What is the ACA Marketplace?
Passed in 2010, the Patient Protection and Affordable Care Act or ACA is a health care law that changed the system’s approach to addiction treatment coverage. The ACA marketplace is the online platform where you determine your eligibility for coverage and enroll in a health care plan.
You can also search by state for insurance providers in the marketplace. Insurance plans on the ACA marketplace are offered to individuals, families, and small businesses. Before the passing of the Affordable Care Act, it was harder to find coverage for addiction treatments and other medical concerns that were considered pre-existing conditions.
Over the last decade, the Affordable Care Act has extended health insurance coverage to millions of previously uninsured individuals across the country.
What Does ACA or Obamacare Insurance Cover?
In recent years, ACA has been a convenient and popular way to pay for addiction treatments, including drug and alcohol rehab. If you are in recovery or looking to begin your journey, an Affordable Care Act insurance plan may help cover the costs.
Marketplace rehab coverage applies to several different aspects of addiction recovery. Your ACA coverage may include, among other things:
- Addiction evaluations.
- Brief interventions.
- Detoxes and medications for addiction treatment, including those that reduce or eliminate cravings and other withdrawal symptoms.
- Visits to addiction clinics.
- Drug and alcohol testing.
- Home health visits.
- Family counseling sessions.
Marketplace rehab coverage can vary depending on the state, individual income, and other qualifications. Your insurance provider can help you identify the out-of-pocket costs, if any, that you will incur when you participate in addiction treatments.
Medicare, Medicaid, and the ACA
ACA was created to help people obtain affordable, quality healthcare. Because it is closely aligned with other government-sponsored healthcare programs, including Medicare and Medicaid, many people have trouble distinguishing between each.
So, before we move on, we’ll give a quick overview of each of these insurance options. As we mentioned, ACA was passed to make healthcare more affordable. To accomplish this goal, the act created laws prohibiting insurance companies from canceling individual coverage due to an injury or illness.
The Affordable Care Act also states that insurance providers can no longer charge more for a pre-existing condition or a discriminatory qualifier, including gender. These rules help ensure that insurance companies are not overcharging or otherwise taking advantage of individuals who need affordable health insurance coverage.
Medicaid is the most closely related insurance option to this, with a few notable differences. Rather than covering a wide range of income levels and costs like ACA, Medicaid offers cost-free or low-cost coverage to those who qualify for it.
Another notable difference is that Medicaid is handled by individual states rather than the federal government. This means that the limits, qualifications, and laws can vary depending on where you live. And not everyone will find eligibility through Medicaid.
Medicaid eligibility is mostly limited to those who fall into the following categories:
- Those who are currently pregnant.
- Parents with children under the age of 18.
- Those with physical disabilities, including blindness and deafness, among others.
- Elderly individuals who can’t afford Medicare premiums.
- Low-income individuals.
Medicare has little in common with the other programs because it is specifically designed for individuals over age 65. Younger individuals with certain disabilities may also be eligible. Medicare is primarily paid for during our working years, although a premium may still apply.
A portion of each paycheck goes toward Medicare, and we become eligible to start using it once we hit retirement age. While each program is different, they are still related. The Affordable Care Act has expanded the available funds and addiction treatment options for those with Medicaid or Medicare coverage.
Pre-Existing Conditions and the ACA
If you’re wondering what’s left out of ACA coverage when it comes to addiction treatments, thankfully, the list is shorter than it’s ever been. The Affordable Care Act changed addiction treatment options for the better.
Under this act, addiction isn’t considered a pre-existing condition when it comes to insurance coverage.
Five Types of ACA Plans
Affordable Care Act plans come in different tiers. And one of the things that make ACA so unique is that anyone who needs health insurance can find it through an ACA-sponsored plan, including those who are looking for marketplace rehab coverage.
The five types of ACA plans are platinum, gold, silver, bronze, and catastrophic. The approximate coverage by plan type follows the same order, descending from the highest percentage of coverage to the lowest.
At approximately 90% expense coverage, the platinum plans are the highest tier. After that, the gold plans offer 80% expense coverage. Silver is next at approximately 70%. And catastrophic plans cover 60% of the total average cost, while the bronze plans offer 60% expense coverage.
Eligibility for ACA Coverage
ACA coverage is income-based according to the federal poverty level, which varies according to the size of the household. Those with a household income landing between the federal poverty level and four times that number will earn tax credits from the Affordable Care Act.
Of the millions of individuals who have already enrolled in ACA-sponsored coverage, roughly 87% of them qualified for tax credits. These income-based tax credits are typically applied to the total healthcare plan cost to lower the monthly premium.
In 2021, the limit for the total household income for one individual would be $51,040. For a family of five, the income limit would be $122,720. ACA has made it easier for millions of Americans to find affordable healthcare coverage.
Additionally, the 2021 American Rescue Plan has increased the income limits, reduced out-of-pocket costs, and made additional changes that make it increasingly easier to find affordable insurance. Now is the best time to apply for marketplace rehab coverage.
You can enter your household income information and compare your options here. Depending on which providers you qualify for coverage from, it should also be easy to compare marketplace rehab coverage before choosing a plan.
Millions of individuals across the country have already obtained marketplace rehab coverage.
Enrollment Deadlines and Conditions
The marketplace open enrollment period lasts from November 1st through January 15th. For coverage to begin on January 1st, you’d have to apply before December 15th.
After the open enrollment period ends on January 15th, individuals looking to apply for coverage would only be eligible to do so if they fell into specific exemption categories.
The special exemption periods for enrollment extends your application window if, in the past 60 days, you or someone in your household:
- Got married or lost health insurance coverage due to a divorce or legal separation.
- Had a baby, adopted a child, or placed a child into foster care.
- Lost eligibility due to a death.
- Moved to a different county, zip code, or to or from a shelter or transitional housing.
These exemptions, among others, give individuals in unique circumstances a chance to enroll in healthcare coverage outside of open enrollment.
Seeking Treatment for Addiction with Marketplace Rehab Coverage
ACA’s marketplace rehab coverage has reduced addiction treatment costs, increased addiction treatment options, and eliminated other cost-related roadblocks on the road to recovery. Whether you need residential, outpatient, or another level of addiction care, ACA funding can make it easier to obtain.
The Affordable Care Act’s addiction coverage rules also allow for co-occurring mental health conditions and treatments. Certain mental health disorders, including anxiety and depression, often co-exist with addiction.
At Divine Detox, we offer treatment options for a wide range of addictions and mental health needs. And we are on call today to answer your questions and help you get started. Call us at 818-938-2177.