Does Obamacare/Affordable Care Act Cover Addiction Treatment?

Does Obamacare/Affordable Care Act Cover Addiction Treatment?

The Affordable Care Act (also known as ACA, PPCA, or Obamacare) is a health care reform law established in 2010 during the Obama administration. According to HealthCare.gov, the goal of the ACA is to make health insurance accessible for families in low-income households. But does affordability come with a price for those seeking treatment for addiction?

Does Obamacare Cover Addiction Treatment?

If you or a loved one is struggling with addiction and meet income guidelines, the ACA will help cover your treatment. Before the ACA was established, insurance companies were able to deny coverage if patients had a preexisting condition such as drug and alcohol addiction. The ACA forbids insurance companies from denying coverage on the basis of age or preexisting conditions, thus creating an affordable open marketplace.

Qualifying for the Affordable Care Act

The ACA provides a premium tax credit for families who fall between 100-400 percent, and adults who fall below 138 percent of the federal poverty level. To see if you qualify, visit HealthCare.gov and submit your application. You will need ID, proof of income, your social security number, and housing information.

2018 maximum annual income for eligibility is as follows:

  • Single person: $12,060
  • Family of 2: $16,240
  • Family of 3: $20,420
  • Family of 4: $24,600

While the 2018 open enrollment period is closed as of May 2018, you may still qualify if you have faced a life change or qualify for Medicaid or the CHIP program. According to CMS.gov, parents who purchase insurance under the Marketplace can cover their children until they turn twenty-six years old.

Limitations of Obamacare

The ACA ensures that any patient seeking addiction treatment will receive the same services as everyone else. Insurance under the ACA will cover:

  • Initial assessment
  • Intervention services
  • Specialist visits
  • Detox programs
  • Drug and alcohol testing
  • Home visits
  • Therapy
  • Maintenance medications

Medicaid and Medicare services vary from state to state. There may be certain “preferred” facilities for treatment in your area, as the cost requirements are different than those found in the ACA Marketplace.

Levels of Coverage With Obamacare

The ACA provides different levels of coverage based on the plan chosen for your family. To clarify, this does not change the level of care given by providers. The plans available are based on need and ability to pay. As of 2018, the plan categories are:

  • Bronze—Insurance pays 60 percent, you pay 40 percent. This plan offers the lowest monthly premium but costs the most when you need treatment.
  • Silver—Insurance pays 70 percent, you pay 30 percent. This plan costs more than bronze but covers 10 percent more of your treatment.
  • Gold—Insurance pays 80 percent, you pay 20 percent. This plan costs more than bronze and silver but lowers the cost when you need care.
  • Platinum—Insurance pays 90 percent, you pay 10 percent. This plan offers the lowest cost at the time of care but costs more than any of the others in monthly premiums.

To decide which plan will work best for you and your family, it’s important to decide which care you’ll anticipate needing. Consider the cost of the treatment center and other factors, and break that down into percentage paid by the insurance company. Your premium may also be lower based on your income.

Does Obamacare Promote Treatment of Addiction?

Obamacare works to lessen the financial burden of treatment by offering low-cost insurance options to families who need it. The Marketplace allows those seeking treatment to shop around for the best coverage to fit their medical needs, whether the plan is discounted or free. As of 2018:

  • 87 percent of Americans who apply are qualified for Obamacare.
  • Over twelve million Americans have enrolled in the Marketplace since 2015.
  • The ACA has helped over thirty-three million Americans find low-cost options for addiction treatment.

While there are some limitations to the program, the ACA has provided millions of Americans with ease of access to addiction treatment. Since opioid overdose has been deemed an “epidemic,” lawmakers have made additional efforts to combat addiction and help those struggling to find treatment.

Federal Precautions Since the Opioid Crisis

The National Institute on Drug Abuse (NIDA) has reported that 115 Americans die every day from opioid overdose. Since this crisis was established, additional measures have been taken by the federal government to help combat the growing number of overdose cases in the US. For example:

  • Better, more accessible options for addiction treatment
  • Access to lifesaving overdose-reversing medication
  • Substance abuse education
  • Research into alternative pain treatment
  • Improved intervention processes and increasing accessibility to treatment

The Food and Drug Administration (FDA) also notes that in November 2017, a new electric stimulation device was introduced as a means to help combat opioid withdrawal in treatment. These measures are an effort to make recovery as attainable as possible for those in need of assistance.

Obamacare and Addiction

The ACA recognizes addiction treatment as a necessary tool for anyone struggling with addiction. Policies and procedures within the ACA have made it easier than ever to find help when you need it most. If you or a loved one is in need of help with funding addiction treatment, visit HealthCare.gov to view your options in the Marketplace.

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