How To Obtain Health Insurance For Addiction Treatment

Your physical health matters, and so does your mental health. But, too often, Americans who are quick to take care of physical injuries and illnesses never receive the care and support they need to deal with poor mental health and emotional, psychological, and behavioral problems, including drug and alcohol addiction. 

There are many reasons why this is the case, and cost is often named as one of the biggest. Many people may not be aware that they can use health insurance for addiction treatment services, and obtaining insurance doesn’t have to be difficult. Sources of financial aid are also often available to help people access the care they need when they need it. 

In the U.S., more than half of private sector employees are covered by employer-sponsored health insurance plans. More than one-third of Americans (36.1% in 2022) are covered by public health insurance plans such as Medicaid. 

If you are in need of health insurance coverage, popular options to consider include buying private insurance through the Health Insurance Marketplace or directly from a health insurance company or applying for a public health insurance program.

Buying Private Health Insurance

It’s become more common for Americans to purchase individual or private health insurance plans in recent years, and this option can be a great way to get affordable, high-quality coverage that fits your needs and your budget. 

Private insurance is typically accessed either through the Marketplace or directly from an insurance company.

Visit The Health Insurance Marketplace

The HealthCare.gov site offers a wealth of information and guidance on health insurance in general, as well as the specific plans available to you, your family, or members of your small business. Using this site, you can compare different plans, figure out premium tax credits and subsidies, and enroll in the plan of your choice. 

Per the Affordable Care Act (ACA), all plans sold through the Health Insurance Marketplace must cover standard behavioral health treatments like psychotherapy and counseling, inpatient mental and behavioral health recovery services, and other forms of treatment for substance use disorders, i.e., drug addiction or alcohol addiction. These plans cannot deny care, or charge you more, due to pre-existing conditions including mental health and substance use disorders. Coverage for pre-existing conditions begins the day your coverage starts. Dollar limits are also not allowed on yearly or lifetime coverage for essential health benefits costs, including those related to addiction care.

Understand Enrollment Periods

Most of the time, you can only buy a health insurance policy through the Marketplace during the open enrollment period, beginning in most states on November 1 and running until January 15. However, you may be able to also buy health insurance on the Marketplace during other times if you qualify for a special enrollment period. 

Special enrollment periods last 60 days after certain life events or other conditions, which include:

• losing your current health insurance (e.g., you aged out of your parents’ insurance or lost your job)
• moving
• getting married
• having a baby or adopting a child
• having a projected family income that is at or below 150% of the federal poverty level (around $20K for an individual or $40K for a family of four)

Take Advantage Of Premium Tax Credits (PTC)

PTCs are refundable credits that help certain families or individuals cover the premiums, or monthly costs, for health insurance purchased through the Health Insurance Marketplace. You are considered eligible for this credit if you file a tax return with a Form 8962, have a household income that falls within a set range, or received unemployment compensation for any week of the year, and you are not eligible for employer-sponsored plans or other programs like Medicaid, Medicare, CHIP, or TRICARE. 

If You Need Help, Try An Agent

Still not sure what to do? You can request local help at HealthCare.gov, which will put you in touch with a state-licensed agent, sometimes called a navigator or broker, who can help you with the insurance process and explain your options. There is no cost to you if you choose to use this option, as your agent is paid on commission by insurers. 

Watch Out For Scams

There have been many examples of scam artists setting up fake websites, sending out fraudulent emails, and using the confusing nature of health insurance in other ways to exploit people seeking insurance. These scammers may hope to make off with credit card or bank information, or to harvest other personal information that could be used for identity theft. 

Play it safe. Never give out your personal information, e.g., your name, address, social security number, credit card info, or bank info, to strangers over the phone, online, by mail, or in person. Instead, find out the name of the insurance company being recommended and then research it and its offers to see if it is legitimate and meets the federal requirements for a qualified health insurance policy.

Also be careful to check the URL of any website and be wary of any unsolicited emails, too-good-to-be-true-sounding discount plans, or agents using high-pressure sales tactics. Note that no health insurance agent can legally charge you for their services, and no government official will ever call or email you to inquire about your health insurance status or to demand that you pay unexpected penalties under threat of fines or imprisonment. 

Check Health Insurance Company Websites For Other Offers

Purchasing health insurance, including short-term health insurance plans, from HealthCare.gov allows you to compare options and access subsidies and other benefits. However, you do have the option of purchasing health insurance directly from a health insurance provider. 

Be aware that not all health insurance plans offered in this way will meet the minimum requirements established by the ACA, so you may not have the same amount of coverage, including behavioral health coverage. 

The Cost Of Private Insurance

Health insurance is considered a necessary expense in the U.S. Although private insurance plans can be costly, insurance coverage is a major asset and a hedge against financial disaster in the event that you or someone in your family faces a major injury or difficult diagnosis. It also fully covers a wide range of preventative health services ranging from regular checkups to vaccinations, mental health screenings, cancer screenings, diet counseling, and more. 

According to Forbes, the average monthly cost for health insurance on the Marketplace in 2024 is as follows:

• $326 / month for an 18-year-old
• $412 / month for a 30-year-old
• $469 / month for a 40-year-old
• $655 / month for a 50-year-old
• $994 / month for a 60-year-old

Of course, the cost of any ACA plan will also vary by its tier, coverage details, and the number of family members included. 

Applying For Medicare, Medicaid, Or TRICARE Insurance For Addiction Treatment

Depending on your situation, you may qualify for Medicare, Medicaid, or TRICARE, government programs that provide health insurance to specific groups of Americans at low costs. 

• Medicare is a federal program available to Americans ages 65 and older regardless of income, as well as some Americans who are younger and have certain disabilities or serious medical conditions like ALS
• Medicaid is a joint federal and state program offering health insurance coverage for people who fall under certain state-specific income levels and/or those who are restricted to nursing homes or meet other criteria
• TRICARE is a healthcare program that provides coverage to uniformed service members (past or present members of the United States Army, Navy, Marines, Air Force, Coast Guard, or National Guard/Reserves), their spouses, and their children

These programs provide robust and highly cost-effective benefits that can be used to pay for medical treatment like any other form of health insurance, including mental healthcare services and addiction treatment services.

Using Health Insurance For Addiction Treatment

The costs covered by your insurance and the amount that will need to be paid out-of-pocket will vary depending on your specific insurance plan, your treatment center’s pricing, and whether you are receiving care in-network or out-of-network. It’s always best to reach out and check with your insurance provider and/or your treatment center to estimate the costs of your treatment beforehand.

Depending on your plan, you may be able to use your insurance benefits to pay for treatment at the rehab center or provider of your choice, or the one that best fits your unique needs. For instance, you may choose a treatment center farther away from home in order to provide a greater degree of privacy, one that offers dual diagnosis care for a secondary mental health condition, or one that has certain features or amenities that you feel may help you relax during the treatment process. 

Low-Cost And Free Addiction Care Options

If you are unable to afford insurance or the cost of treatment, other options may be available to help you get the care you need. 

Low-cost and free addiction treatment options include the following:

• nonprofit and state-funded rehab centers that you can connect with through your local health department or community helpline
• sliding-scale, income-based payment plans offered by certain treatment centers
• public or privately funded scholarships and grants 
• medical loans and payment financing plans

Find Addiction Treatment Today

To take advantage of Ark Behavioral Health’s free and fast health insurance verification services, or to learn about our behavioral health programs, please reach out to one of our representatives today. We are always here to help.