Choosing the right plan if you or a loved one suffers from a substance use disorder

substance abuseIf you or a loved one is struggling with a substance use disorder, choosing the right health plan is an important decision in how much you’ll pay for treatment and prescriptions.

You should know that under all health plans through Maryland Health Connection, substance use disorder treatment is covered — but plans vary in how much you’ll pay for care. Learn more here about choosing the right health plan.

Consider your costs before your health insurance begins to pay for medical care.

When you enroll in a health plan, you usually need to pay a certain amount of money (the deductible) out-of-pocket each year before your insurance company begins to pay for medical services.

Depending on your income, you may qualify for financial assistance that lowers out-of-pocket costs—including the deductible—when you enroll in a Silver-level plan.

This kind of financial assistance is called a cost-sharing reduction.

Consider your costs after your health insurance begins to pay for medical care.

If you expect to need extensive inpatient and outpatient substance use treatment services with costs exceeding your deductible, you may want to consider a “no charge after deductible” plan.

That means that for some plans, all out-of-pocket spending on your health care counts toward your overall deductible, and you’ll pay $0 for medical services after the deductible is met.

What to look for when shopping at MarylandHealthConnection.gov:

  • Look for the plan’s “Summary of Benefits and Coverage” document that shows specific costs, including after-deductible costs for common treatment services. You also can search by medications to see what each plan will charge by clicking “Plan Details” and “Prescription Drug (Formulary) Search.”
  • Examine the cost of the most common substance use disorder treatment services that you may be responsible for after meeting your deductible. These may include emergency room visits, inpatient or outpatient substance use disorder treatment, and prescription medication.
  • Make a decision about what works best for your budget. Consider the cost of your deductible, the cost of services once your deductible is met, and your monthly premium.
  • Consider which doctors, hospitals and treatment centers accept your insurance. Make sure your preferred doctors, hospitals, treatment centers, pharmacists and specialists accept the insurance and the specific plan type.
  • Pre-approval of services may be required. You may need to get care pre-approved by your insurance company before you receive services. An in-network provider can do this for you.

Get free help choosing the right plan.

At MarylandHealthConnection.gov you can compare plans and costs, see what financial help you may qualify for, and enroll in a plan.

You can also visit MarylandHealthConnection.gov/get-help-enrolling/ to search for an authorized insurance broker. They provide free help to pick the best plan for your health needs.