The 2023 National Survey on Drug Use and Health (NSDUH) reveals that more than 48.5 million Americans faced some type of substance use disorder (SUD) in the last year. This figure includes 28.9 million individuals with an alcohol use disorder (AUD), 27.2 million with a drug use disorder (encompassing both illegal drugs and prescription medications), and 7.5 million who experienced both conditions. Unfortunately, only 23.6% of those needing treatment received it.
Given the high number of individuals requiring help but not receiving it, it’s crucial for Americans to be aware of their SUD rehabilitation options and the various financial resources available for treatment. These options include various types of public and private financial assistance, cash payment alternatives, and the ability to utilize personal health insurance benefits.
In fact, once you hit your deductible, seeking treatment at a rehabilitation facility can make SUD care (whether outpatient or inpatient) significantly more affordable, allowing you to get the best value while participating in a life-changing recovery program.
Is Addiction Treatment Covered By My Health Insurance?
Addiction treatment services—like medical detox, outpatient care, inpatient rehab, and additional supports—are covered by all health insurance policies that meet Affordable Care Act (ACA) standards as essential health benefits.
Previously, addiction treatment coverage was inconsistent among health insurance plans, if it was included at all. Behavioral healthcare and mental health treatment were often treated as separate services rather than valid medical care.
However, this changed with the passage of the ACA, or Obamacare, in 2010. New regulations mandate that all Marketplace-qualifying plans must include mental health and substance use disorder services as essential health benefits. This covers government insurance programs like Medicare and Medicaid as well as most private and employer-sponsored health plans (excluding short-term plans and certain exceptions).
Moreover, ACA regulations prohibit insurance providers from denying coverage for pre-existing mental and behavioral health conditions and restrict them from imposing spending limits on services identified as essential health benefits. They also require parity in coverage for mental health and substance abuse services compared to other medical services, meaning that your plan must maintain the same deductibles, co-payments, out-of-pocket limits, and other conditions for all essential benefits.
What Is A Deductible Anyway?
Health insurance plans can often be complex and challenging to comprehend, especially if you’re new to them. It’s important to understand key terms like deductible, co-payments, co-insurance, and others that impact your coverage.
Your Deductible
Your deductible is the amount of money you must pay out-of-pocket for healthcare services before your insurance starts covering the costs (with some exceptions for preventive services like check-ups and vaccinations). This amount resets every year on January 1.
Deductibles can differ significantly between plans and may be quite high. CNN reports that the average annual deductible for an individual plan was over $5,100, and more than double that for families ($10,300).
Your Co-Payments
A co-pay is a fixed fee you pay for certain healthcare services (for example, visits to your doctor or prescriptions). Co-pays do not contribute to your deductible, but they do count towards your annual out-of-pocket maximum.
Your Co-Insurance
Even after you meet your deductible, you may still need to pay co-insurance for medical care. This is a percentage of the total bill you are responsible for, while your insurance covers the remainder. A lower co-insurance means your insurance pays more after you reach your deductible, while a higher percentage means you may soon hit your out-of-pocket maximum.
Your Out-Of-Pocket Maximum
This represents the maximum amount you will pay for medical care in a year under your insurance policy, regardless of total medical expenses. Essentially, it is the maximum you would need to pay for medical services annually, after which your insurance covers 100% of the costs.
Your Monthly Premium
Your premium is the monthly payment required to maintain your health insurance coverage. If your insurance is employer-sponsored, this amount is typically deducted from your paycheck.
According to CNN, the overall average premium for a family is more than $1,100 each month, although this can fluctuate based on the specific plan and the age of the insured (with older individuals generally paying more). Remember, premiums do not count towards your health insurance deductible or out-of-pocket maximum.
Going To Rehab After Deductible Is Met: Will Treatment Be Free?
Once you’ve met your deductible, your health insurance is “activated,” meaning your provider will begin covering part of your subsequent medical expenses for the remainder of the year. If your deductible is satisfied, your out-of-pocket costs for substance abuse treatment will be significantly lower.
However, this does not mean your treatment will be entirely free. You will likely still need to cover a co-pay and a co-insurance percentage until you hit your annual out-of-pocket maximum. After reaching that limit, your treatment costs should be fully covered.
If you have met your deductible, you gain access to rehabilitation services including medical detox, outpatient treatment, residential rehab programs, and medication-assisted treatment (MAT) at a more advantageous price than before. This could be a perfect time to obtain the care you need at an affordable rate.
What Other Treatments Can I Use My Health Insurance For?
Substance abuse disorders can lead to various acute and chronic health issues, some visible while others may be less apparent and require thorough evaluation and treatment.
For instance, chronic alcohol abuse is linked to serious health complications such as high blood pressure, heart issues, cancer, and nutritional deficiencies which could potentially impair brain functioning. Similarly, the use of methamphetamine, opioids, cocaine, and even marijuana can lead to a range of health problems, from sleep disorders to lung damage, malnutrition, infections, and more. Individuals with SUD often also struggle with chronic pain and other physical ailments that could be treated through surgical intervention, physical therapy, medication, or additional treatments.
Once you’ve met your deductible and received treatment for SUD, it may be an excellent opportunity to address these associated health issues by collaborating with both your primary care doctor and various specialists. This may also include addressing psychological conditions since mental health issues like anxiety, depression, and bipolar disorder frequently accompany SUD, often exacerbating each other if not treated.
What Else Should I Know?
Although nearly all health insurance plans must legally provide coverage for SUD treatment, the specifics can vary considerably. It’s advisable to speak with your insurance provider before arranging treatment to clarify any requirements, restrictions, and in-network options they may have.
You can also contact Ark Behavioral Health directly. We can assist you in comprehending your insurance benefits and estimating your costs, while guiding you through your treatment options. Our team is dedicated, compassionate, and committed to offering the best possible value for your individual needs. We provide comprehensive care for all forms of substance use disorders and co-occurring mental health issues in comfortable and supportive environments.
To explore your affordable addiction recovery options and the benefits of seeking rehab after your deductible is met, please contact us today.