center. You don’t have to commit to one treatment center or program. Many places accept ACA, so find one that makes you feel supported. However, be sure to choose another program that has space available and accepts your insurance before quitting the one you’re currently in.
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