What an ACA Silver Plan Generally Covers for Substance Abuse

The Affordable Care Act, also known as “Obamacare,” created new regulations that make it easier to get health care coverage for mental illness and substance abuse disorders. These rights were gradually rolled out from 2008 to 2014, and now they are in full effect for those of us who need it.

To meet these requirements and further regulate them, the government created regulations outlining the ACA’s requirements for those with mental health and substance abuse disorders. These laws, also known as the Mental Health Parity and Addiction Equity Act (MHPAEA), state that that mental health and substance abuse treatment must be treated in the same manner as any other illnesses. This means that copays must be reasonable, treatment should be accessible, and there should not be any barriers to treatment that aren’t similar to standard medical care authorizations.

With insurance more accessible than ever through the ACA, people can now get the addiction treatment they need. Some people have coverage through the health insurance marketplace, while others of limited means often get Medicaid coverage.

Almost 32 million Americans with health insurance now have access to substance abuse and mental health treatment, according to the U.S. Health and Human Services Department. Some people have a bare minimum of benefits, while others have higher levels of coverage. All plans, however, give access to treatment and mental health coverage of some kind.


What Does My ACA Silver Plan Cover?

Mental and behavioral health services are now considered essential health benefits, and they must cover many services which are considered standard treatment for those with substance abuse disorders. Your ACA Silver plan should include:

  • Behavioral health treatment including counseling and group therapy
  • Inpatient services for mental and behavioral health treatment
  • Inpatient and outpatient substance use disorder treatment
  • Coverage of any of the above, even if they are pre-existing conditions
  • NO spending limits for the above services

Your specific health benefits typically depend on your insurer and the state you’re in. You should have a plan book that lists what your plan covers, including behavioral health benefits. No insurer is allowed to deny you coverage for pre-existing conditions, and there are no yearly or lifetime dollar limits on coverage of anything considered an essential health benefit. This includes coverage for mental health and substance use disorder services.

If you’re not sure of your benefits or need them broken down further, please get in touch with us. We want to help you find recovery and maximize the benefits of your healthcare plan.

Recovery is possible and help is available. Just pick up the phone and call! All calls are 100% confidential and we’re happy to answer any questions you have. (800) 411-8019