Insurance Coverage for Addiction Treatment in Ohio: Types, Plans and Coverage

Ohio’s health insurance plans both public and private offer varying levels of coverage for substance use disorder (SUD) treatment. These include detoxification, inpatient rehabilitation, outpatient programs, counseling, and medication-assisted treatment (MAT). The extent of coverage often depends on the type of plan, the insurer’s network, and state or federal regulations.

Ohio provides 3 primary insurance coverage types for addiction treatment through Medicaid, ACA Marketplace plans, and employer-sponsored insurance. The Affordable Care Act mandates that health plans cover mental health and substance use disorder services as one of ten essential health benefit categories, with 477,793 Ohioans signing up for 2024 ACA Marketplace plans representing record-high enrollment (CMS, 2023; CMS, 2024). 

Ohio integrated behavioral health services into Medicaid managed care in July 2018, extending Mental Health Parity and Addiction Equity Act protections to 2.6 million Medicaid enrollees, while federal funding provided over $1 billion for mental health and addiction services for expansion enrollees in 2024 (Community Solutions, 2019; HPIO, 2025).

What Types of Insurance Cover Addiction Treatment in Ohio?

The three main types of insurance that cover addiction treatment in Ohio are Medicaid, ACA Marketplace plans, and employer-sponsored coverage. 

Medicaid covered roughly 3.21 million Ohioans in 2024, representing about 27% of the state’s population (USAFacts, 2024). Nearly 477,793 Ohioans signed up for 2024 ACA Marketplace health plans, marking record-high enrollment for the state (CMS, 2024). 

Under federal law, all three insurance categories must provide addiction treatment coverage as one of 10 essential health benefit categories mandated by the ACA (CMS, 2023).

Medicaid serves as the dominant payer for Ohio’s substance abuse treatment, funding approximately 60% of treatment admissions statewide, while private insurance covers roughly 15% of cases (SAMHSA, 2020). 

The Mental Health Parity and Addiction Equity Act requires insurance plans impose no stricter cost-sharing or treatment limits on substance use disorder benefits than on medical benefits (CMS, 2023).

How Does Ohio Medicaid Cover Addiction Treatment Services?

Ohio Medicaid covers addiction treatment services by functioning as the state’s largest addiction treatment payer, financing approximately 60% of substance abuse treatment admissions (SAMHSA, 2020). Medicaid covered 3.21 million Ohioans in 2024, representing 27% of the state’s population (USAFacts, 2024). Survey data reveals 18% of Medicaid enrollees ages 12-64 had substance use disorders in 2020 when including undiagnosed cases (KFF, 2023).

Ohio integrated behavioral health services into Medicaid managed care in July 2018, extending parity protections to approximately 2.6 million Medicaid enrollees (Community Solutions, 2019). This integration affects 90% of Ohio Medicaid enrollees who participate in managed care plans, ensuring parity requirements apply to behavioral health services (Community Solutions, 2019). 

What Addiction Services Do ACA Marketplace Plans Cover in Ohio?

Ohio Marketplace plans provide comprehensive addiction treatment services as mandatory essential health benefits, including counseling, inpatient rehabilitation facilities, and FDA-approved substance use disorder medications (CMS, 2023).

All 13 insurers offering ACA plans in Ohio for 2025 must cover these behavioral health services under federal law, providing residents in nearly all areas access to at least five different insurers’ addiction treatment coverage options (HealthInsurance.org, 2024). Mental health parity requirements ensure addiction services receive equivalent coverage to medical treatments, eliminating separate annual limits that previously restricted substance use disorder care (CMS, 2023).

Marketplace enrollment protections include a $9,450 annual out-of-pocket maximum for individual plans in 2024, preventing catastrophic expenses for intensive addiction treatments (CMS, 2023). Federal parity enforcement has pushed insurers to remove prior authorization barriers and dosage limits on addiction medications, though provider network gaps persist (NAMI, 2024).

High deductible challenges create affordability barriers, with many Ohio Marketplace health plans requiring several thousand dollars in out-of-pocket costs before coverage begins for addiction services (Commonwealth Fund, 2025). Roughly 478,000 Ohio Marketplace enrollees gained mental health and substance use disorder coverage in 2024, representing dramatic expansion compared to pre-ACA years when addiction treatment often lacked insurance coverage (CMS, 2024). 

How Do Employer-Sponsored Plans Handle Addiction Treatment Coverage?

Employer-sponsored plans handle addiction treatment coverage through federal parity laws that require equal benefits for substance use disorders and medical conditions. The Mental Health Parity and Addiction Equity Act (MHPAEA) mandates that insurance plans impose no stricter cost-sharing or treatment limits on addiction benefits than medical benefits (CMS, 2023). These workplace health plans maintain an average annual deductible of $1,735 for single coverage, similar across Ohio and national markets (KFF, 2023). 

Federal parity enforcement has pushed insurers to remove unequal treatment limitations from employer plans covering addiction services. The U.S.  Department of Labor took action in 2022 against health plans that failed parity tests, requiring insurers to eliminate discriminatory practices (DOL, 2022). 

Which Ohio Insurance Companies Provide the Best Addiction Treatment Coverage?

Anthem dominates Ohio’s insurance market with 31% market share and provides comprehensive addiction treatment coverage under federal parity requirements (AMA, 2024). CareSource operates as Ohio’s largest Medicaid managed care plan, serving over 2.1 million members with extensive substance use disorder benefits (CareSource, 2023).

All Ohio insurance companies must comply with the Mental Health Parity and Addiction Equity Act, requiring equal cost-sharing and treatment limits for addiction services compared to medical care (CMS, 2023). Network adequacy remains problematic, with Ohio patients 5x more likely to seek out-of-network care for behavioral health services than other medical needs (Community Solutions, 2019).

What Are the Coverage Requirements for Addiction Treatment Under Ohio Law?

Coverage requirements for addiction treatment under Ohio law mandate that insurance plans provide mental health and substance use disorder services as one of ten essential health benefit categories under the ACA (CMS, 2023). The Mental Health Parity and Addiction Equity Act requires Ohio insurance plans impose no stricter cost-sharing or treatment limits on addiction benefits compared to medical/surgical benefits (CMS, 2023). Despite federal requirements, Ohio’s state parity law enacted in 2006 remains narrower than federal mandates and conflicts with MHPAEA standards (Ohio Senate, 2020).

Ohio received an “F” grade in national mental health parity performance assessments due to outdated state statutes that allow more restrictive limits on behavioral health benefits than physical healthcare (Ohio Senate, 2020). The U.S. Department of Labor took enforcement action in 2022 against health plans that failed parity compliance tests, pushing Ohio insurers to remove discriminatory treatment limitations (DOL, 2022). Federal audits discovered numerous parity violations nationwide, including more frequent denials for inpatient addiction rehabilitation compared to medical hospital stays (DOL, 2022).

Why Did Ohio Receive Poor Grades for Mental Health Parity Compliance?

The state enacted its parity law in 2006, but this legislation is narrower than federal requirements and has not been updated to align with the Mental Health Parity and Addiction Equity Act (MHPAEA) (Ohio Senate, 2020). Ohio’s antiquated parity statutes allow more restrictive limits on mental health and substance use disorder benefits compared to physical healthcare, creating compliance gaps that earned the failing grade.

Ohio’s parity compliance failures create significant barriers for patients seeking behavioral health services.  Federal MHPAEA requirements mandate that insurance plans impose no stricter cost-sharing or treatment limits on mental health and SUD benefits than on medical/surgical benefits (CMS, 2023). Ohio’s outdated state insurance provisions still permitted more restrictive limits on mental health and SUD benefits than on physical healthcare as of 2019 (Community Solutions, 2019).

How Do Federal Parity Laws Affect Ohio Insurance Plans?

Federal parity laws prohibit Ohio insurance plans from imposing stricter cost-sharing or treatment limits on addiction benefits compared to medical and surgical benefits. The Mental Health Parity and Addiction Equity Act (MHPAEA) requires insurance plans to eliminate disparate treatment limitations on mental health and substance use disorder services (CMS, 2023). Ohio integrated behavioral health services into Medicaid managed care in July 2018, extending these federal parity protections to approximately 2.6 million Medicaid enrollees (Community Solutions, 2019). About 90% of Ohio Medicaid enrollees are in managed care plans that must comply with parity requirements for behavioral health needs (Community Solutions, 2019).

Federal audits in 2022 identified numerous parity violations by insurers nationwide, including more frequent denials for inpatient substance use disorder rehabilitation compared to medical hospital stays (DOL, 2022). The U.S. Department of Labor took enforcement actions in 2022 against health plans that failed parity compliance tests, pushing insurers in Ohio to remove unequal treatment limitations (DOL, 2022). Despite federal requirements, Ohio’s own parity law enacted in 2006 remains narrower than federal standards and has not been updated to align with MHPAEA (Ohio Senate, 2020). Due to outdated state parity statutes, Ohio received an “F” grade in one national assessment of state mental health parity performance (Ohio Senate, 2020).

Behavioral health services now account for 3.8% of all medical claim costs in 2023, more than double their share of 1.8% in 2018 (PwC, 2023). Insurers paid an average of $122.79 per behavioral health claim in 2023, up from $106.84 in 2018 (PwC, 2023). In-network reimbursement for mental health clinicians remains approximately 22% lower than for other medical clinicians, creating provider network participation barriers (NAMI/RTI, 2024). Ohio patients seeking behavioral health services are up to 5 times more likely to go out-of-network for care compared to patients with other medical needs (Community Solutions, 2019).

What Are the Main Coverage Challenges for Ohio Residents Seeking Addiction Treatment?

The main coverage challenges for Ohio residents seeking addiction treatment include:

• Inadequate Provider Networks: Patients must often seek out-of-network behavioral health services at five times higher rates than for other medical needs (Community Solutions, 2019).
• Low Provider Reimbursement Rates: Mental health clinicians are paid 22% less than other medical professionals, discouraging addiction specialists from joining insurance networks (NAMI/RTI, 2024).
• High Deductibles and Affordability Barriers: Ohio Marketplace plans impose high deductibles, making addiction treatment services financially inaccessible for many residents.
• Network Adequacy Issues Despite Parity Laws: Even with federal parity requirements mandating equal coverage, network gaps and access challenges continue for addiction and mental health care.
• High Out-of-Network Utilization Nationally: Nationwide, out-of-network use is 3.5× higher for mental health and substance use disorder treatment than for general medical care (NAMI/RTI, 2024).
• Restrictive Insurance Market Structure: Most Ohio individual market plans are HMO or EPO models, offering no out-of-network benefits for non-emergency addiction care (ODI, 2023).

What Plan Types Are Available in Ohio’s Insurance Market?

Ohio insurance markets offer 3 primary plan types with distinct network arrangements affecting addiction treatment access (ODI, 2023). HMO and EPO plans dominate the individual marketplace, providing no out-of-network coverage for non-emergency care including substance abuse treatment (ODI, 2023). 

PPO plans represent a minority option, delivering partial out-of-network benefits with higher cost-sharing when patients seek addiction services outside provider networks (ODI, 2023). Residents across nearly all Ohio areas access at least 5 different insurers’ Marketplace plans for 2025 coverage, expanding treatment options (HealthInsurance.org, 2024).

Network restrictions create significant barriers for behavioral health services, with Ohio patients needing addiction care up to 5× more likely to go out-of-network compared to other medical needs (Community Solutions, 2019).

How Has Ohio’s Medicaid Expansion Affected Addiction Treatment Access?

Ohio’s Medicaid expansion transformed addiction treatment accessibility by reducing uninsured self-pay admissions from 43,136 in 2008 to just 9,979 in 2018 (SAMHSA, 2020). Medicaid became the primary payment source for 60% of Ohio’s substance abuse treatment admissions by 2018, while self-pay admissions dwindled to under 10% of total cases (SAMHSA, 2020). Federal funds totaling over $1 billion supported mental health and addiction services for Ohio’s Medicaid expansion enrollees in 2024 (HPIO, 2025).

Medicaid expansion coverage facilitated better addiction outcomes statewide through comprehensive treatment access. States expanding Medicaid, including Ohio, experienced slower opioid overdose mortality growth compared to non-expansion states during 2014-2017 (JAMA, 2020). 

Ohio’s Medicaid program covers all 3 FDA-approved medications for opioid use disorder including buprenorphine, methadone, and naltrexone without prior authorization requirements (ODM, 2021). 

Treatment utilization increased dramatically among covered populations following expansion implementation. Nearly 3 in 4 Medicaid enrollees with diagnosed substance use disorders accessed treatment services in 2020, though disparities persist with only 4 in 10 Black enrollees receiving medication treatment versus nearly 7 in 10 White enrollees (KFF, 2023).