Is the cost of care a factor that’s keeping you from entering a treatment program for substance abuse or addiction? You’re not alone – this is a common reason people give for not going to treatment when it’s needed. But health insurance is something you can lean on to pay a portion of your treatment costs, so you won’t be responsible for as much as you might have thought.

Marketplace Coverage

Under the Affordable Care Act, all plans give you coverage for substance use treatment, which is a great option when you want to enter treatment for alcohol or substance use. These plans also cover mental health treatment, which is beneficial if you have a dual diagnosis of a mental illness along with substance abuse or addiction.

With these plans, you can choose between outpatient treatment that can work around your schedule or inpatient care that helps you leave your life for a while to truly start over. Insurance will often cover detox, counseling, evaluations, and other services under your plan.

Options in New Mexico

In New Mexico, the Aetna HealthFund CDHP/Aetna Value Plan is one of the Aetna plans you can choose that follows the minimum essential coverage needed to meet the Affordable Care Act guidelines. The plan requires you to get certain substance treatment and mental health care pre-approved, including for outpatient detox services, partial hospitalization or intensive outpatient programs. It also requires preauthorization for psychological testing, electroconvulsive therapy on an outpatient basis and some other treatment services.

For evaluations, individual counseling, group therapy, detox programs, and various other treatments for substances, you are responsible for 15 percent of the plan allowance for in-network providers or 40 percent for non-network providers. You pay the same percentage for outpatient or inpatient services in a hospital or other facility. This is after you use your plan’s medical fund of $1,000 for an individual and then cover the individual deductible of $1,000.

Aetna offers a variety of other plans within this part of the country through the insurance exchange. There are bronze, silver, and gold level plans, which range from low premium and high deductible plans at the bronze level to higher premium and lower deductible plans at the gold level. Bronze plans cover 60 percent of health care services, silver cover 70 percent, and gold cover 80 percent.

You could enroll in various Aetna plans depending on what is available to you. One gold plan you might want is the Aetna Banner Health Network Gold $5 Copay plan. With a gold plan, you would have a larger portion of care covered, which could potentially be beneficial since you know you want to enter substance treatment. This plan has a $1,400 individual, in-network deductible. Care costs you $40 for outpatient visits or a 20 percent coinsurance for inpatient care. If you’d rather go outside the network, you pay a 50 percent coinsurance for inpatient and outpatient care.

A silver plan is the Aetna Banner Health Network Silver $10 Copay plan. With this plan, you have an individual, in-network deductible of $3,750. Outpatient visits cost you $75, while inpatient treatment costs a $500 admission copay and a 30 percent coinsurance. You pay a 50 percent coinsurance instead if you want inpatient or outpatient care outside the network.

And if you would rather spend less on your monthly premiums, you could enroll in the Aetna Banner Health Network Bronze HSA Eligible plan. It comes with an individual, in-network deductible of $6,300. Once you meet the deductible, the plan covers the cost of either inpatient or outpatient if you stay in the network. If you’d rather go outside it, you pay a 50 percent coinsurance instead.

Deciding on a Plan

Aetna provides various plan offerings in your state of New Mexico. You can choose a plan based on the premium amount you need to pay each month to fit your budget. Nonetheless, it’s also important to keep in mind how much of your care each plan will cover since you’re planning to enter treatment. With health insurance, treatment is a possibility for more people. If you fit into this group, rely on insurance to enter the treatment program you’ve been waiting for. Contact us at DrugRehab.org to start your journey towards recovery today.