Health Insurance Rehab Coverage

Health Insurance Addiction Rehab Coverage


Legal Background for Addiction Treatment Coverage


Addiction rehab has always been a necessity for those who have suffered from Substance Use Disorders. Yet, it was not treated as such and was close to being a luxury. Addiction rehabs were hard to afford, especially for those who have low-paying jobs. Added to this is the fact that majority of health insurance restrictively covered addiction and other mental health disorders. That was until the advent of MHPAEA and ACA. Today, those laws improved insurance coverage for addiction rehab.


Mental Health Parity Act


Before MHPAEA, mental health problems are treated with discrimination when it comes to insurance. Insurance plans usually restrict mental health coverage by implementing higher copayments, out-of-pocket maximums and coinsurance. This rendered such coverage impossible to utilize. Thankfully, MHPAEA removes such restrictions.


MHPAEA creates parity between the coverage of mental health and physical health. Thus, an insurance provider can never restrict mental health coverage more than how they restrict physical health coverage. For instance, an insurance plan that applies $100 copayment policies for physical health cannot apply copayment policies greater than $100 when it comes to mental health.


Take note, however, that MHPAEA does not oblige insurance companies to include mental health coverage in their plans. Fortunately, only a few insurance companies will not include mental health coverage because such a step will render their insurance plans unattractive in the health marketplace.


Another limitation of MHPAEA is the fact that it is limited to insurance from large employers. Group health insurance plans that involve less than 50 employees are exempt.


By itself, MHPAEA will not suffice to assure the coverage of addiction rehab. Thankfully, it acts synergistically with ACA.


Affordable Care Act


The affordable care act, also known as the Obamacare, makes mental health an EHB (Essential Health Benefit). This means that insurance providers are required to cover mental health (substance abuse included). Furthermore, they require such insurance to comply with the MHPAEA. Thus, the coverage of MHPAEA is widened. However, this does not include grandfathered plans.


ACA requires individual and small group health insurance plans to cover mental health and cover it in a manner complying to the MHPAEA. Hence, the birth of ACA means that even the supposedly exempted individual and small group plans are now obliged to comply to ACA and are even required to cover mental health thus overriding the all-or-nothing mental health coverage of MHPAEA.


State Parity Laws


Prior to the existence of MHPAEA and ACA, some states attempted to solve the mental health insurance coverage problems that avoid drug addiction. Thus, local state parity laws existed. Now that ACA and MHPAEA are in place, there will be conflicts between state parity laws and those two. Fortunately, state parity laws can override ACA if they offer stronger mental health insurance coverage.


What is covered under state parity laws?


One of the most confusing part of insurance mental health coverage is the type of treatment they cover. While ACA and MHPAEA guarantees the coverage of certain treatment methods, a number of methods are not covered.


The coverage of detox is enforced. This includes both inpatient and outpatient detox. However, ultra rapid detox is rarely covered, if any insurance covers it at all. This is because the process of ultra rapid detox is still experimental and is not deemed as a necessary rehab method.


Counseling and medication are also covered. In addition, insurance is still required to cover in case of dual diagnosis. Take note, however, that there may be quantitative limitations imposed on your insurance plan. For example, a plan may allow you to visit your psychologist ten times, and at the eleventh time the insurance company may assess your condition and judge if the visit is a necessity. In case they recognize the 11th visit as an unnecessary step to your recovery, they will not pay for the visit.


Addiction Treatment coverage RECAP:


MHPAEA sets the parity between mental health and physical health. This means that mental health coverage of group plans with greater than 50 participants are not allowed to be more restrictive in mental health compared to physical health if ever they decided to include mental health coverage to the plan. ACA extends this by obliging non-grandfathered plans to include mental health coverage and to comply to MHPAEA. Thus, MHPAEA and ACA synergistically asures the mental health coverage of a good number of insurance plans. In addition, State Parity Laws can override ACA in case they provide stronger mental health coverage.