Skip to main content

What to Know About Health Insurance for Addiction Issues

Alcoholism and drug addiction may not seem as serious as cancer or heart disease, but for the countless people they affect, health insurance can mean the difference between kicking the habit and ending up sick and hopeless.

Drug abuse and addiction is expensive to America, with the Office of National Drug Control Policy pegging the cost at $200 billion in health care, criminal justice, legal and lost productivity in 2007, way before the opioid crisis plagued the nation. Meanwhile, according to the National Survey on Drug Use and Health, 21.5 million American adults were fighting some form of substance abuse in 2014.

While the Affordable Care Act certainly has critics and is under attack from the Republican-led Congress, it has helped people with addictions get the treatment they need. “On the marketplace side, the ACA helped strengthen rules that require most plans to cover mental health and substance abuse services at the same level as they do for physical health,” says Peggy Bailey, director of the health integration project at Center on Budget and Policy Priorities, the District of Columbia-based research and policy institute. “[Prior to the ACA] on the Medicaid side, if your primary condition was substance abuse disorder, that wasn’t enough to qualify you for Medicaid.”

[Read: Why Do You Need Health Insurance?]

Obamacare Paves the Way for More Coverage

Under the Affordable Care Act, which is still the law despite efforts to repeal it, substance abuse is considered one of the essential health benefits. That means insurers have to offer coverage for it in their marketplace health insurance plans.

Paul Rooney, vice president of small business, individual and family products at eHealth — the Mountain View, California, online health insurance exchange operator — says the services covered for people suffering from addiction include behavioral health treatments such as counseling, mental and behavioral health inpatient services, and inpatient and outpatient substance abuse treatment.

What’s more, Rooney says that under the Affordable Care Act, patients can’t be turned down because of a prior condition, with coverage kicking in on day one under any new plan. Insurance companies are prevented from placing any annual or lifetime coverage caps on substance abuse treatments, although deductibles, copayments and other cost-sharing expenses will apply, Rooney says. The Affordable Care Act also expanded the parity law to cover substance abuse, which means insurance plan providers can’t impose restrictions on addiction services that are more restrictive than medical and surgical services.

[Read: 6 Health Care Expenses Medicare Won’t Pay For.]

Limitations Still Abound

Still, Rebecca Farley David, vice president of policy and advocacy at the National Council for Behavioral Health — a District of Columbia-based nonprofit — says there are still limitations to the coverage that creates roadblocks for people looking for help depending on what state they live in. That’s because it’s up to each state to determine what essential benefits are covered in the plan, which has led to some states offering less comprehensive coverage than what addiction experts would like. David adds that when it comes to substance abuse care, there’s a much higher use of out-of-network providers than there is on the medical and surgical side of things. That makes it harder and costlier to find a provider in-network. “In an ideal world, we would love to see more comprehensive coverage benefits,” David says.

Help for Uninsured

Consumers who currently have health insurance or already purchased their plan for 2018 don’t have to worry about being shut out of addiction treatments.

Those who missed the deadline and are uninsured must have a life event to purchase coverage on the marketplace exchanges outside of open enrollment, or they’ll need to wait until next year. Such life events under the ACA include getting married, losing a job, having a baby and becoming a divorcee.

[See: How to Pick a Health Insurance Plan.]

There are options for people who end up uninsured and need help with an addiction. “Significant mental health resources are available both at the local and national level — even for those without health insurance,” Rooney says, noting that the free and low-cost services vary from one state to the next. On the national level, Rooney points to the Health and Human Services Department, which offers a list of free clinics around the country. He says that when someone is shopping for health insurance with an eye toward addiction treatment, it’s important to know if you’ve met your full deductible before the coverage kicks in. If the deductible will be an issue, Rooney suggests opting for a plan that has substance abuse treatment with only a copayment and coinsurance.

“Keep in mind that coverage may differ for inpatient and outpatient care under the same plan, so look at the benefits summary to make sure you understand how these may be paid differently by the insurance company,” Rooney says. “If you have a specific provider in mind for substance abuse or mental health care treatment, make sure that they are part of the plan network before you enroll.”

More from U.S. News

11 Strategies for Staying Sober While Traveling

4 Opioid Drugs Parents Should Have on Their Radar

What Only Your Partner Knows About Your Health

What to Know About Health Insurance for Addiction Issues originally appeared on usnews.com

Don’t Settle for Student Loans to Pay for Online Education

Online college programs are becoming a more popular choice for prospective students, with one study finding that more than 6 million students enrolled in at least one online course in fall 2015. The popularity of these courses can be attributed in part to their flexibility with working adults' schedules, students' ability to progress more quickly through online programs and, oftentimes, cheaper tuition. [See 10 low-cost online bachelor's programs for out-of-state students.]Online degrees can be beneficial to many college students, but some studies have shown online learners complete their programs at lower rates than students at traditional brick-and-mortar campuses. Individuals with student loans but no degree comprise two-thirds of defaulted borrowers. Though these numbers are not encouraging, just like for traditional programs, there are ways to reduce how much you'll need to borrow for an online program to ensure you won't become one of these statistics. Don't just settle on borrowing student loans to cover the whole cost of your program and living expenses. Instead, start thinking about how to cut costs and cover your balance in different ways, such as the following. -- Grants and scholarships: Even though you are taking an online course, you can still apply and receive grants and scholarships. But your first step should be to complete the Free Application for Federal Student Aid, commonly referred to as the FAFSA, which will allow you to receive a Pell Grant if your expected family contribution is low enough. The EFC criteria and award amounts are adjusted annually, but the 2017-2018 academic year awards range from $606 to $5,920, which could significantly lower the amount you borrow annually. Your next step is to apply for scholarships. You can start by checking online scholarship search engines, such as the Salt Scholarship Search, College Board's BigFuture and Peterson's. But don't forget to take advantage of local organizations and your school's financial aid office. Both may offer scholarships that you can't find with a national scholarship search. [Review these 10 sites to kick off your scholarship search.]For instance, organizations like the Elks Club, Knights of Columbus or the Rotary Club typically offer scholarships annually to local students. Just because you're going to school online doesn't mean you're ineligible. Visit your local library for scholarship listings, and ask around town. You might be surprised how many local organizations offer scholarships. While these scholarships typically aren't large, every little bit counts. Each dollar you receive in a scholarship is a dollar you don't have to borrow and pay interest on. -- Work-study: Another option for online students may be work-study awards. Not all students enrolled in online programs are eligible, but students at some schools -- including, for example, SUNY Empire State College and Liberty University -- are. Work-study awards are not given upfront like scholarships and grants. In most cases, they are an offer to earn up to the awarded amount if you secure an eligible work-study job. While there is a misconception that all work-study jobs must be on campus, students can work for off-campus, nonprofit or public employers as long as the work is in the public's interest. You may be able to work for a for-profit employer if the job is relevant to your course of study. No matter who the outside employer is, it will need to have an established agreement with your college for you to receive work-study funds. Remember, to be eligible for federal financial aid, you must be enrolled and pursuing a degree or certificate. If you're not working toward a credential, Pell Grants and work-study won't be option, but you may still be able to take advantage of private scholarships -- just be sure to read the eligibility criteria carefully. [Explore what to know about financial aid in online programs.]-- Pay as you go: One of the great benefits to enrolling online is the flexible schedule, which can allow you to complete your college coursework around your responsibilities. But prospective students often overlook using their part- or full-time job earnings as an option for paying for college. Almost 80 percent of college students in 2015 worked at least part time while attending classes, according to the National Center for Education Statistics. By budgeting and thinking strategically about your college costs, you can likely reduce your dependence on student loans by paying a portion out of pocket. Many -- but not all -- online programs are less expensive than traditional programs and often have shorter payment periods. Six, eight or 10 weeks are common course durations. Because of the frequency of payments in an online setting, you may be well-placed to pay as you go and possibly avoid borrowing altogether. Attending college online and avoiding student loans may be challenging, but if you are willing to put in the effort, you can limit the amount you need to borrow. More from U.S. News Q&A: Understanding Student Loan Discharge Eligibility Student Loan Refinancing Isn't Right for All Borrowers
Read Next Story