Insurance Plans Not Covering Necessary Services for People with Addiction: Report

A new report finds insurance plans around the country are not covering the necessary services for people with addiction. The National Center on Addiction and Substance Abuse reviewed addiction benefits offered in the 2017 Essential Health Benefits benchmark plans and found more than two-thirds violate the Affordable Care Act.

None of the plans are adequate, the report concluded. “Our findings reveal that people with addiction may not be receiving effective treatment because insurance plans aren’t covering the full range of evidence-based care,” Lindsey Vuolo, JD, MPH, Associate Director of Health Law and Policy at The National Center on Addiction and Substance Abuse, and lead author of the report, said in a news release. “For example, our review did not find a single state that covers all of the approved medications used to treat opioid addiction.”

The Essential Health Benefits benchmark plans determine which addiction benefits are available to the 12.7 million people who are insured under Affordable Care Act plans. Substance use disorder services must be covered under the law, since they are designated as an Essential Health Benefit.

The healthcare law also requires substance use disorders services must be provided at parity, meaning they are equal or comparable to medical and surgical benefits. The Affordable Care Act does not identify which benefits should be covered. Each state chooses an Essential Health Benefits benchmark plan to determine which addiction benefits must be covered by the Affordable Care Act plans sold in that state.

“We are still a long way from treating addiction like a disease,” said Samuel A. Ball, PhD, President and CEO at The National Center on Addiction and Substance Abuse. “Insurers are still not providing the same level of benefits for addiction treatment and services as they do for medical or surgical care. The absence of sufficient coverage for medication-assisted treatment for opioid addiction is particularly alarming given the number of people dying or suffering on a daily basis. This kind of health care discrimination would never be tolerated during an epidemic for any other life-threatening disease.”