Paying for Rehab with the Affordable Care Act

The Affordable Care Act, or “Obamacare,” offers options to help pay for addiction treatment.

What is the Affordable Care Act (ACA)?

The Patient Protection and Affordable Care Act (ACA) is a health care system law passed in 2010 that covers addiction treatment. If you are addicted to drugs and alcohol, the ACA may be a way to help pay for it. Under the ACA, addiction is no longer considered a pre-existing condition for insurance purposes.

The ACA sponsors the sale of insurance plans on an online platform called the Health Insurance Marketplace. These medical insurance plans offer addiction treatment coverage similar to private insurance plans.

The ACA expands funds and treatment options available to Americans covered by Medicare and Medicaid. The costs and requirements for Medicare and Medicaid coverage are different from Marketplace medical insurance plans.

Coverage of Affordable Health Care Medical Insurance

Under the ACA, coverage for addiction treatment must be as complete as it is for any other medical procedure. Treatment services you can get with these insurance plans include:

  • Addiction evaluation
  • Brief intervention
  • Addiction treatment medication
  • Clinic visits
  • Alcohol and drug testing
  • Home health visits
  • Family counseling
  • Anti-craving medication

ACA health insurance plans also assist with inpatient services like medical detoxification programs.

Some states run their own Health Insurance Marketplace platforms separate from Healthcare.gov. Differences between state and federal medical plans are based on Medicare and Medicaid coverage in each state.

Get Help from SAMHSA

Call to find a rehab that accepts Medicaid or Medicare.

Percentage of Addiction Expenses Covered by Obamacare

Anyone shopping for medical insurance can purchase an ACA-sponsored health plan. The five types of Health Insurance Marketplace plans available include:

  • Bronze plans – 60 percent expense coverage
  • Silver plans – 70 percent expense coverage
  • Gold plans – 80 percent expense coverage
  • Platinum plans – 90 percent expense coverage
  • Catastrophic — 60 percent total average cost coverage*

*Available only to those under 30 years old or those with extending circumstances

Who is Eligible for Coverage?

Americans with incomes between the federal poverty level (FPL) and four times the federal poverty level are eligible for ACA tax credits. The FPL changes based on family size. Statistics from the Medicaid government website outline federal poverty levels in 2015 are:

ACA Income Eligibility
Family Size Max. Annual Income
1 $11,770
2 $15,930
3 $20,090
4 $24,250

“Cost-sharing” support is available to Silver Plan holders living below 2.5 times the poverty level. For example, a single person making $29,425 a year or less would be eligible; a two-income household would need to make $39,825 or less. The cost-sharing measures reduce deductibles, co-payments, insurance premiums, and other out-of-pocket expenses for those consumers.

How Does the Affordable Care Act Broaden Treatment?

The ACA reduces addiction treatment costs, increases treatment options, and extends many benefits of employer-provided insurance plans to individual medical insurance plans. The ACA allows young adults ages 26 and younger to remain on their parents’ health care plan.

The expanded benefits include addiction treatment despite “pre-existing health conditions.” ACA funding opens hundreds of new inpatient and outpatient health centers every year to support this increased care. Many of these new centers also cover treatment for co-occurring mental health conditions like depression.

Who Accepts Affordable Care Act Plans?

Many addiction treatment centers accept Health Insurance Marketplace plans.

If you don’t already have an ACA-sponsored plan, you can apply for one online during the open registration periods. You can find a registration schedule or request a special registration form at Healthcare.gov if you miss the normal registration window.

An addicted person can purchase one of these medical insurance plans by completing the following steps:

  1. Logging on to the Website – Visit the Health Insurance Marketplace at Healthcare.gov to begin the process.
  2. Creating an Account – Create a Health Insurance Marketplace online account.
  3. Completing Your Application – Fill out the Marketplace application and see available health plans.

Once approved for an ACA-sponsored plan, you should speak with a Health Insurance Marketplace attendant to determine which health insurance package is right for you and your family. Whether you plan to enter an inpatient or outpatient program is one of many factors to consider when purchasing an ACA coverage plan.

Finding a Rehabilitation Center

Addiction recovery can be a long, difficult process. Settling on the right rehabilitation program is crucial to getting and staying sober. Not every program offers the same treatment options or accepts every insurance plan. Our treatment specialists can help you determine which treatment centers accept your insurance.

Call now to find a treatment center that’s right for you.