Rehab Centers That Accept Obamacare (Affordable Care Act) Insurance

Overcoming a substance use disorder (SUD) is a challenging feat, and many people find that outside help supports their overall goal of recovery. Rehab programs are a great option and are often covered partially or in full by insurance companies.

RehabNet provides confidential and free assistance to help you achieve your recovery goals by finding a treatment program that’s within your insurance’s network and meets your unique needs. Reach out to our helpline today to learn more or use our RehabNet treatment locator to search on your own.

Substance use disorders are a growing epidemic in the United States, and more and more people are seeking help to recover. The Affordable Care Act (ACA), commonly known as Obamacare, mandates addiction treatment as an essential health benefit in its various plans.

Obamacare itself is not a health insurance plan, but is a United States health law that improved accessibility to affordable healthcare coverage. For example, the ACA created the online Marketplace to allow individuals to obtain private coverage at a reasonable price. It also broadened Medicaid eligibility for those who can’t afford private insurance plans.

All ACA healthcare insurance plans are required to provide various benefits, including substance use disorder treatment. Because each Obamacare plan is different, the specific Affordable Care Act addiction treatment covered will vary. By offering this type of coverage, ACA plans help individuals access affordable rehab care, including detox, therapy, and medication-assisted treatment.

There are various options when it comes to ACA insurance plans, including HMO, PPO, POS, and EPO plan types.

Here’s a breakdown of each type of plan you may find in the Marketplace:

• Preferred Provider Organization (PPO): This plan includes a network of pre-selected preferred providers that offer reduced costs to consumers. Many PPO plans don’t require individuals to select a primary care physician like other plans, and some don’t require specialist referrals.
• Health Maintenance Organization (HMO): This plan offers health coverage within a network similar to PPO, but typically comes with fewer provider options. You may also be required to have an in-network primary care physician for referrals for specialty services like addiction treatment.
• Point of Service (POS): This type of plan utilizes HMO and PPO features to provide healthcare flexibility at a reduced cost.
• Exclusive Provider Organization (EPO): An EPO only provides coverage for providers in-network for non-emergency healthcare needs.

Most plans include metal tiers that dictate the premiums, deductibles, and other specifics of ACA coverage.

These tiers include:

• Bronze: This tier offers the most affordable premiums but has the highest out-of-pocket rates for healthcare services.
• Silver: A silver tier provides coverage with moderate out-of-pocket expenses and premiums.
• Gold: This option offers individuals lower out-of-pocket rates with a higher premium.
• Platinum: A platinum plan typically has the lowest out-of-pocket costs with the highest premium of all plans.

Various insurance companies offer Obamacare health plans, with some of the most popular being:

• Blue Cross Blue Shield
• Aetna
• Kaiser Permanente
• Molina
• Cigna
• United Healthcare
• Ambetter
• Magellan Behavioral Health Insurance
• Optum

When looking at your plan, it’s important to understand the difference between premiums, deductibles, and out-of-pocket costs. Out-of-pocket expenses are what you’re responsible for paying upfront for a service, and typically won’t be reimbursed by your plan. A deductible is what you pay before your marketplace rehab insurance plan covers any substance use disorder treatment or other services. Once your deductible is met, many plans begin paying more or covering services fully. A premium is typically the monthly amount you pay to carry the plan and receive coverage.

All ACA plans must provide substance use disorder services as part of the 10 essential services covered under Obamacare. Each plan is required to provide parity with medical coverage, which means that any substance use disorder coverage must be equal to the ACA mental health coverage offered through the plan.

Common Obamacare addiction treatment benefits and coverage include inpatient and outpatient drug addiction treatment, detox services, various therapies, and medication-assisted treatment programs.

The specific plan you have will determine the amount of coverage and treatment options covered by your insurance provider. Luckily, many treatment facilities accept a range of Obamacare plans. RehabNet can help you find the best fit for your specific needs.

There are various addiction treatment options with ACA plans. It’s important to work with a specialist to determine the best substance abuse treatment for you.

Common services that Obamacare insurance covers include:

• Medical detox: Medical detoxification services often require individuals to remain at the site of the facility throughout the period of their detox. Individuals are closely monitored by medical professionals to ensure safety and comfort through the detox process.
• Inpatient treatment: This type of treatment includes a residential stay at a drug or alcohol rehab program for a certain amount of time, most typically 30 days.
• Medication-assisted treatment (MAT): MAT is often seen in disorders such as alcohol addiction and opioid use disorder and includes a combination of medication therapy and behavioral therapy.
• Intensive outpatient programs (IOP): Intensive outpatient rehab programs provide alcohol and drug abuse treatment on an outpatient basis, meaning the individual is not required to stay on property for an extended period. Components of an IOP typically include individual therapy for substance use and mental health disorders, group counseling, and family counseling.
• Partial hospitalization programs (PHP): PHPs are more intensive than IOPs but still allow individuals to return home each day after treatment. For example, a person may participate in treatment services for eight hours every day from Monday through Friday. This may be a good option for those requiring less intensive rehab treatment or those transitioning from an inpatient rehab facility to further support recovery.
• Therapy: Therapy may include individual, group, and family counseling for drug addiction. Examples of therapies used to treat SUDs include cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT).
• Dual diagnosis treatment: This type of treatment aims to provide both substance abuse and mental health services for those with co-occurring disorders like anxiety and depression.

Each plan may vary in terms of insurance coverage for different types of treatment.

Various factors affect your rehab eligibility with ACA insurance. Understanding factors affecting ACA rehab coverage can help you make a more informed choice based on your unique needs and health insurance provider.

Common things that impact substance use disorder insurance benefits include:

• In-network vs. out-of-network providers: Most health insurance Marketplace plans include discounts when policyholders use in-network providers. This means that in most cases, choosing inpatient or outpatient treatment within your plan’s network will save you money or even be no cost to you, depending on your insurance policy. However, many plans do not offer out-of-network coverage. Being familiar with inpatient and outpatient care options that fall under your policy’s network can help ensure you know whether you’ll receive coverage or not.
• Preauthorization requirements: A prior authorization or preauthorization requirement is when an insurance policy requires the provider to seek authorization from the insurance company before providing coverage for a service. Any plan can require prior authorization, but it is seen in HMO plans.
• Medical necessity assessments: A medical necessity assessment analyzes a service or treatment based on the policyholder’s condition and needs. This is a requirement for some plans, such as Medicaid, to greenlight coverage for SUD treatment. Each plan has different requirements and will vary from state to state.
• Tier of the plan: The tier of the plan—such as bronze, platinum, silver, or gold—will also play a role in your overall cost of rehab or other SUD treatment options due to varying coverage percentages offered in each tier.
• State-specific mandates and regulations: Different states have unique mandates and regulations for insurance companies in relation to paying for substance use disorder and other healthcare treatment. For example, California, Colorado, Connecticut, Delaware, Illinois, Maryland, New Hampshire, New Jersey, New York, North Carolina, Rhode Island, Tennessee, Texas, Washington, and West Virginia all require state-regulated commercial healthcare insurance policies to utilize particular level-of-care tools like medical necessity assessments to decide if SUD treatment is necessary for a policyholder. They will then offer coverage based on this decision.
• Income-based subsidies: Income-based subsidies are offered by ACA plans to help minimize or eliminate premium costs for those who can’t afford them. These are based on income and may include an Advanced Premium Tax Credit (APTC), a Cost-Sharing Reduction (CSR), or both. If you have an insurance-based subsidy for your insurance plan, you may pay less for treatment.

Most ACA plans restrict rehab programs and other SUD treatment coverage to in-network healthcare providers and services. This is especially true with HMO and EPO plans.

Some plans, such as PPO plans, may provide partial reimbursement for out-of-network drug addiction rehab programs. This may include both outpatient and inpatient services.

Most emergency treatment services are covered regardless of whether the provider or facility is in or out of network. However, every plan varies, so it’s important to familiarize yourself with the specifics of your policy.

To check a provider or facility network status, you can log in to your healthcare insurance company portal. Most companies provide a tool that allows you to search for providers and gives details on whether they are in or out of network. You can also call the number on the back of your insurance card to speak with a representative.

If you believe you were wrongly denied coverage for treatment, you can ask for an internal appeal directly through your insurance provider. Your ACA rehab coverage appeal will be reviewed, and you’ll be given an answer. If you’re not happy with that answer, you have the right to seek the opinion of a third party, known as an external appeal.

There are several Obamacare plan types to choose from to best suit your budget and medical needs. Common plan categories to consider include:

• Bronze: This tier offers the most affordable premiums but has the highest out-of-pocket rates for healthcare services.
• Silver: A silver tier provides coverage with moderate out-of-pocket expenses and premiums.
• Gold: This option offers individuals lower out-of-pocket rates with a higher premium.
• Platinum: A platinum plan typically has the lowest out-of-pocket costs with the highest premium of all plans.

Bronze and silver plans are often best for those with low medical needs due to their higher out-of-pocket costs and deductibles. If you have a bronze or silver plan, you may be required to meet your deductible before you receive any coverage for addiction treatment. This means you will likely pay the most out-of-pocket with these plan types.

A representative with your healthcare insurance company can walk you through your coverage and benefits and answer any questions you may have about your financial responsibility for substance use disorder services.

The covered substance use disorders with Obamacare are those that are diagnosable by the Diagnostic and Statistical Manual for Mental Health Disorders, 5th Edition (DSM-5).

These disorders include:

• Alcohol Use Disorder
• Opioid Use Disorder (heroin, fentanyl, oxycodone)
• Stimulant Use Disorder (amphetamines, methamphetamine, cocaine)
• Sedative, Hypnotic and Anxiolytic Use Disorder (Valium, Xanax, Ambien)
• Other Hallucinogen Use Disorder (LSD, Ketamine)
• Cannabis Use Disorder
• Phencyclidine (PCP) Use Disorder
• Inhalant Use Disorder
• Prescription medication misuse
• Dual diagnosis and co-occurring mental health disorders, such as depression and anxiety

If you or a loved one suffers from addiction to any of the above substances, you are likely eligible for treatment that is at least partially covered by your Obamacare insurance plan.

Most Obamacare insurance plans provide online directories that include treatment centers accepting your ACA plan. This is typically found once you log in to your portal. State exchange websites can also be of help during this search process.

Additionally, you can call the number on the back of your insurance card to reach a representative who can further help you find addiction services that are within the network and meet your needs. They can also help you understand what will be covered and what won’t, as well as verify your coverage and the facility or provider’s in-network status.

RehabNet also offers a tool to search for rehab centers by using your zip code and provides information on centers that include accepted insurance and treatment types offered.

If you’re unsure of whether a treatment facility accepts your insurance, you can reach out to your insurance company or to the facility directly for verification. You can also rely on RehabNet to verify your coverage and a facility’s in-network status, free and confidentially.

The following are commonly asked questions about ACA insurance plans and substance use disorder treatment:

Getting help for a substance use disorder is a huge step, and RehabNet is here to support your journey. We are a free and confidential resource, and our only goal is to assist you in finding the most appropriate treatment services or facility for your specific needs and insurance coverage. You can use our free online RehabNet rehab directory to search for facilities by ACA plan type, specific substance of abuse, location, insurance plan, and treatment level. You’ll also gain access to expert guidance to verify coverage and place you in a qualified facility.

You don’t have to suffer any longer, and you don’t have to seek recovery on your own. Reach out to RehabNet today to learn more about how we can help you on your journey.