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What You Need to Know About the Affordable Healthcare Act


Sober Recovery Expert Author

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You’ve likely heard about the Affordable Care Act of 2010, which is a federal overhaul of the existing American healthcare system that seeks to provide cheaper and more widely available health insurance coverage to Americans. As you know, addiction and its impacts cut across all demographic divides including race, gender, income, religion and, yes, even the partisan divide. Wherever your political leanings lie, the reality is that for the majority of persons struggling with addiction, or struggling to help someone else battle addiction, getting help trumps political ideology. Fortunately, several provisions in the Affordable Care Act will help addicts in active addiction obtain coverage for treatment centers and recovery addicts receive post-rehab treatment. The most critical provisions included in the ACA for addicts seeking treatment, those seeking treatment on behalf of addicts and for people in recovery are:

Mandatory Health Care Coverage for Substance Abuse Treatment

The Affordable Care Act explicitly includes substance abuse treatment as one of ten mandatory health coverage services that must be provided by insurers participating in state exchanges or benefiting from federally funded programs, such as Medicaid. In short, for all public and public-private insurance company providers, addictions and substance abuse treatment coverage must be provided.

Several provisions in the Affordable Care Act will help addicts in active addiction obtain coverage for treatment centers and recovery addicts receive post-rehab treatment.

No Denials of Coverage for a History of Substance Abuse or Mental Health Issues

Prior to the Affordable Care Act, insurers were able to deny coverage to people with pre-existing conditions, especially those with a previous history of substance abuse issues. Not too surprising considering the exorbitant costs of rehabilitation centers (nevermind the healthcare costs related to active addiction). Now, the ACA forbids insurance companies to deny coverage for a pre-existing condition. This includes conditions such as a history of addiction or even active addiction itself. However, the Act does not define exactly the costs of insurance coverage or the length of treatment covered by an insurance company. Ultimately, each individual health insurance policy plan will dictate the terms and conditions of treatment center or post-rehab counseling coverage.

Retroactive Coverage and Free Assessment and Referral Options in Certain Cases

Addicts in active addiction aren’t exactly the most fiscally responsible group when it comes to maintaining and prioritizing healthcare coverage. This poses a problem as you have to be insured to take advantage of the insurance benefits mandated under the ACA. However, certain state-specific coverage plans for youth and impoverished demographics allow eligible recipients to retroactively claim coverage benefits. In other words, a person can enter treatment immediately if he or she is actively working on obtaining coverage under certain state-specific healthcare programs or related federal programs such as Medicaid. Most insurance programs deriving whole or partial funding from the federal government provide preventative screening and assessments for substance abuse and can offer them without cost to eligible patients. In other words, there is now no co-pay or other costs required in order to obtain a substance abuse assessment and referral to an appropriate addictions treatment venue if needed.

Mandatory Coverage of Children Up to the Age of 26

As many of us know from attending support groups, the youth are especially impacted by substance abuse and addictions issues. A critical provision in the Affordable Care Act includes mandating that carriers extend dependent coverage to the age of 26. That is, a child is covered under his or her parents’ existing insurance plan, whether private or public, until they turn 26 years old. For parents, or people struggling to afford the prospects of long-term recovery, this provision gives ample grounds to seeking treatment before addictions get too far.

Equal Coverage for Mental and Physical Health Issues

In the past, insurance companies would regularly elect to cover--or not cover at all--mental health and addictions issues in a much smaller capacity than any other traditional medical issues in terms of co-pay, length of coverage and possible denial of claims coverage. Parity Protections enshrined in other healthcare reform laws (Mental Health Parity, Addiction Equity Act and now the Affordable Care Act) mandate that all insurers, whether private or public, provide benefits coverage for mental health and addictions treatments in a comparable or equal manner to other essential healthcare matters such as primary physician visits, maternity or other conditions lacking the stigma often associated with addiction and substance abuse issues. In this sense, the Affordable Care Act enshrines into law the prevailing notion that addiction is a disease and not a moral failing, which often times requires outside medical help.

For the addict in recovery considering professional help outside the rooms, post-treatment care better defined as psychological, psychiatric or ongoing counseling services is also included under Parity Protections, often times falling under the catch-all category of mental or behavioral health services. These services now fall under the same costs and benefits in terms of length of treatment coverage as any other traditionally-defined medical issue.

Easier Access to Help

To many addicts, maintaining health insurance coverage lost its priority or affordability a long time ago. This is understandable for the active addict but with the Affordable Care Act they can now reach out and get the help that they need. For current people in recovery, taking responsibility may require acknowledging the need for outside help, which may also mean taking necessary steps in making it financially feasible.

Like many things facing people in recovery, the help that you need is out there waiting for you. All you have to do is ask.

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