There is no question that one of the greatest challenges within the health care world remains affordability and accessibility. As the United States lags behind many other industrialized nations in terms of what is covered by public or private insurance, many U.S. citizens have experienced trouble affording basic health care services. Sadly, lack of care has happened in many areas, including rehabilitation for many types of substance use disorders.
Thankfully, over the past few years, many insurance companies have gotten more aggressive about covering drug and alcohol rehabilitation. This includes many forms of public and private insurance.
Recent Insurance Changes and Rehabilitation Services Access
The health insurance market has changed dramatically over the past decade. In many ways, these have been positive changes for consumers who are in need of coverage for substance abuse treatment, as a variety of changes have expanded their access to that coverage. Furthermore, these changes have ensured that people who have received treatment for a substance use disorder cannot be denied coverage due to having received treatment. However, while positive changes have been made, there is still a wide degree of disparity in the insurance world, and some plans go much further than others.
Recent changes to insurance law have required that all new insurance plans offer ten essential health benefits. These benefits included mental health and substance use disorder services. These same changes have also made it so that that lifetime limits cannot be placed on the coverage given to people who require rehabilitation. That is not to say that there will be no copays or deductibles because both of those are absolutely still a part of the private health insurance world, and indeed, they can be costly. However, rehabilitation stays must be covered.
These are all federal requirements and not state ones. However, the federal government sets the minimum requirements for insurance coverage. States must adhere to these requirements, but they may make additional requirements when it comes to what insurance companies that operate within their borders must cover. As such, states can require additional services to be covered within the realm of substance abuse rehabilitation. For example, in late 2020, the state of California defined the phrase “medically necessary.” This requires insurance companies to cover any procedure that is deemed medically necessary as set by non-profit groups like the American Society of Addiction Medicine. California has gone further than most other states within the realm of expanding insurance coverage, but all states are free to make additional requirements.
Furthermore, a variety of treatment modalities that may be related to substance abuse must be covered by policies sold in the current health exchange. This includes mental health treatment, hospitalization, prescription drug coverage, and more.
The same changes to the law that made modifications about what must be covered by insurance companies also expanded protections for the tens of millions of Americans who have suffered from some sort of preexisting condition. These preexisting conditions could be any number of illnesses endured by people and could include a wide variety of physical or behavioral illnesses. Such a condition could mean that an insurance company would choose not to insure someone, citing the individual as too much of a risk. One such example of a preexisting condition is drug or alcohol addiction. However, thanks to recent legal changes, individuals who had previously been treated for some sort of addiction could still get insurance without having to worry about not qualifying due to their preexisting conditions.
Public Insurance and Rehabilitation
The vast majority of Americans have some sort of private insurance. However, individuals who are too impoverished to afford private insurance or who are older will usually use one of two different types of programs: Medicare or Medicaid. These popular programs, which have been around since the 1960s, have long served as the backbone of our social safety network, ensuring that tens of millions of Americans do not fall through the cracks and can receive the health insurance coverage that they so desperately need. Most recent estimates show that 44 million Americans are currently enrolled in Medicare, the health insurance program for the elderly. Another 78 million are enrolled in Medicaid.
As such, the question of substance abuse rehabilitation for public insurance impacts well over one hundred million Americans.
Medicare provides coverage for individuals who are experiencing a substance use disorder. This includes a variety of services, such as screening, therapy, testing, family counseling, and inpatient stays. The specifics of the coverage will vary depending on a variety of factors, such as what plan you have and whether you are on Medicare Part A, B, or C. Furthermore, there may be limitations about who you can see, and you will absolutely have to meet deductibles and make copays. These out-of-pocket costs can be expensive and potentially prohibitive. Furthermore, some support services, like transportation, are not covered. The importance of transportation to services cannot be understated, so this lack of coverage may require you to make alternative arrangements in order to get to the facility in question. Thankfully, broadly speaking, individuals who are on Medicare can absolutely get access to the help they need.
As Medicaid covers even more patients, the question of whether or not it covers substance use disorders and rehabilitation stays is even more important. The answer, thankfully, is yes. While the specifics are left to the 50 states that partially fund Medicaid, states are required to work with the federal government to develop benefit options that cover inpatient stays in rehabilitation facilities. As noted by the federal government, 12% of all Medicaid beneficiaries actually have a substance use disorder, meaning that this is a major area of concern for all Medicaid patients.
Changes to Medicaid expansion have made a huge difference in the lives of people who were seeking health insurance coverage. One of the most critical health insurance movements of the past 10 years has been the expansion of Medicaid. Medicaid provides insurance coverage for low income Americans, and recent expansions increased the income limits for people who were eligible for this critical government service. This expansion resulted in a huge uptick in Medicaid’s numbers.
Originally, states essentially had no choice but to expand their Medicaid enrollment. However, the United States Supreme Court decision in the National Federation of Independent Businesses vs. Sebelius case ruled that this mandate was unconstitutional. As such, states were given the option to expand Medicaid or not. An increasing number of states have done so. At the moment, 39 states – including Washington, D.C. – have expanded Medicaid.
This expansion has had a major impact on the lives of many people who are on Medicaid and who are seeking access to substance abuse rehabilitation treatment. Because an estimated 21 million people in America suffer from substance use disorders, but a mere 13% receive treatment, any expansion of health care access is bound to result in more people being able to afford rehabilitation facilities.
This Medicaid expansion did succeed in getting more low-income people access to the rehabilitation services that they need, resulting in an uptake in service use among this population. That, in turn, has led to lower rates of addiction and death among people who had traditionally not been able to afford services. It is also worth noting that states that did not expand Medicaid did not see similar increases in substance abuse treatment.
However, Medicaid expansion has not just expanded access; it has also expanded access to certain types of programs and rehabilitation facilities. Medication-assisted treatment is a scientifically supported method in which people who suffer from opioid use disorder are given medication to help ween them off of drugs and manage cravings.
According to studies of states that expanded Medicaid, the court system began to refer more individuals who had involvement with the criminal justice system for medication-assisted treatment, helping individuals who would not otherwise have access to high-quality services get the help that they needed. This is critically important because people who are engaged with the criminal justice system often lack the resources or the support to get the help they need, despite the fact that people who have been arrested for crimes often suffer from some sort of mental illness or substance use disorder.
Despite the robust treatment options that many plans offer, it is clear that not all Americans will be able to afford the help that they so desperately need, particularly if they are uninsured, underinsured, or have other financial difficulties that may make getting access to care impossible. Thankfully, these barriers have been experienced and overcome by millions of Americans, and many rehabilitation facilities offer additional options that can ensure that all people get the help that they need.
If you need additional assistance in affording a rehabilitation stay or in ensuring that your family is financially protected while you get the help you need, your best bet is to call the facility in question and to find out what options they may have available. Many rehabilitation facilities are able to work out payment plans with individuals to ensure that they get the help that they need while also making payments.
Furthermore, some rehabilitation facilities can give you some sort of uncompensated care, meaning that you won’t have to pay for the full value of the treatment that you receive. This obviously varies from facility to facility, but it is always worth making a phone call and finding out what sort of options are available.
Finally, if your time in a rehabilitation facility will result in your family losing money, make sure you work with the facility to find out what sort of social service programs may be available to your family. Many facilities have ample experience in this area and have worked with patients to ensure that their families are financially cared for during the rehabilitation stay.
Money and insurance should not be a barrier that keeps people from getting the help that they need. While there are major issues that must be addressed, it is clear that insurance companies and rehabilitation facilities have the capacity to help ensure that you are financially covered during this difficult time.
If you are looking for a high-quality rehabilitation facility for your substance use disorder, you’re in luck. First Recovery Center is available to help you receive treatment for numerous types of addictions, traumas, or post-traumatic stress disorders. We offer a variety of levels of care and take many types of commonly accepted insurances. Don’t wait. Call us today at 877-595-3330.