Does Health Insurance Cover Addiction Treatment?

The Mental Health Parity and ACA Requirement

Yes, health insurance is required to cover substance use disorder (SUD) treatment. The ACA includes mental health and substance use disorder services as one of the 10 essential health benefits that all ACA-compliant plans must cover. Additionally, the Mental Health Parity and Addiction Equity Act (MHPAEA) requires that coverage for SUD be provided at parity with coverage for medical and surgical conditions — meaning SUD cannot have more restrictive limits than other medical care.

What Addiction Treatment Coverage Includes

Covered SUD services typically include:

• Inpatient detoxification and medical stabilization
• Residential rehab programs (may require prior authorization)
• Partial hospitalization programs (PHP)
• Intensive outpatient programs (IOP)
• Standard outpatient individual and group therapy
• Medication-assisted treatment (MAT): buprenorphine (Suboxone), methadone, naltrexone (Vivitrol)
• Substance use disorder screenings as preventive care

Prior Authorization for Rehab

Residential and inpatient SUD treatment almost always requires prior authorization. This can create delays in accessing treatment. Under federal rules, urgent prior authorization requests must be processed within 72 hours. If prior auth is denied, you have the right to appeal and to request an expedited appeal. The denial of prior auth for SUD treatment that a licensed clinician recommends is often successfully appealed.

Medication-Assisted Treatment Coverage

Buprenorphine/naloxone (Suboxone, Zubsolv, Sublocade) for opioid use disorder and naltrexone (Vivitrol) are covered as prescription drugs on ACA plans. An ACA screening provision also requires that alcohol screening and brief counseling be covered as preventive services at $0 cost-sharing. Access to MAT is one of the most significant evidence-based advances in addiction treatment — confirm your plan covers your specific MAT medications.