Insurance Basics

Health insurance helps individuals and families cover medical costs. While you typically associate insurance coverage with doctor’s visits or hospital stays, insurance can also cover other mental and physical health issues. It can cover addiction treatment. When you or a loved one struggles with addiction, the last thing you want to worry about is navigating confusing insurance plans and paying for treatment. Learn about insurance basics to take some of the stress out of planning for recovery.

Do I Have Addiction Treatment Coverage?

Worried woman with computer and papersNot all plans cover addiction treatment. However as laws change, more and more do. Any plan offered through the Healthcare Marketplace must cover mental health and substance abuse services. These services are considered essential health benefits. Marketplace plans must also follow parity regulations.

Healthcare.gov[1] explains, “This generally means limits applied to mental health and substance abuse services can’t be more restrictive than limits applied to medical and surgical services.”

Your deductibles, copayments, and limits should be the same regardless of whether you are receiving medical or mental health treatment. If you receive insurance through your employer or other non-Marketplace source, parity laws still apply.

You don’t have to understand the ins, outs, and fine print of your insurance plan. Addiction treatment programs have years of experience working with insurance providers and getting the most out of plans. They can navigate your insurance plan on your behalf and ensure you get the coverage and benefits you deserve. They can help you answer questions such as the following:

  • What is the deductible on the policy?
  • What is the covered percentage after the deductible has been met?
  • What specific services are covered?

Answers to these questions let you know how much you will owe out of pocket. They will help you make the best personal and financial decision regarding what type of treatment you get and where you get it. You don’t want to cut corners on your recovery in the name of saving money, but you do want to know what to expect.

Addiction treatment has not always received the coverage it deserves, and it still doesn’t under some plans. The Surgeon General’s report, “Facing Addiction in America,”explains, “Substance use disorders are similar in course, management, and outcome to other chronic illnesses, such as hypertension, diabetes, and asthma. Unfortunately, substance use disorders have not been treated, monitored, or managed like other chronic illnesses, nor has care for these conditions been covered by insurance to the same degree.”[2]  Addiction is a real disease, and real treatment exists. Even if you don’t have insurance coverage, you need professional care.

The report continues, “The costs of care and lack of insurance coverage are particularly important issues for people with substance use disorders. The 2015 NSDUH found that among individuals who needed and made an effort to get treatment but did not receive specialty substance use treatment, 30.0 percent reported that they did not have insurance coverage and could not afford to pay for treatment.”

If you do not have coverage for treatment, do not give up on recovery. Addiction is a costly disease, and leaving it untreated will ultimately be more expensive than any treatment program. Some providers offer services on a sliding scale. Others will gladly work with you to arrange a manageable payment plan or find recovery “scholarships.”

If you need help navigating your or a loved one’s insurance coverage, please call us. We have extensive experience working with insurance companies, and we’re happy to help your family. Let us answer questions about insurance and other payment options. We are here to make sure you get the care you need for a long, healthy, and sober life.


Sources

[1] “Mental Health and Substance Abuse Coverage.” Healthcare.gov. 2017.

[2] “Facing Addiction in America.” SurgeonGeneral.gov.2016.

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