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Does insurance cover substance abuse treatment?

It depends on your plan, but many plans are required to cover it. Every ACA Marketplace plan must cover substance use disorder treatment as an essential health benefit, and Virginia Medicaid covers a range of addiction treatment through its ARTS benefit. What you pay depends on your plan, its network, and your deductible.

Admissions and coverage review at Lighthouse

Marketplace plans

According to HealthCare.gov, Marketplace plans:

  • Must cover substance use disorder treatment, behavioral health treatment such as counseling, and inpatient behavioral health services
  • Cannot deny you coverage or charge you more for a pre-existing substance use condition
  • Cannot put yearly or lifetime dollar limits on these services
  • Must apply "parity": deductibles, visit or day limits, and prior-authorization rules for substance use care generally cannot be more restrictive than for medical and surgical care

Virginia Medicaid (ARTS)

Virginia’s Department of Medical Assistance Services launched the Addiction and Recovery Treatment Services (ARTS) benefit in 2017. It covers a continuum of addiction treatment for members in Medicaid, FAMIS, and FAMIS MOMS. For ASAM Level 2.5 partial hospitalization, the regulation requires the program to be licensed by DBHDS as a partial hospitalization program and contracted with DMAS or a Medicaid health plan, so ask any program whether it works with your plan.

What to ask before you start

  • Is the program in my plan’s network?
  • Does my plan require prior authorization for this level of care?
  • How much of my deductible is left, and what will I owe?
  • If I am uninsured, does the program offer a sliding-scale fee or payment plan? (NIAAA suggests asking.)

If your coverage is through an employer

The rules above are the ones HealthCare.gov lists for Marketplace plans. For employer coverage, check your plan documents or call the member number on your insurance card.

Sources

Sources checked November 2, 2026. This page is general information, not medical or legal advice. Your clinician, your health plan, and (for VASAP) your court order and ASAP case manager set what applies to you.

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