substance abuse

ACA Coverage for Drug Addiction Treatment

understanding the affordable care act substance abuse

Victims of substance abuse finally got the support they need with the passage of the Affordable Care Act (ACA).

The ACA now mandates health insurance companies must treat substance abuse and mental disorders as a disease and provide coverage.

Prior to the ACA, substance abuse treatment was not normally covered by private health insurance plans unless specially requested.

This change makes a lot of sense from a national health policy standpoint.

Substance abuse causes a number of serious health problems that can cost a lot to treat. Most rehabilitation centers and private treatment programs also cost a lot, making it difficult for most Americans to obtain those services. The passage of the ACA will go a long way to helping those suffering from addiction.

In this article, we discuss the measures that the ACA has taken to ensure all substance abusers are covered at an affordable cost. We will also look at the progress made by the ACA over the years. Categories that are not clearly covered will also be discussed.

The New Mandate: Substance Abuse is a Disease

In the new mandate, the ACA has included the mental health and substance abuse which is also referred to as a “substance disorder” in the list of essential health benefits.

This means that all health insurance plans available in the market must cover victims of substance abuse.  All health services sold on Medicaid and the Health Insurance Exchange must include substance abuse disorder in all adults.

This new health benefit package covers direct professional treatment of substance abuse, including counseling and psychotherapy.

For the most part, this means that most people with health insurance can now visit a rehabilitation center without paying from their pockets.

However, the specific benefits gained depend on the state and the type of health plan they have chosen.

Currently, the department of Health and Human Services is determining the specific substances that should be covered under this new act. The department is also looking at the type of treatment individuals will require for each drug covered.

Mental Health and Substance Abuse Services Covered by the ACA

The ACA mandates that all health care providers must cover at least 10 categories of the following health services:

  1. Maternity and newborn care
  2. prescription drugs
  3. Ambulatory patient services
  4. Hospitalization like surgery
  5. Emergency services
  6. Mental health and substance use disorder
  7. Habilative and rehabilitation services and devices
  8. Laboratory services
  9. Chronic disease management
  10. Pediatric services; oral and vision care
  11. preventive and wellness services

The following specific rehab services are covered under the ACA. However, the specifics of coverage and services may differ from state to another.

substance abuse treatment services

Diagnosis and drug treatment coverage is mandated. Early and periodic screening is also covered. The screening process includes laboratory tests and other required services.

Counseling from physicians and licensed substance abuse professionals is also generally covered. For those that need to visit a rehabilitation center, the costs of medically required treatments in such facilities are also covered by most policies, although there is still some fine tuning left in many policies and states.

Services not covered

While insurance will pay for the medically required services provided by a rehab center, they will not pay charges for the room, TV and meals in the treatment facilities.

All States expanding Medicaid programs must also include all these benefits and offer them to newly eligible adults.

A Health Insurance marketplace may also not deny people coverage just because they have pre-existing medical condition, and this applies to substance abuse as well.

Further good news: there is no waiting period for the covered services to be utilized.  Coverage for substance abuse is immediate and begins when your marketplace coverage has started.

The substance abuse services offered above are the most important ones, but individuals can opt for packages that cover additional health benefits.

Some Gray Areas Remain

Despite the improvements made by the ACA, there are still several areas that have not been clearly covered or stated.

For example, the ACA claims that prescription drugs is an essential health benefit that all Marketplace must offer.  However, some anti-addiction drugs like Naloxone and Methadone may not be covered right now by some policies.


The ACA has made major strides towards ensuring that Americans are widely covered by their health insurance policies.  More individuals today have access to substance abuse treatment that were not initially covered.

Substance abuse is also no longer a troublesome pre-existing condition. People suffering from addiction can now receive treatment for any conditions that came from substance abuse without a waiting period.

The compulsory rule that all insurance policies must cover all the essential health benefits ensures no American citizen should miss out on medical services just because they do not have enough money.


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