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Substance Abuse Health Coverage


Substance abuse (otherwise known as substance use disorder) is a serious issue, with which many people suffer on a daily basis. Addiction can affect anyone, at any time in life, and as such, treatment for any form of substance abuse must be addressed through appropriate and adequate means. However, professional treatment such as clinical rehabilitation, counseling, or pharmaceutical assistance inevitably runs very costly for those seeking to achieve long-lasting sobriety. There are a number of systems through which treatment costs may be covered or subsidized.

Public Health Coverage

Due to the high demand for substance abuse treatment facilities across the U.S., and the concomitant financial burden of treatment costs, there exists a large number of funding schemes, at local, state, and federal levels, available to those in need of financial assistance, provided that those who avail of the services satisfy certain criteria as per each scheme. The Patient Protection and Affordable Care Act (ACA), in operation since 2010, has provided millions of U.S. citizens with much needed, financially subsidized, health care plans. Under federal supervision, all of these marketplace health care plans now class substance abuse treatment as ‘an essential health benefit’.

Private Health Coverage

Although more people are relying on public health insurance funding, many others still hold private health insurance, either through their employment or as individual policy holders.

Employer-subsidized insurance (available through the majority of employee benefit packages) may provide the finances to those in need of substance abuse health coverage, either in the form of direct account payment to the chosen facility, or financial reimbursement to the employee if out-of-pocket expenses must be incurred.

Coverage provided through private health insurance for the treatment of substance abuse can vary greatly, depending on the insurance company and the type of treatment being received by the client. Only in the last few years have legislation policies been introduced on a national level to address parity protection for private health insurance regarding substance abuse health coverage. These national parity legislatures have begun to implement mandates regarding an increase of substance abuse treatments covered (either fully or with low-deductibles) by private health insurance companies, in addition to an increase in the number of treatments permitted each year. Although national parity protection has gained strength in recent years, individual state regulations on parity protection also greatly determine the final distribution of substance abuse health coverage and private expense.

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