Are you using Marketplace insurance for rehab? Millions of people nationwide want to pursue recovery and need the support that a rehab program readily offers. They worry that they won’t be able to afford the cost of care, even with good insurance coverage.
All Marketplace plans are subject to the Affordable Care Act, ensuring coverage for all with essential benefits for addiction treatment and mental illness. Depending on your plan, you may still owe out-of-pocket rehab costs, but you could be surprised by how many will be covered in full.
Changes Healing Center offers a soft space to land when you need a rehab program that accepts your Marketplace plan. We can verify your insurance benefits in a quick call and let you know what to expect so that there aren’t any surprises down the line. Here is everything you need to know about your plans.
More than 24 million people are currently enrolled in a Marketplace insurance program. With enrollment this high, there is bound to be a large percentage of people seeking addiction treatment. The problem is that many people don’t understand their policy or what the Affordable Care Act (ACA) offers them.
This deep dive into your health insurance coverage will help you navigate the waters of rehab.
Part of the reason people get confused about coverage for rehab is that insurance companies of the past did not often cover it. They were free to deny services that they felt were unnecessary or cost-prohibitive.
While they might have covered your surgery to have a gallbladder removed, the odds that they would pay for rehab were slim.
That all changed with the Affordable Care Act.
Now, your health insurance provider has a federal mandate to offer coverage for rehab. It is considered one of your ten essential health benefits. This means that your addiction treatment is covered. Beyond that, it also covers mental health services.
It’s all well and good that substance use disorder is covered by your insurance company, but will they charge you an exorbitant rate? This is where parity protections come into the picture. This means that all health insurance plans must cover substance abuse and mental health the same as medical or surgical issues.
What does that mean for your out-of-pocket costs?
Think of it this way: Your insurance plan charges you a $300 copay for an emergency room visit when you have a kidney stone. After paying that copay, you may owe 30 percent of the final bill. Insurance coverage will kick in to cover the remainder of the cost.
Health insurance plans can’t treat your substance abuse treatment any differently. You may pay a small copay or have to hit your deductible first (more on these in a minute), but you’ll ultimately pay the same percentage of the final bill–in this case, 30 percent.
The sticker price on an inpatient rehab facility can be quite high. After all, you’re paying for room and board, meals, therapy, and medication-assisted treatment. Insurance coverage can help foot the bill, with some people not having to pay out of pocket at all.
But there used to be a condition where your insurance plan would only cover a certain amount over the course of your lifetime. A rehab facility can eat into those lifetime limits quite fast if you aren’t careful.
The ACA eliminated lifetime limits on the policies in the Health Insurance Marketplace.
If you need to seek treatment more than once to find sobriety (and many people do), you don’t have to worry about what percentage of your healthcare budget is left.
Pre-existing conditions are hard to jump into because a couple of facets have defined the industry for decades. First, pre-existing conditions used to be grounds for health insurance companies to deny the request for coverage. A health maintenance organization would look at your file and decide if you had too much risk for them to insure.
If they did decide to extend insurance coverage to you, they might exclude the coverage for rehab or your pre-existing condition. It is applied outside of behavioral health also. If you had a chronic medical condition, they might refuse to pay for your treatment.
The Affordable Care Act altered how insurance companies offered coverage for rehab and related services. Pre-existing conditions are no longer grounds for denial, and they can’t deny your claims.
In other words, the health insurance plans available on the Marketplace make finding insurance much easier and less stressful.
One of the reasons that people flock to the Health Insurance Marketplace is because plans tend to be more affordable than they were through employers and private health insurance companies. You might qualify for a needs-based tax credit if you are not a high earner or fall below the federal poverty level.
This financial assistance is designed to help you afford coverage that will help you improve your health over the course of the year.
If you qualify for a needs-based tax credit and you know that you’ll enroll in a rehab program this year, getting a better plan that covers more might be worth it. You will still have a lower monthly payment due to that credit, making the more elite plans like Gold and Platinum more affordable. These tend to have a lower deductible and lower coinsurance rates.
Alternatively, you might decide to stick with a bronze or silver plan. Both health insurance policies will kick in to cover the cost of a rehab stay, but you may owe more out of pocket. The benefit is that your actual health insurance coverage may be free.
Addiction treatment costs can soar into the thousands if you’re uninsured, but they can be affordable with the right Marketplace insurance providers. Shop around for the best plan that will hit your needs, keeping these things in mind to minimize your out-of-pocket costs on rehab this year.
Your deductible is the amount of money you must spend on your healthcare costs before insurance will start to cover your care. Deductibles can span quite a range from Bronze plans at the lower end to the more expensive Platinum plans on the other end of the spectrum.
One important thing to keep in mind about your insurance plan is that your deductible resets every year. This means that you might want to consider seeking help at addiction treatment programs earlier in the year so that your deductible doesn’t reset while you’re still in treatment.
After this sum of money is paid, you may have outstanding costs and out-of-pocket expenses in the form of a coinsurance payment.
You must pay a coinsurance payment once your deductible has been fully paid. On most plans, this is represented as a percentage of the total cost of your addiction and mental health treatment. You may also be responsible for a copay, which is a set fee for a service.
The exact coinsurance payment depends on your plan, and you can follow a couple of guidelines if you want to calculate your cost. Here’s what each of the Marketplace tiers will cover:
Of course, that’s only until you reach your out-of-pocket maximum annually. Once you hit this payment threshold, your insurance will cover all of your treatment costs. Every plan is different, but you may find that this helps fund your treatment unless you’re on a catastrophic-only plan.
One of the easiest ways to ensure that your health insurance provider will cover the cost of your rehab (or any other treatment) is to search for an in-network provider. These facilities have already hammered out a contract with various private insurance companies, securing a negotiated rate for their clientele.
Changes Healing Center is proud to accept many forms of private insurance that are available freely on the Health Insurance Marketplace.
We commit to making accessing care more affordable than ever before. In some cases, your insurance may cover the entire bill for your addiction treatment or mental health services. Let our enrollment team help you navigate the waters of the insurance industry.
A quick call allows us to verify your benefits and give you a quote on what detox, residential, or outpatient substance abuse treatment could cost.
Marketplace plans are surprisingly robust and offer great assistance toward your recovery. But how do the insurance companies bill you for the treatment you receive? The answer might surprise you: it often costs less than you think and covers more than you imagined!
When asking questions about addiction treatment programs covered by your healthcare insurance, you should remember some of these issues. Changes Healing Center can help you navigate the many paths to affordable care with some of these treatment options.
Did you know that there’s more than one option for how you enroll in rehab? The good news is that your Marketplace plan likely includes all levels of substance abuse treatment coverage so that you can make the transition from one level of care to another as you grow, change, and heal.
The process typically starts with a medical detox. A medical team can monitor you around the clock for symptoms and withdrawal side effects as you get clean. Given that many detoxes are accompanied by worrisome symptoms like seizures or hallucinations, this is a welcome reprieve to put your mind at ease.
As you move away from detox, enrolling in a residential program might make the most sense. You reside in the rehab program for as long as you need, typically thirty to ninety days. A treatment team includes your individual therapist, group activities, complementary therapies, and support groups.
After all of that, you might take one more big leap into outpatient treatment. This allows you to spend all day in treatment but permits you to return home at night. You get to practice newfound skills before you are completely on your own.
Changes Healing Center offers a wide continuum of resources available to meet you where you are.
Did you know that mental health and substance use disorder are often inextricably linked? One in four adults with a mental illness will also struggle with a substance use issue. It makes sense that you want to ensure that your coverage extends to both issues.
Fortunately, behavioral health treatment is part of a very thorough rehab program like Changes Healing Center. Our team not only assesses your substance use but also takes a look at anxiety, mood issues, and more to ensure that we treat the whole person instead of just parts.
Mental health is also considered an essential health benefit under the Affordable Care Act, so you don’t have to worry about incurring extra costs from your treatment center. You’ll find that you aren’t alone in this journey toward recovery. Many clients fall into this dual diagnosis category.
Many people won’t be able to get sober on their own, and there may be no reason to white-knuckle it. It may make sense for your provider to prescribe you a medication that eases some of your symptoms. A medication-assisted recovery could prescribe medicine that minimizes your high, makes you immune to the substances you take, or helps ease withdrawal symptoms.
However, they can also prescribe something that helps with mental health issues that you present with and that contribute to substance misuse. For example, anxiety might lead you to drink. Medication is an option for treatment alongside behavioral therapies.
Your prescriptions may even be covered in full by your insurance company. Talk with Changes Healing Center and your healthcare provider about potential options if you think that medication-assisted treatment is right for you.
If you think you must enroll in a fly-by-night rehab just to afford your care with Marketplace insurance coverage, we have good news! You can usually afford to step up to an accredited facility with proven standards of care for clients. Changes Healing Center is just one option among many, but you should never sacrifice quality regardless of insurance coverage.
Our facility is accredited by the Joint Commission. This means that we uphold a stringent set of criteria when it comes to your care. Our facilities meet OSHA, CMS, and Joint Commission standards so that you can rest easy knowing that your needs will be taken care of when you trust in us.
This can put your mind at ease so that you focus entirely on your recovery journey.
Are you ready to get the help for substance use that you need on a Marketplace insurance program? You don’t have to navigate the waters of insurance providers all on your own. Our enrollment team is available to verify your benefits and let you know what’s covered.
Plus, those calls are always quick, confidential, and come with no obligation.
Reach out to us today to learn more about our treatment programs and enroll at a level that feels right for your individual needs!