The prevalence of substance use disorders has increased dramatically in recent years, with deaths caused by opioid misuse quadrupling over the past two decades. The Affordable Care Act includes substance use disorder services as an essential health benefit, and there is evidence that Medication-Assisted Treatment (MAT) can be effective in treating these disorders. We have examined all silver marketplace plans in six cities looking at both drug coverage, and the associated cost sharing requirements in receiving treatment. We conclude that while the drug coverage is generally good, the cost sharing requirements for MAT as well as inpatient and outpatient coverage varies significantly.