Drug and Alcohol Rehab Coverage with Obamacare and the Affordable Care Act
Obamacare, also known as the Affordable Care Act, was signed into law by President Obama in 2010 with the goal of making healthcare coverage more accessible and affordable. Under Obamacare, health insurance providers must cover 10 essential health benefits, including mental health and substance use disorder services.1
What Is Obamacare and the Affordable Care Act?
Obamacare, also known as the Affordable Care Act (ACA), was signed into law by President Obama in 2010. As a result, it’s often referred to as “Obamacare.”
The ACA focuses on making healthcare coverage more accessible and affordable to Americans while expanding the essential benefits health insurance companies are required to provide.1
Under the ACA, each state has a health insurance Marketplace. Those without employer-provided health insurance can buy a health insurance policy in the Marketplace, which provides at least the minimum level of health coverage. Depending on your income, you may also get assistance paying the monthly premium for the coverage.2
The plans available in the Marketplace vary depending on where you live and what health insurance companies have decided to participate. If you’re interested in seeing the plans available in your area, you can enter your zipcode here.
Keep in mind that you can only enroll in a Marketplace health insurance plan during open enrollment, which occurs between November 1st and January 15th of each year. Outside of that timeframe, you have to qualify for a special enrollment period to make changes or buy a plan.3
Is There a Difference Between Obamacare and the Affordable Care Act?
No, there is no difference between Obamacare and the ACA. They are different names for the same law. People often call the ACA “Obamacare” because it was enacted and championed by President Obama.
Does Obamacare Cover Drug and Alcohol Rehab Treatment?
Any plan that you buy through the Obamacare program using the Marketplace will have at least some coverage for substance use treatment and rehab. Substance use treatment is one of the 10 essential health benefits required by the law.4
The essential health benefits that Obamacare covers are:4
- Ambulatory patient services.
- Children’s medical care.
- Emergency services.
- Hospitalization (e.g., overnight stays and surgery).
- Laboratory services.
- Mental health and substance use disorder services, including behavioral health treatment (e.g., counseling and psychotherapy).
- Pregnancy, maternity, and newborn care.
- Preventive and wellness services.
- Rehabilitative services.
The amount of coverage you can expect for each category depends on your specific plan. However, every long-term plan will provide coverage for each of the items in the list above.
Types of Addiction Treatment That Obamacare May Cover
Several types of addiction treatment may be covered by your Marketplace plan, such as:
- Medical detox: Although not always necessary, medical detox can help patients withdraw from a substance comfortably and safely. This helps facilitate the transition to ongoing addiction treatment, such as inpatient or outpatient rehab.
- Inpatient programs: Inpatient rehab programs allow patients to get help for addiction in a residential setting. Most inpatient programs involve a combination of group and individual therapy and other activities to support recovery.
- Outpatient programs: In an outpatient program, patients live at home while attending treatment at a rehab facility during the day.
- Intensive outpatient programs (IOP): IOPs are a form of outpatient program involving more frequent, longer treatment sessions. Patients in an IOP attend treatment several days a week for a few hours at a time.
- Partial hospitalization programs (PHP): A PHP offers a similar level of intensity to an inpatient program while allowing patients to live at home. In this type of program, patients usually go to treatment 5 or more days a week for sessions lasting 4 to 6 hours.
- Aftercare: Aftercare programs help ensure patients maintain recovery and identify ways to prevent relapse.
Check Your Rehab Coverage
With so many rehab options available, it’s easy to feel overwhelmed. Knowing exactly what your insurance plan covers can bring you peace of mind and make finding treatment easier. To check your insurance coverage, call the number on the back of your insurance card and ask your insurer for details. You can also fill out the form below and American Addiction Centers will review your coverage and let you know what to expect.
What Rehab Centers Take Obamacare?
Choosing a rehab program that’s covered by your insurance plan is an important way to make rehab more affordable. The Obamacare Marketplace sells insurance from several companies, and each will have its own network of medical providers.
You can determine what facilities are in-network with American Addiction Centers by verifying your coverage online. Keep in mind that we have treatment centers across the U.S. so you aren’t limited to your area.
Do Rehab Centers Need to be In-Network?
All health insurance plans have a specific provider network, and many plans do not provide any coverage outside the network. Whenever possible, it’s important to choose a rehab program that’s within your insurance network.5
Does Obamacare Cover Mental Health Treatment?
Yes, Obamacare covers mental health treatment. In fact, the Obamacare law represents one of the biggest expansions in the coverage of mental health and substance use disorders in many years.
Because mental health is considered an essential benefit, it must be covered by all long-term health plans, including those sold through the Marketplace. More importantly, mental health and substance use need to be covered at the same level as other medical care provided by the plan.6
How Much of the Rehab Cost Does Obamacare Cover?
The amount of coverage you will receive depends on your specific plan and the level of coverage it provides. Plans that cover more of the cost generally have a higher monthly premium, while lower-premium plans may have higher out-of-pocket costs for you.
The Obamacare Marketplace offers several tiers of health plans, divided into “metal” categories. A bronze plan covers approximately 60% of your medical costs, while you pay 40%. These plans have the lowest monthly premiums. Silver plans cover an average of 70% of your costs, and Gold plans cover an average of 80% of your costs. The plans with the highest monthly premiums are Platinum, which covers 90% of your costs while you pay 10%.7
What Should I Do If the Cost of Rehab Is Not Fully Covered?
While health insurance can help with the cost of rehab and treatment, it may not cover the full cost. Fortunately, there are other ways to cover your out-of-pocket costs.
Some facilities offer sliding scale fees in which they will work with you to establish treatment fees based on what you can realistically pay. Other facilities offer payment plans and scholarships to help pay for treatment. Although paying for rehab treatment may feel overwhelming, getting the help you deserve is a priceless investment in yourself or a loved one struggling with substance use. Getting your life back and breaking the cycle of addiction is priceless.
If you are looking to learn more about addiction treatment or have questions about your insurance coverage, you can contact American Addiction Centers 24 hours a day at