Alcoholism and Drug Addiction – The American Medical Association recognizes alcoholism (alcohol use disorder) and substance addiction (substance use disorder) as diseases and forces health insurance companies to recognize the need for treatment coverage.

In addition, the 2008 Affordable Care Act and Mental Health Parity and Addiction Equity Act require that, for insurance providers that offer coverage for behavioral health conditions, mental health and substance abuse treatment benefits be comparable to medical care benefits. This means insurance policies – both public and private -must cover substance abuse treatment to the same extent that they cover other medical conditions.

The Affordable Care Act further ensures that insurance agencies can no longer deny coverage to anyone based on a pre-existing condition, including substance addiction. If you do not have insurance, you can apply for coverage at any time. This may help to drastically reduce your out-of-pocket costs for treatment.

What Insurance Generally Covers

Insurance policies vary in the amount of treatment services that they cover. But most policies will cover one or more of the following:

• Assessment – generally fully covered.
• Detoxification – generally mostly covered, but rapid detox and ultra-rapid detox tend to not be covered.
• Outpatient treatment – generally mostly covered.
• Inpatient (residential) treatment – generally partially covered.

Insurance policies will cover addiction treatment to the same extent that they cover other medical conditions. But they will only cover what a professional determines to be “medically necessary.”

Healthcare.gov defines medically necessary as “health care services or supplies needed to diagnose and treat an illness, injury, condition, disease or its symptoms and that meet accepted standards of care.” Most of the coverage will cover the basic necessities but does not extend to luxury accommodations.