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Paying for Rehab with the Affordable Care Act

The Affordable Care Act, also known as “Obamacare,” offers options to help pay for addiction treatment.

What is the Affordable Care Act (ACA)?

6127243966_e9189f1099_zThe Patient Protection and Affordable Care Act (ACA) is a health care system law passed in 2010 that covers addiction treatment. If you are addicted to drugs and alcohol, the ACA may be a way to help pay for it.

Under the ACA, addiction is no longer considered a pre-existing condition for insurance purposes.

The ACA sponsors insurance plans for sale on an online platform called the Health Insurance Marketplace. These medical insurance plans offer addiction treatment coverage similar to private insurance plans.

Need-based tax credits make many ACA plans less expensive for consumers.

The ACA also expands funds and treatment options available to Americans covered by Medicare and Medicaid. The costs and requirements for Medicare and Medicaid coverage are different from Marketplace medical insurance plans.

What Affordable Health Care Medical Insurance Covers

Under the ACA, coverage for addiction treatment must be as complete as it is for any other medical procedure. Some of the things you can get with these insurance plans include:

  • Addiction evaluation
  • Brief intervention
  • Addiction treatment medication
  • Clinic visits
  • Alcohol and drug testing
  • Home health visits
  • Family counseling
  • Anti-craving medication

ACA health insurance plans also assist with inpatient services like medical detox programs.

Some states run their own Health Insurance Marketplace platforms separate from Healthcare.gov. Differences between state and federal medical plans are based on Medicare and Medicaid coverage in each state.

Questions about treatment?

Call now to be connected with a compassionate treatment specialist.

Percentage of Addiction Expenses Covered by Obamacare

Anyone shopping for medical insurance can purchase an ACA-sponsored health plan. The five types of Health Insurance Marketplace plans available include:

  • Bronze plans – 60 percent expense coverage
  • Silver plans – 70 percent expense coverage
  • Gold plans – 80 percent expense coverage
  • Platinum plans – 90 percent expense coverage
  • Catastrophic — 60 percent total average cost coverage*

*Available only to those under 30 years old or those with extending circumstances

Who is Eligible for Coverage?

Americans with incomes between the federal poverty level (FPL) and four times the federal poverty level are eligible for ACA tax credits. The FPL changes according to family size. These statistics from the Medicaid government website outline federal poverty levels in 2015:

ACA Income Eligibility
Family SizeMax. Annual Income
1$11,770
2$15,930
3$20,090
4$24,250

“Cost-sharing” support is available to Silver Plan holders living below 2.5 times the poverty level. For example, a single person making $29,425 a year or less would be eligible; a two-income household would need to make $39,825 or less. These cost-sharing measures reduce deductibles, co-payments, insurance premiums and other out-of-pocket expenses for those consumers.

How Does the Affordable Care Act Broaden Treatment?

The ACA reduces addiction treatment costs, increases treatment options and extends many benefits of employer-provided insurance plans to individual medical insurance plans. The ACA also allows young adults 26 and younger to remain on their parents’ health care plan.

These expanded benefits include addiction treatment despite “pre-existing health conditions.” ACA funding opens hundreds of new inpatient and outpatient health centers every year to support this increased care. Many of these new centers also cover treatment for co-occurring mental health conditions like depression.

Affordable Care Act Statistics

11.7million

Nearly 12 million Americans have enrolled in Health Insurance Marketplace plans since February 2015.

87percent

Over 87 percent of ACA website enrollees qualify for financial assistance.

32million

The ACA has given 32 million Americans access to substance abuse treatment.

Who Accepts Affordable Care Act Plans?

Many addiction treatment centers accept Health Insurance Marketplace plans.

If you don’t already have an ACA-sponsored plan, you can apply for one online during the open registration periods. You can find a registration schedule or request a special registration form at Healthcare.gov if you miss the normal registration window.

An addicted person can purchase one of these medical insurance plans by completing the following steps:

  • 1
    Logging on to the Website

    Visit the Health Insurance Marketplace at Healthcare.gov to begin the process.

  • 2
    Creating an Account

    Create a Health Insurance Marketplace online account.

  • 3
    Completing Your Application

    Fill out the Marketplace application and see available health plans.

Once approved for an ACA-sponsored plan, speak with a Health Insurance Marketplace attendant to determine which health insurance package is right for you and your family. Whether you plan to enter an inpatient or outpatient program is one of many factors to consider when purchasing an ACA coverage plan.

Finding a Rehab Center

Addiction recovery can be a long, difficult process. Settling on the right rehab program is crucial to getting — and staying — sober. Not every program offers the same treatment options or accepts every insurance plan. Our treatment specialists can help you determine which treatment centers accept your insurance.

Call now to find a treatment center that’s right for you.

Sources & Author Last Edited: January 10, 2017

  1. Beronio K, Po R Skopec L, Glied S (2013). Affordable Care Act Expands Mental Health and Substance Use Disorder Benefits and Federal Parity Protections for 62 Million Americans. Retrieved on June 11, 2015, from: http://aspe.hhs.gov/health/reports/2013/mental/rb_mental.cfm
  2. Substance Abuse and Mental Health Services Administration (2014). Health Financing. Retrieved June 11, 2015 from: http://www.samhsa.gov/health-financing
  3. Healthcare.gov (2013). Mental Health and Substance Abuse Coverage. Retrieved June 11, 2015: https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage/
  4. Vimont C (2013). Affordable Care Act to Provide Substance Abuse Treatment to Millions of New Patients. Retrieved on June 11, 2015 from: http://www.drugfree.org/join-together/affordable-care-act-to-provide-substance-abuse-treatment-to-millions-of-new-patients/
  5. Healthcare.gov (2013). How to Choose Marketplace Insurance. Retrieved on June 11, 2015 from: https://www.healthcare.gov/choose-a-plan/plans-categories/
  6. Medicaid.gov (2015). 2015 Poverty Guidelines. Retrieved June 11, 2015 from: http://www.medicaid.gov/medicaid-chip-program-information/by-topics/eligibility/downloads/2015-federal-poverty-level-charts.pdf
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