Am I Covered for Substance Abuse Treatment?
There is little worse than wanting and needing substance abuse treatment for yourself or a loved one and not being able to afford it. Many people can relate to needing medical procedures, surgeries, counseling, office visits, or even a prescription and opting out because of the costs. Even with insurance, medical expenses can be daunting. At Stepping Stones of Lincoln, Nebraska, we understand that a lot goes into making difficult choices about whether or not to seek out substance abuse treatment. We encourage anyone who wants or needs treatment to look into their options. Substance abuse treatment is possible, you are not alone, and we are here to help.
You are not Alone.
The National Survey on Drug Use and Health, shows that 19.7 million Americans, aged 12 and older, battled a substance use disorder in 2017. Yet many are not aware that they may have access to substance abuse treatment coverage. According to the Affordable Healthcare Act, health insurance can be used to pay for medical, surgical, and behavioral health services, which includes substance abuse treatment. Substance abuse and mental health are part of the “essential” health benefits that are to be covered by any insurance plan sold on the Federal Health Insurance Marketplace. Plans can be confusing and they vary, so it is important to be able to pick a plan that will work best for each individual situation.
The First Step: Know the Terms
When assessing coverage, some general health insurance terms to know include:
Deductible: Amount paid before any insurance kicks in
Monthly Premium: Amount paid to insurance each month to keep insurance coverage
Percentage Covered: Percentage covered by insurance; members pay the rest
Out-of-pocket Expenses: Fees paid by the member on top of the monthly premium
Maximum Allowed: Services may have maximum visits per lifetime or calendar year
Annual Out-of-pocket Maximum: Maximum member expenses before insurance provides 100 percent coverage
Coinsurance: Additional insurance policies that can be combined to cover treatment services
Copay: Small amount paid at the time of services
In-Network Provider: Discounted rates offered by insurance when using certain providers
Out-of-Network Provider: More expensive, non-negotiated rates with insurance provider
Verification: Individuals may need to obtain a verification that services are “medically necessary” from a primary care provider before they will be covered
Preauthorization: Authorization required prior to specialty services for coverage to apply
The Second Step: Get Covered
There are options for substance abuse treatment coverage, but they all start with an insurance plan. For low-income, elderly, children, and people with disabilities, look into Medicare, medicare.gov/index, and Medicaid, medicaid.gov, or Basic Health coverage. Youth who do not qualify for Medicaid may qualify for CHIP. Many employers offer medical insurance coverage. The Healthcare Marketplace offers options for individuals outside of the aforementioned plans.
The enrollment period for the Healthcare Marketplace at HealthCare.gov begins November 1 and remains open until December 15 annually, with coverage beginning in January of the following year. The “ins” and “outs” of healthcare coverage for substance abuse treatment can be overwhelming, and the amount of coverage for substance abuse treatment can differ depending on the insurance plan a person has, where they live, and what services are offered. Having insurance is key and there are options. Follow this link for what you need to have ready in order to start the process: healthcare.gov/apply-and-enroll/get-ready-to-apply.
If you do not have health insurance and are in emergency need of treatment, please do not hesitate to get help for yourself or a loved one. Often, hospitals will offer a variety of payment options, grants, and forgiveness programs for people who cannot afford to pay outstanding medical bills. If you cannot afford to pay for your substance abuse treatment bills, contact the billing department of the place you received treatment and ask about their payment and forgiveness options. Do not put your health and recovery on the back-burner. Call Stepping Stones of Lincoln, Nebraska at (402) 488-6511 for a more in-depth substance abuse evaluation and get back your ability to enjoy life. For more information, visit steppingstoneslincoln.com.
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