Coverage of Substance-Use Disorder Treatments in Marketplace Plans in Six Cities

Treatments for alcohol- and opioid-use disorders are generally covered by marketplace health insurance plans, however, improvements could be made when it comes to the transparency of costs and which specific treatments are covered.

The Issue

The Affordable Care Act (ACA) identified substance-use disorder services as an essential health benefit, ensuring that all marketplace plans must cover services to treat the disorder. To what extent and at what cost the services are covered, however, is left up to the insurers. The report looks at marketplaces in six cities to determine how medication-assisted treatments, as well as outpatient and inpatient care—coverage mandated by the ACA—are covered under marketplace plans.

Key Findings

  • Medications for alcohol-use disorders are covered more frequently and at lower cost-sharing tiers than their counterparts for opioid-use disorders, though coverage of both is widespread across plans.

  • In some cases, consumers will have difficulty identifying whether a plan covers a drug, such as methadone.

Conclusion

Transparency of consumer out-of-pocket costs for substance-use disorder treatments could be improved by limiting the use of co-insurance cost sharing (i.e., consumers paying a percentage of the total cost of the treatment) whenever possible. Doing so would improve consumers’ ability to make informed choices.

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