If you are struggling with an addiction, you are not alone. According to the National Institute on Drug Abuse, an estimated 23.9 million Americans age 12 or older had used an illicit drug in 2012 (the latest year of recorded data). However, only a small number of those people—about 2.8 million—got the addiction treatment help they needed according to the. Those who make the choice to find treatment options for their addiction may find themselves confused and overwhelmed by the terminology and lingo used by most insurance companies. However, by knowing just a few basics, you can find out the information you need from your insurance provider when you call about your benefits related to addiction recovery.
Mental Health Coverage vs. Physical Health Coverage
In 2010 the United States enacted the Mental Health Parity and Addiction Equality Act, also known as Parity Law. One of the most significant portions of this law pertains to mental health treatment. Under this law, health insurance companies must offer equal coverage for physical health and mental health including substance abuse treatment. An insurance company can no longer require higher copays or deductibles for mental health treatment, and it cannot set separate visits or overnight stays for inpatient drug treatment. In other words, if your insurance company will allow 30 overnight stays in the hospital for a medical problem per year, then it must allow 30 overnight stays per year for addiction treatment. If your insurance company offers you fewer days for treatment or requires higher copays or premiums, they are breaking the law.
The Affordable Care Act and Addiction Treatment
In 2010 the U.S. government enacted the Affordable Care Act (ACA). According to the Office of National Drug Control Policy, the ACA requires insurance companies on the Health Insurance Exchange to include services for substance use disorders like addiction beginning in 2014. The ACA also prohibits insurance companies from creating lifetime limits on coverage. This means that if you have gone to treatment before, you can still go to treatment again in another year, but each year has a limit on visits. If you relapse, which is common, ten years from now, you will still be able to utilize the addiction treatment benefits provided by your insurance company. The Affordable Care Act also requires Medicaid to follow the same treatment mandates.
Premiums, Copays, and Deductibles
Before you call your insurance company, familiarize yourself with some of the basic elements of any health insurance plan. This working knowledge will give you confidence as you talk with your provider. Knowing the terms can also cut down on any miscommunication. Terms to know when calling your insurance company include the following:
- Premium – This term refers to the amount of money you pay to keep your life insurance. Most insurance companies will allow you to choose your payment schedule: monthly, by quarter (every three months), or yearly. If you fail to pay your premium, your insurance company will drop you from coverage and you will have no insurance. Typically the higher the premium, the lower the deductible and lower the copays. The lower the premium, the higher the deductible and copays.
- Deductibles – A deductible is the amount of money that you must pay out of pocket before your insurance will begin to pay all or part of your medical or mental health bills. For example, your insurance company may set your policy with a $500 deductible. This means that you must pay $500 for your addiction treatment before your insurance benefit will begin to pay for services.
- Copays – This is the amount of money you are required to pay for each visit to a doctor or mental health professional. You may be required to pay $25 each time you visit a doctor, and then the insurance company will pay a percentage of all of the remainder of the bill.
The cost of your insurance is based on the benefits you receive. Lower benefits result from cheaper insurance. Many young adults prefer this option since they are healthy and rarely need medical attention. When you talk with your insurance provider about addiction treatment, the service representative will likely use these terms.
Limits of Coverage
In the past insurance companies could set yearly dollar limits for mental health services like addiction treatment. It could also set a lifetime limit. Because of the Affordable Care Act, insurance companies that participate in the Health Insurance Marketplace, and most major insurance companies do, cannot set yearly or lifetime dollar limits. Additionally, insurance companies can no longer deny you coverage for addiction treatment because you have a history of substance abuse, called a preexisting condition. Companies cannot charge you more for treating a preexisting condition either. If your insurance company tries to set these limits, they are in violation of the law.
Getting Help for Your Addiction
If you or a loved one is struggling with an addiction to drugs, we can help. You can call our toll-free helpline anytime, 24 hours a day, 7 days a week. You can discuss your situation with one of our admissions coordinators. Together you can determine the best treatment options for your life situation. We can also do a cursory check of your insurance benefits for addiction treatment. Don’t let an insurance company scare you out of getting help. Call us today, and start on your recovery path.