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.