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Do Health Insurance Companies Drug Test?

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Do Health Insurance Companies Drug Test?

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Updated: August 27, 2018    Published: July 5, 2017

Do Health Insurance Companies Drug Test? | The CheckUp by HealthCare.com
Image: kevinkarnsfamily / Flickr

It’s not common practice, but health insurance companies sometimes do drug test prospective policyholders.

While it’s more common for life insurance, there are a few cases where health insurance companies drug test prospective policyholders. But because of the Affordable Care Act, prior drug abuse could be considered a pre-existing condition. This means that health insurance companies technically can’t deny coverage or raise your insurance rates if you previously “suffered” from drug addiction or abuse.

Drug Abuse as a Pre-Existing Condition

Pre-existing conditions has been a hot topic in healthcare lately. The designated group of conditions, which includes ailments such as cancer, heart disease, and obesity, has in the past been commonly used by health insurance companies to charge customers higher premiums for coverage or deny coverage altogether. When people think of the label “pre-existing conditions,” they often associate it with physical conditions like asthma or diabetes. But a history of drug abuse is one unexpected disqualifier.

The ACA (“Obamacare”) mandated that insurance companies couldn’t deny coverage or raise your prices due to any pre-existing conditions – and this includes drug abuse. This is likely to change, though, if the ACA is repealed and replaced. Under the House draft of a new healthcare bill, the American Health Care Act, states were permitted to deny people with certain conditions coverage (although lawmakers insist that no one will be denied coverage due to pre-existing conditions). With the rollout of the Senate’s Better Care Reconciliation Act, people with pre-existing conditions no longer need to worry about completely being denied coverage, although states can still reduce essential benefits offered to people with certain conditions. Regardless of what the final bill specifically stipulates, it’s pretty clear that insurance costs for people with pre-existing conditions are likely to increase.

To Test or Not to Test

Use of illegal drugs and prescription opioids is on the rise in the United States. According to data compiled by the National Institute of Drug Abuse, abuse of illicit drugs and prescription opioids cost the country a combined $37 billion (based on data from 2007 and 2013).

Those with no tracked history of drug abuse and are purely drug users on a recreational basis may, however, be subject to drug testing. Given the high cost of health conditions that may result from drug use and abuse, and the cost of rehab programs, it’s not surprising that health insurance companies want to charge more for coverage of those things. But, this raises the question: for those with no tracked history of drug abuse, how will insurance companies know whether or not they should group a user in this category? Can health insurance companies drug test?

The short answer: it depends. Whether or not you’ll get drug tested before enrolling in a health insurance plan depends on the type of plan you’re enrolling in, your health insurance provider, and your state.

If you’re getting insurance in a group policy from an employer, it’s extremely unlikely that you’ll be drug tested before your coverage kicks in. Group policies are designed to cover an array of conditions on their enrollees, so drug testing an individual would be unnecessary.

If you’re purchasing an individual plan, it’s possible that your insurer may require a drug test. It isn’t very common due to the high cost of the test itself, but again it all depends on your specific provider and your state laws. You’re most likely to be required to take a drug test before being approved for a policy if you’re receiving coverage via a government program (such as Medicaid). It’s still up to each state whether or not to test enrollees, but a growing number of states are working on putting laws in place to vet, in some capacity, health insurance enrollees for possible drug use.

There’s plenty of debate whether or not drug testing for healthcare is worth it from a financial standpoint (not to mention an ethical one). The tests are expensive and don’t differentiate between recreational and chronic use, which makes it hard to gauge how to apply the results to plan pricing. Still, plenty of policymakers and state governments support the testing. If you’re tested and the results indicate drug use, be prepared to be denied coverage or pay a significantly higher premium than you would otherwise pay.

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