Under the Affordable Care Act (ACA), which is the federal health care reform law, most U.S. health plans must provide some level of coverage for a variety of essential health benefits, including mental and behavioral health care. Specifically, most health plans must cover behavioral health treatment (e.g., counseling and psychotherapy), substance use disorder treatment (e.g., detox and rehab), and mental and behavioral health inpatient care.
While this doesn’t guarantee that your addiction treatment will be covered in full by your insurance provider, these mandates may help you receive more affordable care. The first step in seeking out covered care is to contact your insurer and find out what your health benefits may include.
As previously mentioned, the ACA’s mandate does not guarantee that your addiction treatment will be fully or partially covered under your health plan. In most cases, you’ll be subject to cost-sharing requirements, as well as specifications for coverage. What this means is that you may have out-of-pocket costs for your care and you may be limited to which facilities you can obtain care at if you use your insurance.
Here are some things to be mindful of when researching addiction care:
Plan details—Carefully review your health insurance summary of benefits and coverage. You can call the number on the back of your insurance card and request this information, or, if there’s an online portal, log in and look for this document. This plan should detail:
Network—In-network providers are those who are under contract with your insurer to provide lower rates to you. This means that seeking out care at an in-network facility may be the most cost-effective option for you.
Preauthorization requirements—Some plans require certain procedures or treatments to be preauthorized by the insurer before coverage will kick in.
Contact Us To Learn More
The road to recovery isn’t always linear, and we’re here to help you throughout your journey. Give the team at Horizon Insurance Agency a call to learn more.