According to the Substance Abuse and Mental Health Services Administration (SAMHSA), treatment spending for mental health and substance use disorders is expected to total over $280 billion in 2020. This represents a substantial increase in the expenditures for these issues. These amounts in part reflect the effects of Obamacare or the Affordable Care Act.
Based on projections from SAMHSA, the costs to treat mental health and substance use disorders in the United States are broken down across multiple areas.
Thus, in this time following the Affordable Care Act, Medicaid pays the most significant percentage of expenditures for the coverage of mental health and substance abuse treatment compared to other single providers.
The Affordable Care Act passed in 2010 pushed the issue a step further. It classified addiction and mental health services as essential health benefits. This change in the status of substance use disorder treatment meant that insurance companies have to treat addiction in the same manner that they treat other conditions. Thus, the treatment for substance use disorders under a particular plan must provide equivalent coverage to other medical issues.
Plans in the health marketplace follow the mandates of the Affordable Care Act. The act also made it mandatory for individuals to have some form of health insurance, or they would be penalized on their tax returns.
This led to significant increases in enrollment in low-cost programs, like Medicaid, for people who qualify for them.
Medicaid is a state-funded insurance program that is designed to provide health insurance for individuals who have low-income levels. The level of income that is needed to qualify for Medicaid coverage is determined by each state’s definition of poverty.
Certainly, Medicaid is not the best insurance for many people because they do not fit the established guidelines that would qualify them to receive it. In addition, many quality treatment providers do not accept it, thus limiting provider options significantly.
Most people will need to get some type of group coverage or private insurance coverage.
All forms of private insurance have different types of insurance plans.
Private insurance plans offer different rates of coverage at different monthly premiums. These plans typically have out-of-pocket costs associated with them. They include:
An HMO offers access to certain doctors and hospitals within a specific network that have agreed to lower their rates for members of the plan. Care under an HMO plan is only covered if you see a provider within the HMO network.
These provide more flexibility and fewer restrictions on seeing non-network providers. PPO plans will pay some part of the cost if you see a non-network provider.
A member pays less by using health care providers that belong to a network of the plan. They also require a referral from a primary care doctor to see a specialist.
Services are covered only if one uses providers in the plan’s network (except in emergencies).
The best type of plan depends on a person’s particular situation and needs.
All insurance plans that are sold on the federal marketplace have some basic coverage for each of the categories of health care services, but a plan will pay for different amounts of coverage and have a specific premium. There are four categories of private insurance plans.
Bronze plans have the lowest monthly premiums but typically only pay for about 60 percent of health care costs.
Silver plans have higher monthly premiums and pay for about 70 percent of health care costs.
Gold plans have even higher monthly premiums and pay for about 80 percent of health care costs.
Platinum plans have the highest monthly premiums and pay for about 90 percent of health care costs.
Not all insurance providers offer all four levels. Again, the best choice depends on the person’s situation.
The best plan for one person is not the best plan for another. For instance, an individual who does not have too many medical issues may opt for a Bronze plan because they do not utilize health care often, whereas someone with chronic issues, like a chronic substance use disorder, may prefer a higher level plan that covers more of their expenses.
Insurance companies cannot deny health coverage to individuals who have pre-existing conditions (people who already had the condition before they signed up for the insurance plan).
You should consider how much you can afford monthly for insurance, how much coverage you need, and what type of treatment providers you are able to utilize.
Ready to get Help?
ADDICTION IS HARD, BUT RECOVERY DOESN’T HAVE TO BE. LET US DO THE WORK, REQUEST A CALL NOW!
Because the treatment coverage for substance abuse must be equivalent to coverage for other types of medical conditions, the Affordable Care Act has made the process of choosing an appropriate insurance provider easier. Even so, it can still be confusing.
(2014). Projections of National Expenditures for Treatment of Mental and Substance Use Disorders, 2010–2020. Substance Abuse and Mental Health Services Administration. Retrieved March 2019 from https://store.samhsa.gov/system/files/sma14-4883.pdf
(December 2017). About the Affordable Care Act. HHS,gov. Retrieved March 2019 from https://www.hhs.gov/healthcare/about-the-aca/index.html
2019 Open Enrollment is Over: Still Need Health Insurance? Healthcare.gov. Retrieved March 2019 from https://www.healthcare.gov/
Medicaid.gov. Retrieved March 2019 from https://www.medicaid.gov/
(April 2017). Top 5 Largest Health Insurance Payers in the United States. Health Payer Intelligence. Retrieved March 2019 from https://healthpayerintelligence.com/news/top-5-largest-health-insurance-payers-in-the-united-states
How to Pick a Health Insurance Plan. Healthcare.gov. Retrieved March 2019 from https://www.healthcare.gov/choose-a-plan/comparing-plans/
(October 2013). How to Choose Between Bronze, Silver, Gold and Platinum Health Insurance Plans. Forbes. Retrieved March 2019 from https://www.forbes.com/sites/investopedia/2013/10/01/how-to-choose-between-bronze-silver-gold-and-platinum-health-insurance-plans/#26be5fda2b2e