If I need Help for Alcohol or Drug Abuse
Will My Health Insurance Cover Me?
If you’re considering treatment for substance abuse, we have some wonderful news. Thanks to the Affordable Care Act (ACA) passed in 2010, substance abuse now falls under the same category as mental health, meaning it’s covered by insurance. Starting with the Mental Health Parity and Addiction Equality Act (MHPAEA) of 2008 and then continuing with the ACA, all health insurance providers are required to provide some degree of substance abuse treatment to their members.
So, whether you have private insurance, marketplace insurance (Obamacare), Medicare, Medicaid, or TRICARE for veterans, rest assured, you can get the treatment you need. Also, under the ACA, substance abuse is no longer considered a pre-qualifying condition, so treatment for it cannot be denied. It must be treated equally the same as any other conditions or diseases like diabetes, cancer, or heart disease. That said, your specific coverage and how much you pay out of pocket all depend on your particular health plan.
Health Insurance Does Not Cover All Rehab Services
While health insurance is required to cover many things, it still doesn’t cover everything, and it’s important to understand what your insurance does and does not cover. Generally, if it’s something medically necessary, your insurance will cover it. For example, if you needed medication for withdrawal, that would be deemed medically necessary.
On the other hand, things like music and art lessons (although perhaps relaxing to a person) will probably not be considered medically necessary.
What Rehab Services Will Health Insurance Cover?
Many who struggle with substance abuse, also struggle with mental health disorders like depression, anxiety, and bipolar disorder. Often, treatment will include medication, therapy, and rehab for both provided it’s medically necessary.
Detox
Often the first step in getting help is Detoxification, which is enduring withdrawal symptoms as the addictive substances exit the body. This can be both an unpleasant and medically dangerous time. To aid in this, many hospitals and addiction treatment centers offer non-addictive medicine to make the person comfortable.
Inpatient Rehab
Sometimes, those looking to recover from substance abuse problems need an inpatient setting to do so. This inpatient setting will usually include detox, medications, counseling, and the person residing at the treatment center for anywhere from 28-90 days.
Outpatient Treatment
Outpatient treatment allows the person to still reside at home, work their normal job, and maintain their regular life while still getting help for their disease. Oftentimes, this therapy includes group and individual therapy along with medication as it’s needed.
Healthcare Coverage for Rehab Services with Nevada Insurance Enrollment
Different health insurance plans have different coverage options. So, if you need substance abuse rehab services, we’ll find the perfect plan for you. At Nevada Insurance Enrollment, our health insurance agents are here to plan for your needs and find the best coverage options available.
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Is Health Insurance Worth The Cost?
If you experience a more extensive medical emergency and require hospitalization, hospital bills may quickly become a burden. A three-day stay, for example, could set you back about $60,000 depending on what tests are ordered and what happens during your stay.
What is Co-Insurance?
Co-insurance means two parties will be paying for the bill. “Co” means joint, mutual, two, or more. The health insurance company will usually pay the larger amount (example 70%) and you as the member will usually pay the lesser amount (example 30%). This would be considered co-insurance 70/30. This (co-insurance) usually happens AFTER the deductible is met.
Health Insurance Coverage Effective Dates
Once you have picked a health insurance policy and paid your first month’s premium, you probably expect your coverage to begin immediately. However, depending on when you enrolled and under what circumstances, you may have several weeks before your health insurance coverage takes effect.
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Things Potentially NOT Covered By Your Health Insurance
To be fair, in recent years, health insurance companies have made strides towards transparency. If you have an ACA-compliant plan, there are many services that your health insurance is legally required to cover, taking some of the guesswork out of budgeting for health expenses.
Medical Loss Ratio
This Medical Loss Ratio states that when a family or individual buys a medical plan, 80% of every dollar collected and paid to an insurance company MUST pay medical claims/research. So that leaves the insurance company to pay ALL of their expenses with the remaining 20%. .20 cents on the dollar for their employees, buildings, broker costs, etc.
Why Does Health Insurance Have an Open Enrollment?
The Affordable Care Act / Obamacare, put specific enrollment periods in place to prevent people from only enrolling in health insurance when they were sick or needed surgery.
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