With open enrollment at healthcare.gov beginning November 1st, 2017, many people needing substance abuse treatment may be wondering, “Does Obamacare cover treatment”? Here is some of the history and facts about ACA coverage.
Before the passage of the Affordable Care Act, the controversial health care policy known colloquially as Obamacare, it was estimated, based on CDC data, that over 18% of Americans were without health insurance. By 2016, 2 years after the full implementation of the new health care act, the rate had dropped to just over 10%. Given that the goal of the policy was to make health insurance available to more Americans than ever before, the policy was touted by its architects as an overwhelming success.
But success in terms of a piece of legislation means different things for different people. Despite the fact that the ACA gave more people access to health care than ever before, you may have questions about the quality and types of care provided. The question we’re going to be exploring here is, does Obamacare cover rehab?
If you or a loved one find yourself struggling with addiction, call TTC Care today at [phone] to learn how we can help you take the first steps toward complete recovery. We accept most insurance plans, and our addiction counselors are standing by to help you with admission into our state-of-the-art inpatient addiction facility.
First, A Brief Background on Obamacare (The ACA)
Let’s paint a quick picture of the American health care landscape before Obamacare:
Insurance premiums were rising an average of 8% a year from 2000 to 2010, causing fewer and fewer people to be able to afford it each year. For those who could afford coverage, insurance companies found ways to cover fewer procedures, so that even those with insurance often were left to pay for their medical needs out-of-pocket. The result was a 2008 survey in which 82% of respondents supported a health care overhaul.
President Obama ran on a platform of healthcare equity when he was first elected to the nation’s highest office later in the same year. Shortly after taking office in 2009, Obama and his policy team began formal work on the bill that would become, officially, the Patient Protection and Affordable Care Act, widely nicknamed as Obamacare. The bill was signed into law in 2010, though the rollout would take several years until it would go into effect in full. The first health insurance marketplace wouldn’t go active until November 2013.
Of course, no bill is perfect, especially after it first goes into effect. Many questioned, and still do question, the role of government with healthcare, the marketplace’s website had some very public malfunctions and some Americans reported higher premiums after the law went into effect, but one crucial population emerged as one bettered greatly by the new law: the mental health services and addiction treatment community.
Does the ACA Cover Rehab?
In short, yes. The vast majority of plans provided by the ACA’s legislation are mandated to support addiction treatment services. Here are the stated goals of the policy.
But to understand how the important needs that Obamacare covers for an enormous addicted population in America, we first need to discuss some of the provisions that made this coverage possible.
Understanding Health Care Parity
Before 2008, medical services and mental health services were covered at different rates. After Congress passed the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA), this changed, with insurance companies no longer being allowed to cover mental health and addiction services less than traditional medical services.
Admittedly, the 2008 parity bill was imperfect, failing in its goal to protect the rights and coverage for many crucial mental health and addiction services. Obamacare changed this for the better with a stricter mandate on health care plans. This addition to the practice of healthcare parity mandated that the following should be covered equally in medical and mental health/addiction treatment, according to the National Alliance on Mental Illness (NAMI):
- Inpatient and outpatient in-network
- Inpatient and outpatient out-of-network
- Intensive outpatient services (IOPs)
- Partial hospitalization and partial outpatient services
- Residential care
- Prescription medications
- Emergency visits
- Out-of-pocket expenses
- Approval or denial of care
- Reimbursement methods
- Other factors such as geographic location and facility type
Certain treatment facilities are exempted from the bill, mostly facilities that only serve Medicaid or Medicare recipients and those that have verified approval that the costs to provide parity exceed a reasonable amount.
Expansion of Medicaid
One of the first actions that went into effect as part of the Affordable Care Act was a nationwide expansion of Medicaid, the federal program that provides health insurance coverage for a population of the poorest Americans. This policy eventually changed, after the Supreme Court ruled that mandates concerning the use of Medicaid funds, which are controlled by the states, is unconstitutional.
After this, states were given the option to opt in, and those who did saw a major positive effect on their rate of uninsured citizens. Addiction treatment is typically covered by social programs like Medicaid, especially recently, as Medicaid spending on addiction treatment has spiked in recent years.
ACA Mandate for Addiction Coverage
It’s no secret that the pre-ACA health care picture didn’t devote many resources to mental health and addiction treatment services. For this reason, the language of the 2010 bill specifically included sections about mental and behavioral health provisions, including substance abuse treatment:
First, substance abuse disorders are listed as pre-existing conditions, which Obamacare says cannot be discriminated against by insurance companies. Thus, insurers are not allowed to deny anyone coverage based on their current health circumstances. Coverage for pre-existing conditions must be included from day one of the new policy, according to the ACA.
Second, the law bars insurers from placing dollar limits on coverage of essential health benefit, a category that includes a set of 10 categories of services decided by individual state boards.
Limitations to Obamacare’s Cover Rehab
Factors that may limit the ACA’s coverage of addiction treatment include descrepancies between the type of treatment needed and the type of treatment insurers are willing to cover. According to the bill’s language, it favors outpatient programs with multi-faceted approaches to treating addiction in most cases, when groups like the National Institute on Drug Abuse state that treatment is more effective when it occurs over a longer period of time, with a more comprehensive treatment continuum. In some places, the ACA may just cover detox or outpatient therapy, which is useful, but in many cases residential treatment may have the best outcomes for the patient.
The Bottom Line
If you have a plan provided by the ACA or Medicaid, it’s likely that you’ll be able to qualify for treatment at TTC Care. To learn more about whether or not you’re covered, and how much you’re covered for, call 844-310-9546 to speak with one of our professional addiction counselors.