How Obamacare Affects Rehab: A Fiasco Turned Friendly—For a Few
Of the 23 million Americans struggling with alcohol or drug problems, only about 10% receive treatment right now. In the state of California, almost 3 million people aged 12 and over need, but are not receiving, alcohol and other drug treatment.
Although certain stigmas and associations motivate many to bypass treatment, about a quarter of these 23 million don’t have insurance. Legislators knew this was a big problem and did some pioneering to create a solution: Obamacare.
However, the solution is not coming without complications. More than 1 million Californians are receiving cancellation notices for their current individual health insurance policies because their plans do not meet the new regulations. Between Americans getting dropped from their private insurance companies and not being able to easily and conveniently shop for and purchase insurance in the new exchanges, the distaste for Obamacare has continued to grow.
That said, Obamacare has the potential to be extremely beneficial for those struggling with an alcohol or drug addiction. It should actually be a good turn of events. According to Tom McLellan, Obama’s former deputy drug czar,
“There is not an illness currently being treated that will be more affected by the Affordable Care Act [Obamacare] than addiction.”
He goes on to explain that our system of treatment was built for a time when addiction wasn’t understood as an illness. The National Drug Control Policy deputy director, Michael Botticelli, added
“This is probably the most profound change we’ve had in drug policy ever.”
So how exactly can Obamacare help you pay for drug or alcohol residential treatment?
Obamacare for Alcohol and Drug Rehab Treatment
The Affordable Care Act (ACA or Obamacare) brings major innovations to the health care reform table by mandating that everyone—yes, you too—have a form of health insurance. And the changes significantly affect addicts and alcoholics, whether using or sober.
Insurance is easier to get—even if you have an addiction.
Because insurance is required for everyone, one of the main components of Obamacare has been to increase the eligibility for insurance coverage. You can no longer be denied insurance due to a pre-existing condition, including an addiction, as long as you enroll during an open enrollment period. Right now, that period lasts until March 31, 2014, for the Insurance Marketplace. (Exception: the insurance you buy yourself, i.e. "grandfathered individual health plan.")
Insurance is more affordable for more demographics.
Availability and affordability often overlap, so yet another component of Obamacare deals with keeping insurance costs down:
- If you're a young adult, you will now be covered under your parent's insurance plan until you're 26; this should help a significant number of young adults who struggle with alcohol, prescription, or illegal drug use.
- Medicaid has expanded its income limits (except certain states opted out,) which allows more people to enter publicly funded rehab programs.
Insurance is offering higher quality coverage.
Every (well, almost every) health plan must include coverage for the “10 essential health benefits," which include "mental health and substance use disorder services."
- Your insurance policy will also have to include services like behavioral health treatment, counseling, psychotherapy, and other mental health and substance use disorder services. This may mean that your doctor will have to add a “neck and up” check-up to their traditional repertoire of “breathe deep” and triangular mallet thumps.
Insured Californians: What Do You Have to Do?
According to Gallup, before October 1—the day government websites were launched and the insurance marketplace opened—82% of Americans were happy with their healthcare. Maybe you fit into that group.
But Obamacare wasn’t created for the majority, nor was it created to tamper with your current health care situation. So unless you have a stingy (and I mean that lightly) health plan, you should be able to coast through the next few months unscathed. But don’t think it’s so easy for your insurance company—most likely they’re scrambling to keep up with the new requirements, including, among other things, coverage for mental health and substance use disorder services and preventative screenings, like SBIRT which we discussed above.
Although the original idea for this law was that currently insured people could keep their existing insurance plans, the reality is that many people are finding themselves dropped by their insurance company. The most common reason for this is that insurance companies cannot offer plans that meet both the pocketbook and the new requirements for the Affordable Care Act.
Uninsured Californians: What Do You Have to Do?
That said in the Golden State, 18% of us don’t have insurance: that’s about six million people. Obamacare requires everyone to have health care and seeks to provide a solution for those without it. (If you decide not to budge and stay in your quagmire of uninsured mediocrity, the consequences are minimal at first . . . careful though, they get worse with time.)
As an uninsured American your next step is to find a health plan in the Health Insurance Marketplace.
Health Insurance Marketplace & CoveredCA.com
Ah yes, simplicity and affordability at last. Californians—even those with bronchitis, cystic fibrosis, and emphysema—can breathe easy. In fact, no matter your pre-existing medical condition or addictive propensities, health coverage is just a few well-spent minutes behind a screen or on the phone away.
In a perfect world, maybe. But unfortunately, our world, and government websites, are far from perfect.
If you live in California, you'll need to sign up through the state marketplace: https://www.coveredca.com. If you do not live in California, then you should use the national site: https://www.healthcare.gov.
PPOs vs HMOs
If you're considering using insurance for addiction treatment, you'll want to lean toward PPO plans (plans that cover out-of-network services). The majority of treatment centers who take insurance take PPO plans; a few accept HMOs.
CoveredCA Sample Plans: What Might a Typical Residential Treatment Cost With Rehab?
But the question you really want to know is, "how much will treatment cost me if I purchase insurance through the marketplace?" Unfortunately, it's impossible to know this before verifying your insurance benefits with a treatment center; there are simply too many variables. Every insurance plan is different depending on where you live, how much you make, how old you are, the plan you pick and so on, so we can't really tell you what to expect for costs, but the site will give you an estimate.
That said, to give you a little sample idea, we've created two accounts on coveredca.com:
What to Expect in California's Marketplace: A Walkthrough of CoveredCA.com
How did we get the numbers above? Meet Covered California, the insurance marketplace for Californians, the place where you can find your health coverage options and whether you qualify for free or low-cost health insurance.
"Get Started," fill in some information and you'll be able to shop anonymously for plans. (And no, don't type in 150 years old just because you can.) This calculator can help you predict your costs as well. And at last, information. (After you close the little box letting you know the differences among the metal tiers)
Again, click around. It's nice because when you click on the "links," you never leave the page. Be sure to click the arrows on the side to see more plans. When you're done shopping around, you can click "get contacted for more info" and fill out the form. Or if you want to apply for coverage, you must click "start here" on the homepage. It will redirect you to the page below.
Here you can create an actual account. Click "go" under the category that fits you (e.g. individual or family). Then, select "apply now" to create an account. (Or click "Create Account" on the top right, and select the appropriate category.) Fill out user and contact information, then make up a username and password. Remember you only have to fill out the fields with a red asterisk. When you see a confirmation window, you've successfully created an account.
After logging in for the first time, you'll be prompted to select and answer security questions. From here you can preview plans and apply for one. In order to browse with more accurate cost estimates, pick which category of medical and prescription use best fits each family member.
The results are very similar to ones you would have seen with the "shop and compare tool", except these ones have more details about coverage. When you're ready to apply, you can watch the video tutorial, otherwise the form is fairly simple. Good luck! And be sure to log out.
Misconceptions About Obamacare and Substance Abuse Coverage
At this point, you might be looking for the fine print for some hidden catch. After all, it sounds too good to be true. There must be that disclaimer at the end of the advertisement.
While the “catch” is not exactly hidden, the lack of information on the law’s limits has created many misconceptions about just what this law means. Certainly, Obamacare marks a giant leap for mental health and substance use treatment, but it will not eliminate all the barriers for attaining quality treatment.
So let’s clarify some concepts:
- Obamacare is not your insurance. It’s a law that poses specific requirements on the insurance industry.
- Insurance plans must cover preventative screenings, designed to head off addiction before it requires more expensive, drastic treatment. However, the transition from where we are now (many people being in basically Stage 4 addiction) to catching addiction before it gets that severe is a little unclear.
- The specific substance abuse services that will be covered are still being determined.
- Obamacare can't fix bad quality treatment centers or ensure that you get the best ones.
- Although the new requirements may help you pay for treatment, it will not cover the entire cost of private residential rehab.
Obamacare Meets Drug Addict
Obamacare makes some people in the field of addiction treatment smile. Others—probably those dealing with insurance companies—it infuriates. Either way, Obamacare will place its mark on the fields of addiction recovery and mental health.
Our sincerest hope is that these policy changes cause you or a loved one to discover hope and sobriety for the first time. A success like that would make more than just Obama and his aides smile.
Infographic: A Visual Overview of Obamacare and California
Here's a quick overview of Obamacare in an easy to view format:
- Number of Americans and Californians with and without insurance: Over 5 million people in California are eligible to use the marketplace.
- Income & eligibility: You might be eligible for premium assistance or Medi-Cal, depending on your income and number of dependents.
- Enrollment timeline: Get coverage on January 1 by registering before December 15, 2013.
- Overview of the types of enrollment plans: Many treatment centers accept PPOs; fewer ones accept HMOs.