Uncovering Coverage Gaps: A Review of Addiction Benefits in ACA Plans

This comprehensive review of the addiction benefits offered in the 2017 Essential Health Benefits (EHB) benchmark plans found that none of the plans provide adequate addiction benefits, and over two-thirds violate the Affordable Care Act (ACA).

The ACA holds great promise for expanding access to addiction treatment. The law mandates coverage of substance use disorder services, and requires that these benefits be provided at parity, meaning they must be equal or comparable to medical/surgical benefits. The ACA does not identify which benefits should be covered; instead, each state chooses an EHB benchmark plan to determine which addiction benefits must be covered by the ACA plans sold in that state.

Key Takeaways

Nearly all of the 2017 EHB benchmark plans were non-compliant with ACA requirements and/or provided inadequate coverage of addiction benefits.

Findings included the following:


For the government: