Partnership Research

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

Partnership Research

There are numerous barriers to addiction treatment, but cost and lack of insurance coverage are commonly cited reasons people with a perceived treatment need forgo care. In a 2016 report, we examined each state’s 2017 EHB Benchmark Plan – the insurance plans selected by each state to determine which addiction benefits must be covered by the ACA Plans sold in that state. We found that none of the plans provide adequate coverage for addiction benefits and over two-thirds violate the ACA’s requirements.

In 2017, we built on this study by reviewing a national sample of commercial plans modeled on the 2017 EHB Benchmark Plans and sold to consumers on state and federal marketplaces in that same year (the “2017 ACA Plans”).

Key Takeaways

This report found that there were only modest improvements with ACA compliance and benefit adequacy, compared to the 2017 EHB Benchmark Plans. In the midst of an unrelenting opioid epidemic, the majority of states offered plans in 2017 that were non-compliant with the ACA and provided inadequate coverage for addiction benefits. Additional findings included the following:


For state governments:

Research Methods

This report was based on a review of a national sample of individual market plans sold on federal and state marketplaces in 2017. Each 2017 ACA Plan was reviewed to evaluate the SUD benefits and determine whether the plan: (1) satisfied the ACA’s requirements regarding coverage of SUD benefits; (2) complied with Parity Act requirements; (3) offered adequate coverage for SUD benefits by covering the full range of critical SUD services and medications without imposing harmful treatment limitations; and (4) provided enough information in plan documents to sufficiently evaluate compliance and adequacy of benefits.