Navigating health insurance can be overwhelming—especially when you’re trying to get medical care or substance use treatment for yourself or a loved one. At Ocean Ridge Recovery, we often speak with individuals who are ready to begin their healing journey but aren’t sure what their health insurance will cover or how to use it. If you’re an employee considering substance abuse treatment, this guide is here to help you understand your insurance coverage, your options, and how to access the care you deserve.
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What Is Substance Use Disorder, and Why Insurance Matters
Substance use disorder (SUD) is a medical condition that affects millions of people each year. It can include the misuse of alcohol, prescription medications, or illicit substances, and often occurs alongside a mental health condition such as anxiety, depression, or PTSD. Getting the right substance use disorder treatment is essential—but without clear guidance, navigating addiction treatment costs can feel like another hurdle.
Fortunately, most health insurance plans offer some form of addiction treatment coverage, thanks in large part to the Affordable Care Act (ACA). This law requires that mental health services and substance abuse treatment be included in all ACA-compliant plans as essential health benefits.
What Does Health Insurance Typically Cover?
While plans vary, most employer-provided health plans, as well as those available through the health insurance marketplace, typically cover:
- Detox services
- Residential treatment or inpatient care
- Outpatient services
- Therapy and counseling (group or individual)
- Medication assisted treatment (MAT) for opioid or alcohol dependence
- Co-occurring mental health condition support
- Follow-up or continuing care
Your exact benefits package will depend on your health plan, but you have the right to access care for both mental health and substance use concerns.
Employee Insurance and EAPs: A Hidden Gem
If you’re employed, you may also have access to an Employee Assistance Program (EAP). These confidential services are often included in your benefits package and can connect you with short-term counseling, referrals, and even help navigating your insurance coverage. At Ocean Ridge, we work with many EAPs to ensure a seamless path into care for professionals in high-demand roles.
Understanding the Health Insurance Marketplace
If you’re not covered by employer-provided health insurance, the health insurance marketplace offers a variety of plans that include mental health and substance use disorder benefits. Through the ACA, plans must include addiction treatment coverage, making it more accessible for individuals and families to receive life-changing care.
When choosing a plan, look closely at:
- In-network vs. out-of-network treatment facility options
- Co-pays, deductibles, and out-of-pocket limits
- Access to both mental health services and disorder treatment
- Coverage for residential treatment or medication assisted treatment
How Ocean Ridge Recovery Can Help
At Ocean Ridge, we understand that your focus should be on healing—not on paperwork or red tape. Our admissions team is experienced in helping clients navigate their employee insurance, maximize health coverage, and minimize addiction treatment costs. We work with a wide range of providers and employer plans to make substance abuse treatment as accessible and stress-free as possible.
Whether you’re looking for care through your health insurance marketplace plan, a private health plan, or through an employer-sponsored benefits package, we’re here to help you every step of the way.
You’re Not Alone. Help Is Within Reach
Taking that first step toward substance use disorder recovery is a courageous decision. Understanding your health insurance options shouldn’t stand in your way. At Ocean Ridge, we’re committed to helping you access the mental health and substance abuse treatment services you need—whether you’re just starting to explore your addiction treatment coverage or ready to check into a treatment facility today.
Contact us today for a free, confidential insurance verification, and let’s take the next step together.
Start Your Journey By Getting Help Today
Our medical, clinical, and counseling staffs on site are available 24/7.
Brought to you by the Ocean Ridge Team in San Clemente, blending professional expertise with the healing benefits of coastal living.
