The Affordable Care Act and Health Insurance for Drug Detox

Last Updated: April 10, 2023

Editorial Policy | Research Policy

Also known as the ACA, the Affordable Care Act was signed in 2010 and subsequently implemented across America. The premise of the Act was to make health care, and thus medical insurance, more widely available to US citizens. Since the ACA was put into place, millions of people have been able to secure health insurance who didn’t have it before. By the end of April of 2014, a total of 65 million people were enrolled in Medicaid programs, and seemingly 6 million of these people were enrolled as a result of the ACA, according to The Wall Street Journal.

According to the National Institute on Drug Abuse, 23.1 million people needed professional treatment for a substance abuse problem in 2012 and only 2.5 million of them received it. With the development of ACA insurance plans, the hope is that the number of people seeking treatment will rise significantly in coming years. Between October 2013 and April 2014 alone, 8 million people secured health insurance through the marketplace, and 11.7 million did so between November 2014 and February 2015, with 4.5 million of those cases being re-enrollments.

The Need for Health Insurance

While a lack of health insurance can completely inhibit the ability to get treatment for an addiction, having it hasn’t always meant treatment was readily available or affordable either. Many plans have limitations on what types of services are covered. This means you can have health insurance, but it doesn’t cover any substance abuse-related treatments. So if you needed to go to detox, the bill was still your responsibility. If you were in need of substance abuse counseling, you might not have had any help.

That’s changed now, because the ACA requires that new policies under the health insurance marketplace provide certain coverages referred to as “essential health benefits.” These coverage stipulations include:

  • Ambulatory services
  • Emergency care services
  • Hospitalization
  • Pregnant mother and infant care
  • Mental health coverage
  • Behavioral health care for substance use disorders (SUDs) and mental illness
  • Substance use disorder care
  • Prescription drug coverage
  • Rehab and habilitative devices and services
  • Laboratory services
  • Wellness and preventative screenings
  • Chronic disease management
  • Pediatric care, including oral health and vision services

In 2011, the Substance Abuse and Mental Health Services Administration reported that 59.6 percent of those over the age of 25 who did seek treatment reported having no health insurance, while 21.3 percent had Medicaid and 10.5 percent had private insurance. Between 2008 and 2010, 32.3 percent of those who didn’t get help claimed the reason was a lack of health insurance, per the White House.

What Is Detox?

The first step in the recovery process is often getting clean, which happens in detox. Not everyone can get clean on their own, and it’s not necessarily safe for most to try either. Enter the professional detox experience. Depending on the substances an individual is addicted to, the detox experience may be inpatient or outpatient, and it could consist of medication for long-term maintenance, as seen with heroin and prescription opioid painkiller addicts, or short-term maintenance, such as for patients who need to taper off benzodiazepines.

Another component of a quality treatment experience is mental health care. Fortunately, the ACA also mandated that these services be covered for all insurance beneficiaries, too. This is a huge leap forward in substance abuse treatment since reportedly 53 percent of all drug addicts and 37 percent of all alcoholics suffer from a severe mental health disorder, Helpguide states.

A lack of care for mental illness has been a problem for years in America, but it was especially prevalent among those who battled addiction. Long seen as a problem of willpower and motivation, those who were dependent on drugs or alcohol weren’t properly screened for mental illness during substance abuse treatment. Thus, at the end of detox, they were shipped home with little resources available to aid them in staying clean. When symptoms of an underlying mental health disorder came bubbling to the surface, the addict would reach for booze or drugs in an effort to self-medicate — the only tried and true remedy they knew of that made them feel normal.

Treatment in Tandem

Treating mental illness alongside substance abuse has never been more important than it is now. According to the National Alliance on Mental Illness, some 61.5 million American adults cope with mental illness in any given year. It’s hard to say whether or not this number is larger than it was in the past, or if more awareness has just led to more discovery and diagnosis. Regardless, substance abusers who were led down the path of drugs and alcohol due to depression, anxiety, or another mental health disorder are now able to receive dual diagnosis treatment that gives them a real shot at a peaceful and addiction-free life.

If you’d like more information on how health insurance can cover detox treatment, contact us today. We can help you work with your insurance carrier so you can get the treatment you need. Call now.