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Access to Treatment: Insurance and Other Barriers

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By Editorial Team

Last Updated:

3 min read

There are many treatments that are effective in helping people with opioid use disorder (OUD). These include prescription medicines, community needle exchanges, and inpatient or outpatient programs.1-3

Although there are many options, few people can access treatment. One 2019 study estimated that less than 35 percent of people with OUD had accessed treatment within the past year. Another study found that in 2020, only 11 percent of people with OUD received one of the recommended prescription medicines.1-4

In rural areas, the situation is even worse. According to another 2020 study, only 1 in 500 people in a rural area received medicine to help treat their OUD.1-4

There are still many barriers to people receiving the treatment that they need.

Insurance-related barriers

One barrier to treatment is not having insurance. Even having health insurance is no guarantee that a person can get treatment. Depending on the type of insurance policy, treatment for OUD may not be covered. This is especially true for cases of relapse.1-3,5

OUD is a mental health disorder. Insurance providers must legally treat mental healthcare problems the same way as any other health issue. This means they cannot charge higher copays for treatment. But how this rule applies can be different depending on which state you live in. Also, insurance providers do not have to cover treatment in cases of relapse.1-3,5

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Even if you have insurance, you may have to pay a high out-of-pocket deductible. This might mean you still cannot afford the suggested medicines or treatment facilities.1-3

Another problem is that the insurance may only cover certain medicines or treatment facilities. Those options may not be the best fit for your circumstances.1-3

When reaching out to your insurance company, have a list of questions ready. These can include:5

  • What services do you provide?
  • Do I need permission from insurance before receiving treatment (preauthorization)?
  • Do I need a referral from my doctor?
  • How much treatment is covered?
  • Which prescription medicines does my insurance cover?

This or That

Do you have health insurance?

Other barriers to accessing treatment

There are many other barriers to treatment, with or without insurance coverage. These can include:

Doctor stigma

You may not feel comfortable talking about OUD with your doctor. Maybe you are worried or afraid of your doctor:2-4

  • Thinking of you as a bad person
  • Ignoring your problem
  • Not being willing to prescribe medicine to treat your OUD
  • Not knowing much about treatment options

Financial issues

Even with insurance coverage, you may not be able to afford the copays for treatment.2,3

Privacy concerns

Many people worry that family, friends, or employers will find out about their treatment.3

Lack of knowledge

People may not know where to start looking for help or what treatments are available.2-3

Logistical barriers

There might be other problems linked to receiving treatment. For people in rural areas, there may not be a treatment facility within a reasonable distance. Even when there is a facility nearby, barriers can include:1-4

  • Transport to the facility
  • Wait time to enter the facility
  • Childcare while in treatment

Lack of community support

Maybe you feel your family or local community will not support your treatment. Or your community has a large number of substance users, and that creates a challenge to remaining sober.1-3

Gender barriers

A lack of gender-specific facilities can put people off seeking treatment.1

Resources for help

If you are just starting your search for OUD treatment, there are several places to go for thorough information:5

  • The Substance Abuse and Mental Health Services Administration (SAMHSA) has a 24-hour hotline that can provide help and referrals. The service is free, confidential, and available in both Spanish and English. Call 1-800-662-HELP (4357).
  • FindTreatment.gov is another SAMHSA resource that can help you locate treatment centers near you.
  • If insurance is a barrier, Medicaid.gov offers information and guidance about whether you are eligible for Medicaid in your state.

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