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Are all American families with insurance plans under the Affordable Care Act (ACA) getting the benefits required by law for substance use treatment?
That’s the main question we wanted to answer in our latest research report, Uncovering Coverage Gaps II: A Review and Comparison of Addiction Benefits in ACA Plans.
The answer is a resounding “no,” demonstrating the need for policymakers to better protect families from discriminatory practices and enforce the law.
We know that most loved ones and their families cannot afford or receive care if it is not covered by their insurance plan. Improving insurance coverage for addiction treatment is essential to resolve the opioid crisis and move toward an approach where we finally treat addiction as the disease it is.
Before examining where plans sold in 2017 fell short of providing treatment coverage, it’s helpful to understand some lingo — mainly, Essential Health Benefits (EHB) and the Parity Act.
Essential Health Benefits (EHB)
The ACA requires most individual and small group insurance plans, meaning the plans that individuals purchase on the state or federal marketplace (commonly known as “Obamacare Plans”), to cover 10 categories of benefits known as the Essential Health Benefits (EHB). One of the EHB categories is mental health (MH) and Substance Use Disorder (SUD) treatment, which must be covered at the same level as other medical or surgical benefits.
Parity Act
The federal Parity Act is a 10-year-old law that says insurance plans are not allowed to place more restrictions on mental health and substance use disorder benefits than they place on similar medical or surgical benefits. (It’s important to note, though, that the Parity Act does not actually require plans to cover substance use disorder treatment.)
By requiring plans to cover mental health and substance use disorders benefits as an EHB, in addition to complying with the Parity Act, the ACA provides the strongest protections for consumers seeking care covered by insurance. The more than 10 million people who purchase these plans pay for and are entitled to coverage for SUD treatment.
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