If you have chronic pain, the Affordable Care Act requires your health plan to offer certain services and benefits that can help you. For instance, you will find it easier to get pain medicine. You will also have better access to pain counseling through your family doctor.
But some questions remain. Whether you will be able to use some treatments for pain is still up in the air. Your insurance may not have to cover acupuncture or chiropractic care, for examples. This may depend on where you live. It also is not yet clear just how pain clinics will fit into new health care groups.
Pain Management Benefits
Your health plan must cover a core package of benefits under the Affordable Care Act called essential health benefits. These include:
- Prescription drug coverage. You will have a copay and deductible, though.
- Chronic disease management
- Emergency care
- Hospital care
- Mental health services
If you have Medicare, your plan includes the essential health benefits. So does Medicaid, if you are new to Medicaid. Also, any plan you buy through your state's health insurance Marketplace must offer these benefits. If you get insurance through your job, you might not have the same coverage. Check your health plan to be sure.
Pain Treatment and Counseling
Most of your pain management care should come from your family doctor. Specialists in pain clinics will focus on people with more complex cases. That's the recommendation of a report on pain treatment that was ordered by the Affordable Care Act. The report said that a team of doctors led by your family physician should treat chronic pain.
Depression and Mental Health Treatment
You might feel depressed or anxious because of your chronic pain. You can get free screening for depression under the new law. You also can get mental health treatment for depression, anxiety, and other other mental health conditions.
You might be able to have acupuncture or see a chiropractor for your pain. This will depend on where you live. That's because states can choose whether to include these services as part of the essential health benefits package.
For now, you can get coverage for acupuncture if you live in California, Maryland, New Mexico, and Washington. Other states may follow.
On the other hand, some states don't count chiropractic care as an essential health benefit. These include California, Colorado, Hawaii, Oregon, and Utah.
Medicare provides very limited coverage of chiropractic care. It does not cover acupuncture.
Savings on Drug Costs for Seniors
If you're on Medicare and take medicine for chronic pain, you may be pleased to know that the donut hole -- the gap in Medicare coverage for prescription drugs -- is slowly going away. It will be gone by 2020, leaving you to pay just 25% of the cost of your brand-name and generic medications. See "What Medicare Costs, Part D" to get the details, including what discounts are available until the donut hole closes.