Unless you’ve been living under a rock the past month you’re aware that Congress has tried, and failed, to replace “ObamaCare.”

The fluid state of insurance coverage is leaving many addicts and alcoholics puzzled over what their insurance does and does not cover.

If you’re ready to give up a life of addiction and find out what sobriety is about, there is help. Many addicts and alcoholics have access to insurance through a spouse or employer. Many don’t. For those lucky ones, a thorough review of your health coverage will tell you what to expect in terms of treatment and aftercare.

While it’s impossible to adequately cover all the ins and outs of insurance for addiction treatment, three areas should be considered.

These are:

  • Which addictions are covered, and
  • Mental health issue coverage, and
  • Insurance for maintenance programs

What Addictions Are Covered

HealthCare.gov shows insurance offered in the market must provide care in ten essential health categories. One of those areas is an addiction.

Most policies don’t separate addictive substances into ‘covered’ and ‘non-covered. Once addiction treatment is considered a covered benefit, then coverage is available to anyone with an addiction, regardless of the cause of that addiction.

One example. Some persons develop obesity through overeating. Others gain weight from hormonal or glandular abnormalities. Health insurance plans that include a weight-loss benefit won’t cover one type and eliminate the other. If the insurance carriers discriminated as to the reason for weight-gain, plans would need to cover sophisticated tests to determine the underlying cause of the obesity. The tests would cost additional money, so by covering all obesity treatment; the carrier saves money.

The same goes for addictions. Plan providers don’t want to provide in-depth testing and conduct interviews about what drugs were used or what they may be combined with. Plans keep it simple by covering all drugs.

Mental Health Issues

The Affordable Care Act, ‘ObamaCare,’ doesn’t stop with addiction. The government required policies to provide an equitable level of care for mental health that they do for physical health. For instance, plans that provide for physician visits to a podiatrist for $20 must provide physician visits for depression for $20. Care and cost must be the same.

The American Psychological Association (APA) determined that the parity rules apply to all program types, including ones offered by employers as well as ones coming through health care exchanges or Medicaid.

Parity laws don’t state specifically the types of mental health conditions must be provided, but the rules are similar to those found in addiction treatment. If a plan provides for mental health, they can’t specify that some are covered, and others aren’t.

Maintenance Programs

Maintenance programs are for people who can’t reach a normal level of function without drugs even if they’ve gone through a rehab program. Chemical variations triggered by drugs are often too severe, and medications are needed to correct the imbalances.

Maintenance medicines such as Suboxone, buprenorphine or Antabuse are for people with these types of concerns, but the medications can be expensive. Most experts encourage insurance plans to cover these drugs.

For example, the National Alliance of Advocates for Buprenorphine Treatment says most health insurance policies handle maintenance drugs for people in recovery from heroin, or similar drugs. The group doesn’t specify how many plans provide the coverage or discuss copayments.

On the other hand, the Substance Abuse and Mental Health Service Administration says Medicare and Medicaid plans cover these medications only if their use is deemed vital for the sustained health of the individual in recovery. If the individual is determined to be capable of healing without the medicine, coverage typically isn’t provided.

Obligatory Disclaimer

If you are considering seeking addiction treatment talk to a trained health care provider. Let them review your insurance policy and tell you exactly what you are covered for.

Talk with your insurance carrier, they have support personnel standing by on their helpdesk to help negotiate the insurance maze.