Does Obamacare pay any part of in-patient alcohol treatment ?


Answer

Mental health, including substance abuse disorders (drug and alcohol) are covered on all non-grandfathered plans as part of ten essential health benefits. These services include treatments such as psychotherapy and counseling. They also include mental and behavioral health inpatient services and substance use disorder treatment. So yes, under ObamaCare inpatient addiction services are covered, as are other addiction services, but as we will discuss below they are often subject to cost sharing.

Under the ACA you can no longer be denied or charged more for care (due to receiving addiction, mental health, or behavioral services) and can no longer be barred from care due to annual or lifetime dollar limits... but not every plan covers this services to the same extent and plans can offer different cost sharing on each.

Mental, behavioral, and addiction services are not covered at no out-of-pocket cost on most plans. Rather you will owe the cost sharing amount determined by your plan for treatment considered in-network. You'll want to check with your insurer to see networks, what is covered, allowed dollar amounts, allowed number of services, and under what cost sharing amounts things are covered. The above being said as a rule of thumb insurers must offer "parity protections for mental health services".

Parity protections for mental health services

Non-exempt plans must provide certain “parity” protections between mental health and substance abuse benefits on the one hand, and medical and surgical benefits on the other.

This means that in general, limits applied to mental health and substance abuse services can’t be more restrictive than limits applied to medical and surgical services. The kinds of limits covered by the parity protections include:

  • Financial, like deductibles, copayments, coinsurance, and out-of-pocket limits
  • Treatment, like limits to the number of days or visits covered
  • Care management, like being required to get authorization of treatment before getting it

This may seem less attractive then it simply "covering everything", but remember before the ACA it was very common for addicts not to be able to get the help they needed due to lacking insurance. Before the ACA you either needed a good health plan or you needed to be on Medicaid to get help with addiction through a medical provider. This left millions of addicts hiding their addiction and not getting the medical help they needed. Coverage may still be lacking today, but by keeping a focus on the importance of treating substance abuse disorders and expanding health care reform it can continue to improve.

Each year, untreated addiction costs the country 420 billion dollars due to health care, criminal justice, and lost productivity costs. The ACA helps to reduce the cost of healthcare spending and federal spending by addressing mental health and substance disorders.

Learn more about ObamaCare and substance abuse here and here.

Or learn about what is covered from HealthCare.Gov

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Michelle on


Answer Rating:

Our daughter is a drug addict. She is addicted to Meth, Xanax, Hydrocodone and Ambien. She has also been diagnosed with Bipolar and a few other things. Therefore we are in desperate need of a very long Dual Diagnosis Facilty. Because if she does not get help with her mental issues, she will never stop self-medicating. She has overdosed several times and the last time, we almost lost her. She is currently in 28 day drug rehab. This is her third stay at a Rehab in the last year. She has also been to Tri-County Mental Hospital twice for suicidal thoughts.

These 28 day stays are only long enough to dry her out, and they are not Dual Diagnosis so they will never work for her. She has had two children in the last 2 years, both born addicted. The first one is with her father and the second one we have custody of. Her guilt over that is over whelming. Hence, suicidal thoughts, overdosing and taking A LOT of pills, meth, just about anything she can get.

Our problem is she does not have insurance or a penny to her name. She is homeless and lives house to house or on the street.
So, we just keep hitting brick walls with the answer always being, NO, sorry we can’t help you. Between my husband and I know we have made at least 100 phone calls and/or emails all over the country. We really would like and need is a long term dual diagnosis/ work program, but will take any dual diagnosis facility ANYWHERE. It does not have to be in Texas. We will take her anywhere. Our prayer is she could get into a long term (year or more) Dual Diagnosis Facilty, with a work program and some career training. Teach them to manage a job and to learn to manage money. Live independently clean and healthy. Lord her our prayers…

She qualifies to apply for early enrollment for obamacare. Does it cover anything like this?

Please, help. If she does not get this help soon, we will bury our daughter and her children will bury their mother. Thanks for listening…

S. & Mi. P.

ObamaCareFacts.com on

Well that is heart breaking. Unfortunately Texas and other Republican run states have continued to refuse Medicaid to low-income single adults. This ensures that those dealing with mental or physical illness have no options for care. Other states have expanded Medicaid. Technically if she changed her residence to another state she could get help. She could also get coverage through the Marketplace now starting as soon as Jan 1st, 2016. This would however require her to make at least 100% FPL or for you to add her to your family plan.

All of this being said private charities and other state assistance programs do help drug addicts. Also simple and free programs like Narcotics Anonymous can provide a support group.

Russ Watson on


Answer Rating:

Don’t let this Obamacare loving Lib LIE to you, Texas has over 130 MEDICAID DRUG AND ALCOHOL ADDICTION TREATMENT PROGRAMS IN TEXAS. Yes, that’s right, 130 who take MEDICAID AS PAYMENT. Ironically, Mr. ObamaCareFacts.com likes to make his LIES POLITICAL as well as calling them Facts? This what happens when you worship at the feet of a corrupt Politician. Dont believe me, here is the link to drug treatment centers in Texas……
http://www.addicted.org/texas-drug-alcohol-medicaid-drug-rehabs.html

ObamaCareFacts.com on

Thanks for the link. However, the point was that Texas didn’t expand Medicaid and therefore people can’t use the treatment programs due to not qualifying for Medicaid.

So her daughter can go to a drug center that accepts Medicaid, but she won’t have Medicaid for the center to accept because the “non-lib” run Texas has refused expansion to OVER ONE MILLION single adults.

I wish you were right, i’d gladly eat my words rather than know Americans were going without proper healthcare and mental health treatment due to income and politics.

http://obamacarefacts.com/obamacares-medicaid-expansion/

Lorrie on

You are in Texas.GO AFTER THE STATE LEGISLATORS,WHO…are PAID by YOUR TAXES
There are GRANTS, The Federal Government offers,for care the MOST INSURANCE Companies, “try to get out of paying for.”.
As a 22 YEAR stage 3 Cervical Cancer Survivor, I tell people…research your rights regarding your Health….as we ALL tend to do with our Money.

The Patient’s Bill of Rights, The Family Leave Act,etc
Hope this helps

Mary on

You should look at teen challenge. There is a onetime cost and it is usually only $750 and they stay 12-18 months. You should call a teen challenge in your area and talk to them about your daughters needs. Make sure you call the women’s facility bc they keep them separate from men.

chris on

Michelle there is a dual dig. treamtent center on San Pade Island in Texas…check thhem out. They have been featured on Dr Phil show

Kelly on

Kitsap county in Bremerton Washington is getting a duel diagnosis center by the end of the year, from what I have heard on the streets.

Roxanne Radabaugh on

I feel your pain and hear know what you are going through. I, myself, is a recovering alcoholic and also an addict to opiates, due to Lyme disease and a bad suicide attempt that I drove my car off a cliff in the 80’s. So I have let one addiction go for another one. I was always on a medicine when I was in school [according to my teachers and peers] that I was uncontrollable behavior in school which led to “telling” my parents to put me on a drug to control my ‘Hyperactivity’. It was called Hyperactivity back then and now it is called A.D.H.D. and so many other names. I remember crying when every morning my mom would watch me take that little pill that made me sick from the side effects of that ‘little pill’. Going to counseling 3x’s a week during school hours and my peers telling my parents that I was doing so much better. Yes, all they did was dope me up instead of trying to get to the root of my problem.
I will be 50 years old in 4 days and I also wish and pray that I can get into a treatment program to get off these opiates. I guess I am telling you this so you know that I do understand what you are going through. I have also in the 80’s, went to 2, in-house 28-30 day programs. My first one was ordered by the state after my suicide attempt and the second one was I guess you could say was a 30-day spa vacation. I feel your pain about your daughter for also my youngest son is also an addict but thank the Lord he is in a program dealing with what he must deal with every day to keep and stay clean and sober. I do feel that an addiction can be passed down through your parents’ genes.
I do recommend to you a place called the Dick Van Dyke Treatment Center in Ovid, NY. They have a website, http://www.oases.ny.gov. also, they have a facebook page. The difference in this treatment center is that they are not there to baby you or give you time out for being bad, etc. Unlike the second private, costly 30-day spa vacation place that I went to in New York. At the Dick Van Dyke treatment Center, you will work on yourself and your treatment plan can and do range up to a year. It is a state-funded treatment center, take insurance plans, the Obama Affordable Care Act program and lastly payment of cash which is based on your daughters’ income [she has none, correct?]. They will do a partial assessment over the phone of what treatment plan would be the best for your daughter. I also respected the counselors there for a majority of them are recovering addicts themselves. They really know how you feel, the sickness for the first horrify week with the DT’s and withdrawls in which you are monitored at all times. Doctor and RN nurse is on site at night time and of course during the day fully staffed.
If or when you do call them PLEASE tell them that your daughter has attempted suicide and how many times. That will help you get in very fast. Please, this is not a ‘country club/spa’ place. This is a place where you go to learn to accept, deal and cope with the problems that you have and what you have to deal with every day to keep sober and clean. I still have my “Blue Book’ that I keep in my bedroom and I pick it up and read some of the things that others there when I was there wrote about me and how well I did and what they thought my outcome would be. Some of it harsh but it is an eye opener of what you think that others thought of your participation in that program. They also help her with job skills, but, that is only if they feel you are ready.
It does sound like your daughter needs this type of treatment center. There at that treatment center, which I still to this day, keep mulling over in my mind the tools that they taught me and if or when I do slip, I pick myself up with my big girl britches and start over again.
If your daughter is really ready to get clean and sober and she wants the ‘want’ to get clean; she will be taught the tools that will get and keep her clean and sober and to learn to deal with your demons and how to go through them every day without picking up.
I am no way affiliated with this treatment center except that I can personally give you my own opinion on what the Dick Van Dyke Treatment center did for myself and my family. Remember this place is not a ‘babysitter’ for tour daughter it is a place that will help you and if you want the help they will give it to you. By the way, if she gets there she will have the opportunity to call you and tell you that she made it but after that, the first 2 weeks no outside calls. If you do in case of an emergency they give you her counselor’s name and number and you can talk with them but not with your daughter. They mean business there and they are terrific. Do not waste their time if your daughter is not ready cause there are many addicts out here that really do want the ‘want’. If your daughter goes there she will know what I am saying about the ‘want’.
Good luck with your daughter and please do not beat yourself up over her addiction. All you can do for her now is try to guide her, be her shoulder to cry on and her sounding board when she is angry or not be able to cope. Just listen to her, let her rant and rave and try not to be confrontational, as she will think you are trying to be. Remember she is in her addiction and she is not in her sound mind. She is not here in her present state, her addiction is here for her. Also, do not give her money. If she needs something, then go get it for her but please do not give her monies.
Remember to take care of yourselves also. This addiction your daughter is going through can break up a family cause of the turmoil and resentfulness that may be there. God Bless you both to stand tall and fight this thing together, head on. It is either fight or flight now are her and your options. Rely on your husband, family members, Al-Anon programs, as your husband can also be able to rely on you through this trying time. Be united as one, stand up to her and do not let her addiction do the talking to you because it is probably just a bunch of crap. Normally in the beginning of this long, hard process, her addiction will be doing all the talking and bullsh*tting to get what they want. Addicts are good manipulators always remember that. I, myself, sometimes catch myself doing that ‘stinking thinking’ to get what I want ‘NOW’, instant self-gratification; instead of earning it, being proud of what I accomplished to get what I wanted. The good old fashioned way of earning and working for it gives you the power to respect yourself and to be a responsible person in society. Really now all you can do is try to guide her, listen to her and please get her into this program there.

Ttish on

I need treatment

ObamaCareFacts.com on

If someone needs treatment they need to look outside of this site. This is an information site trying to help people understand how the ACA works. Our answer is always going to be HealthCare.Gov, public hospitals, Medicaid, local assistance programs. We are happy to answer direct questions, but anything that just states “I need help / treatment” must be directed to the proper channels.

Mary Newport on

I have an adult son that is addicted. He is not working and lives away from me, in Las Vegas, NV. I am in New Jersey. He will soon be needing detox, drug treatment and has no insurance. Where can I try to place him and have it covered. I see him hitting rock bottom and have detoxed him in my home before. I can not provide him with the help he requires. He has underlying behavioral issues and tries to self medicate. Bipolar issues run in our family. Obamacare has been a personal blessing to me. I pray that I can utilize this program to save my sons life.

Lisa Bennett on

My brother has a $7500 deductible. Would he have to come up with that money to get treatment? Its the one thing that is standing in the way of him getting rehabilitation.

Anthony Muck on

I have a friend who is covered under the affordable care act. We are trying to get her help for her alcohol problem. I see that she is covered for treatment but was wondering how much she is covered for. Is there a copay? Is there anything else I should know. Thank you for your help

ObamaCareFacts.com on

You should check with your insurer, they will point you in the right direction. Assistance should be covered, but likely not without a co-pay. You can also look into how essential health benefits work for more info.

MICHELLE on

IS IT LEGAL TO CHANGE STATE OF RESIDENCE TO OBTAIN TREATMENT IN ANOTHER STATE

Michael Perner on

I am leaning the only “Marketplace Plan” in Arizona will be Blue Cross and Blue Shield. There will be a $6,000.00 deductible. Have an adult son in Transitional Living at Chapter 5 and he received a letter that before the new policy starts in January, he must move. This jeopardizes his efforts for sobriety at this time. Where is he to go??? What happened to the competition in the Marketplace and where is the “affordable insurance,” now that we learn these new policies will cost over $400/month????