Considerations for Health Insurance for Rehab Before Addiction Strikes - ATS

Addiction is a pervasive and all-consuming disease. No one plans on becoming addicted or needing to use rehabilitation or detox services, yet thousands of Americans use these services each year.

No one plans on dying unexpectedly or incurring serious injuries, yet we purchase life insurance and disability insurance for protective purposes. This is exactly what our health insurance does for detox. It helps us pay for the unforeseen, which may include addiction treatment and detox services.

Addiction Treatment Is an ‘Essential Service’

The Obama administration passed the Patient Protection and Affordable Care Act (ACA) in 2010 – also referred to as “Obamacare.” The administration established a number of so-deemed “essential” medical services under this law. When a medical service is “essential,” insurers must pay for all or at least a portion of these costs.

One of the most groundbreaking aspects of this rule was making addiction treatment services essential. Previously, insurers often refused to pay for addiction treatment, using the justification that “you made your bed, now you get to lie in it.”

Fortunately, the provisions of the Affordable Care Act recognize addiction for what it actually is – a complex medical condition that affects victims physiologically as well as psychologically. In fact, the physiological addiction caused by some substances can be so strong that attempting to stop on your own can lead to dangerous consequences. Alcohol withdrawal, for example, can lead to debilitating or life-threatening seizures.

Is Rehab Covered by Insurance?

Addiction treatment services are essential, but people might wonder if they can still get health insurance for rehab. The simple answer is that any plan, regardless of its level, will offer some assistance with addiction treatment costs. The amount that your insurance company pays will depend on your level of coverage.

The Affordable Care Act recognizes that it’s unrealistic to expect anyone, especially those struggling with addiction, to pay thousands of dollars for rehabilitation costs. When shopping for health insurance, it’s a good idea to look at the percentage of rehabilitation costs your plan may cover.

Who Should Plan for Addiction Treatment?

Everyone should plan for the unforeseen, even if it doesn’t seem in the realm of possibility. It’s essential to understand that addiction can develop unexpectedly, even in an unexpectant individual. Say, for example, that you have a surgery or medical procedure that requires narcotic painkillers. An addiction to these potent substances can develop quickly, and even lead to heroin addiction.

In our scope of practice, we often run into individuals who are “surprised” by their or their loved one’s addiction. Having peace of mind that you have access to treatment for heroin addiction helps you plan for the unanticipated.

Another aspect to consider is young adults aged 18 to 27. This age group is allowed to stay on their parents’ insurance under the Affordable Care Act, though some may elect to establish their own policies. Though no parent wants to think about children developing an addiction, this is a period of experimentation.

Teenagers and young adults often experience their first exposure to alcohol and other drugs in this time period. Even moderate alcohol use can develop into a full-blown addiction within this vulnerable age range, so learning about alcohol addiction treatment centers in the area and if your insurance will cover them is essential.

Taking a Proactive Approach

There’s a chance you’ll never have to use your addiction therapy coverage – but it’s essential to be prepared in the event that you do. Research rehab facilities in your area that take insurance and seek a program that will provide affordable, high-quality addiction treatment services.

It’s best to plan for these contingencies while you’re switching or shopping for health insurance coverage. As a general rule, the higher your premium, the more extensive the coverage. For example, a plan with a higher premium may cover 75 percent of the cost of rehabilitation, while a lower premium may only cover 60 percent.

Your best plan will depend on your budget and other health needs. Ask your insurance company specifically about their portion of the cost, so you can determine what you’ll have to pay out of pocket. It’s much easier to plan these things out now than when a problem arises.

No one likes to think about the potential for addiction, but no one plans on developing an addiction either. By familiarizing yourself with your insurance coverage, you can make important decisions now that may be more difficult to make in the moment.

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