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What you didn’t know about Health Insurance…

Health Insurance for Substance Abuse

This information is available at this link: Affordable Healthcare Act Information

All Marketplace plans must cover treatment for pre-existing medical conditions.

  • No insurance plan can reject you, charge you more, or refuse to pay for essential health benefits for any condition you had before your coverage started.
  • Once you’re enrolled, the plan can’t deny you coverage or raise your rates based only on your health.
  • Medicaid and the Children’s Health Insurance Program (CHIP) also can’t refuse to cover you or charge you more because of your pre-existing condition.

Mental and behavioral health services are essential health benefits

All plans must cover:

  • Behavioral health treatment, such as psychotherapy and counseling
  • Mental and behavioral health inpatient services
  • Substance use disorder (commonly known as substance abuse) treatment

Your specific behavioral health benefits will depend on your state and the health plan you choose. You’ll see a full list of what each plan covers, including behavioral health benefits, when you compare plans in the Marketplace.

Pre-existing mental and behavioral health conditions are covered, and spending limits aren’t allowed

  • Marketplace plans can’t deny you coverage or charge you more just because you have any pre-existing condition, including mental health and substance use disorder conditions.
  • Coverage for treatment of all pre-existing conditions begins the day your coverage starts.
  • Marketplace plans can’t put yearly or lifetime dollar limits on coverage of any essential health benefit, including mental health and substance use disorder services.


out-of-network substance abuse benefits for people with silver plan insurance off the healthcare exchange

Parity protections for mental health & Substance Abuse services

Marketplace plans must provide certain “parity” protections between mental health and substance abuse benefits on the one hand, and medical and surgical benefits on the other.

This generally means limits applied to mental health and substance abuse services can’t be more restrictive than limits applied to medical and surgical services. The limits covered by parity protections include:

  • Financial — like deductibles, copayments, coinsurance, and out-of-pocket limits
  • Treatment — like limits to the number of days or visits covered
  • Care management — like being required to get authorization of treatment before getting it

Many Insurance Plans on the Exchange Don’t Allow Out of Network Benefits for Substance Abuse Treatment

The majority of substance abuse programs throughout the country are out-of-network substance misuse facilities. There are many In-Network Programs for substance abuse in many states. Many of these programs have very high turnover rates and are also provided state funding.

Out-of-Network Substance Abuse Treatment Programs

The Out-of-Network programs providing substance abuse treatment are everywhere. The dominant states with Out-of-Network programs are Florida, Arizona, and California. Many people trying to recover from substance abuse find that relocating allows them to start new and rebuild their life.

What if I don’t qualify for healthcare off the exchange due to how much I make? READ MORE HERE

How can I find out if I qualify through the marketplace? READ MORE HERE

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