Gaps in Insurance Coverage Make Addiction Care Inaccessible and Unaffordable
March 26, 2019, NEW YORK – A new report released today by Center on Addiction – a nonprofit committed to transforming the way the nation addresses addiction – reveals that in 2017 insurance plans did not cover the necessary services for people with substance use disorder (SUD). This comprehensive review examines the addiction benefits offered in plans sold across the country in 2017. These plans are required by the Affordable Care Act (ACA) to cover SUD benefits as an Essential Health Benefit (EHB). The new report builds upon a 2016 report in which Center on Addiction examined each state’s EHB Benchmark Plan – the plans selected by each state to determine which addiction benefits must be covered by the ACA Plans sold in that state.
In Uncovering Coverage Gaps II: A Review and Comparison of Addiction Benefits in ACA Plans, Center on Addiction found that more than half of U.S. states offered a plan in 2017 that did not comply with the ACA’s requirements to cover SUD benefits. The report also found that 20 percent of states offered a plan that violated the Parity Act, a federal law that requires insurance plans to pay for addiction treatment the same way they cover treatment for other chronic diseases, like diabetes or cancer. In comparing ACA Plans sold in 2017 to the EHB Benchmark Plans, the report found continued non-compliance with the ACA and inadequate coverage of benefits in the majority of states. Parity compliance was virtually unchanged, and nearly all plan documents still lack transparent and specific information about SUD benefits.
“Amid a national opioid crisis and public outcry for more treatment, we’d expect to see greater improvements in insurance coverage for addiction benefits,” said Lindsey Vuolo, JD, MPH, the director of health law and policy at Center on Addiction, and lead author of the report. “We need to use all tools at our disposal, including laws that prohibit discriminatory insurance practices, so more people receive affordable care. We are calling on states to ensure health plans cover the full range of effective addiction treatments and address the serious gaps identified in this report. Improving insurance coverage for addiction treatment is essential to resolving the opioid crisis.”
Key findings and highlights from the report include:
More than half of the states offered ACA Plans in 2017 that did not comply with the ACA’s requirements for coverage of SUD benefits. This is a slight improvement from the 2017 EHB Benchmark Plans, more than two-thirds of which were determined to be noncompliant.
Twenty percent of states offered ACA Plans in 2017 that violated parity requirements. Compliance with parity was unchanged – 18 percent of the 2017 EHB Benchmark Plans contain parity violations.
One state (Rhode Island) provided comprehensive coverage for SUD treatment in the two 2017 ACA Plans reviewed, while three other states (California, Minnesota and Oregon) offered at least one plan in 2017 that provided comprehensive coverage for SUD treatment. This marks a slight improvement from the 2017 EHB Benchmark Plans, none of which was determined to provide comprehensive coverage for SUD by covering the full array of critical benefits without harmful treatment limitations.
Of particular concern, the report found that discriminatory coverage worsened with regard to coverage for methadone, the medication that is the gold standard for opioid use disorder treatment. This is problematic given the dire need to expand treatment access and methadone’s demonstrated efficacy for opioid addiction treatment.
Plan documents continue to lack transparency and specificity about covered SUD benefits. Ninety percent of the 2017 EHB Benchmark Plans and 92 percent of states offered ACA Plans in 2017 that were identified as lacking sufficient information about SUD benefit coverage.
“Most people cannot afford addiction treatment unless their insurance plan covers it. Families need to understand they often have the right to insurance coverage – this knowledge can be lifesaving,” said Creighton Drury, JD, the CEO of Center on Addiction. “Health insurance executives and government leaders need to understand that failing to provide insurance coverage for addiction treatment is causing profound heartache and unnecessary loss of lives in our nation. Our report is part of our ongoing effort to call on leaders to take the moral and legal action that is required to address our nation’s addiction crisis.”
This is the first report released by Center on Addiction since merging with Partnership for Drug-Free Kids earlier this year. Uncovering Coverage Gaps II: A Review and Comparison of Addiction Benefits in ACA Plans is available for download and can be found on our website here.