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Paying For Addiction Treatment With The Affordable Care Act

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Does the Affordable Care Act (ACA) Cover Addiction Treatment?

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

  1. Ambulatory patient services (outpatient care)
  2. Emergency services (trips to the emergency room)
  3. Hospitalization (treatment in the hospital for inpatient care)
  4. Maternity and newborn care
  5. Pediatric services
  6. Laboratory services
  7. Prescription drugs
  8. Preventive services, wellness services, and chronic disease treatment
  9. Mental health services and addiction treatment
  10. Rehabilitative services and devices

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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Which Rehab Services Does the ACA Cover?

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

What Isn’t Covered?

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

  • Bronze offers the lowest monthly premiums, but the highest out of pocket costs for care if and when you need it.9
  • Silver offers moderate monthly premiums and costs for care.9
  • Gold offers high monthly premiums for lower-cost care if and when you need it.9
  • Platinum offers the highest monthly premiums, but the lowest costs for care.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

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Who is Eligible for ACA Coverage?

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

Insurance Can Help Pay for Addiction Treatment

Call now to speak with a specialist about your insurance benefits.

How to Choose an ACA-Sponsored Plan 

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:

  • Enter your ZIP code and answer some brief questions about your estimated income on the Healthcare.gov page.
  • The marketplace application for each plan will ask you for more details. After you fill out the details, you’ll see the exact prices for the plans.3
  • Be realistic about both your healthcare needs and budget. Some healthcare plans cost more but also offer more. Other plans may be low-cost but might not include all the services you need.
  • Consider your current healthcare providers. Check to see if they accept the plans you are considering or if you need to find new providers.
  • Make sure to choose your plan in time to receive coverage. You must submit your application during the annual open enrollment period. The deadline for most people is January 15 (every year). 
  • You might be eligible to apply later if you’ve experienced a qualifying life event like losing your current health coverage, moving out of state, getting married, having a baby, or adopting a baby.9

Tips for Finding a Rehab Center

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:

  1. Shop around. Don’t go to the first rehabilitation center you find. Call various locations to learn whether or not they accept your ACA plan and if they have space available. Some rehab centers have a limited number of spots available for those with ACA insurance.
  2. Make sure your doctors accept your plan. Not all doctors, even if they’re at the same rehab center, accept the same insurance plans.
  3. Ask for help. If you have questions, use the Find Local Help tool. This tool connects you to a navigator, agent, or broker in your area for free, in-person assistance. 

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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Updated on March 21, 2022

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All content created by Alcohol Rehab Help is sourced from current scientific research and fact-checked by an addiction counseling expert. However, the information provided by Alcohol Rehab Help is not a substitute for professional treatment advice.

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