Health reform — coverage for methadone treatment

My 25-year-old son gets daily methadone treatment at a clinic.  It’s working and he’s staying clean.  Will health reform change the plan and cut off these services for him?  Or will he have more benefits with health reform?  I just want to keep him on track, at least for as long as he can stay on my plan.

 Worried Mom

Dear Worried Mom,

First, it’s wonderful that the treatment is working for him.  That’s a blessing in itself.

You are correct that health reform will change what mental health and substance abuse services are covered.  In 2014, plans will have to provide “essential health benefits”. Mental health and substance abuse services are considered essential, by health reform’s legal definition. This means that the plan will have to match what the state’s “benchmark” plan covers. The benchmark plan may have limits on the service — the number of visits, the length of time, etc. — that it will pay for.  Whether this means your plan will add or reduce benefits for methadone depends upon how your current benefits compare to the benchmark plan.

You will get information about these changes when your plan has its annual renewal in 2014.  (If your plan renews in 2013, you won’t see these changes yet.)

So, your best strategy is to wait and see what changes come along.   In the meantime, enjoy his success with his current treatment.

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Linda Riddell

About Linda Riddell

A published author and health policy analyst with 25 years’ experience, Linda Riddell's goal is to alleviate the widespread ailment of not knowing what your health plan can do for you.