When considering whether to seek treatment for a substance use disorder, the cost of treatment is often the primary factor that keeps individuals from getting help. However, it’s important to know that there are many options available to help pay for addiction treatment, with the most common option being public or private rehab insurance.
Understanding the plan you have with your insurance carrier is the first step to determining the level of coverage you can receive for a drug and alcohol rehab program or other addiction services. While coverage will vary from plan to plan, most insurance providers offer some form of coverage for drug and alcohol addiction treatment.
How To Use Insurance For Alcohol And Drug Rehab Programs
Many public and private insurance providers offer comprehensive coverage for drug and alcohol addiction treatment and services. The 2008 Mental Health Parity and Addiction Equity Act (MHPAEA) ensures that insurance providers cover treatment and care for substance use disorders as extensively as other medical services.
What’s more, the Affordable Care Act protects those with pre-existing conditions, such as a substance use disorder, from being denied coverage by an insurance company.
In order to understand how to use your insurance for alcohol and drug addiction rehab or other treatment services, you must first know some of the basic terms insurance terms. These include:
- Deductible — A deductible is the amount of money you will need to pay annually before an insurance company will begin providing coverage. For example, if your deductible is $500, you will need to spend $500 on medical services before your insurance carrier will cover the cost of treatment. Each insurance company’s deductible is different and will also vary depending on your plan.
- Coinsurance/Copay — A copay is a flat fee you will be required to pay for each service or treatment received. For example, a visit to the doctor may require a $35 copay and the insurance company will pay for the rest. When it comes to inpatient drug and alcohol addiction treatment, you may be required to pay a copay upfront or daily.
- Maximum Out Of Pocket — Some insurance policies have a maximum out-of-pocket that you can spend each year. Once you have met the maximum out-of-pocket, the insurance company will pay 100 percent of covered services for the remainder of the year.
The amount you will end up paying for drug and alcohol addiction treatment, such as a stay at a rehab facility, will depend on many factors, including the type of insurance plan you have and the treatment facility you choose to attend.
If your insurance plan covers 80 percent of the cost of a stay at an inpatient drug and alcohol addiction treatment center, you will be responsible for paying the remaining 20 percent. This means that if a treatment facility costs $10,000, you will need to pay $2,000, and your insurance carrier will cover the remaining $8,000.
What Types Of Alcohol And Drug Rehab Programs Are Covered?
There are many different forms of alcohol and drug addiction treatment and many services that go into a comprehensive treatment plan. Additionally, each insurance company and plan will vary in the types of rehab facilities and services covered.
Some of the most common forms of addiction treatment and services that are often covered under an insurance plan include:
- Diagnosis — Some individuals choose to meet with their primary care physician to better understand their substance use disorder and discuss the treatment options available.
- Medical Detox — Many individuals choose to begin their journey to recovery with a medically supervised detox program, and for good reason. Withdrawing from alcohol or substances on your own can be very uncomfortable and potentially dangerous. Many insurance companies recognize this and will provide coverage for a medical detox program.
- Outpatient Rehab Programs — Outpatient drug and alcohol addiction treatment may be required before an insurance company will provide coverage for an inpatient rehab program. Outpatient treatment is an intensive form of addiction treatment that requires the patient to attend therapy several times a week for an extended period of time.
- Drug Replacement — Some addictions can be treated through drug replacement therapy, in which the drug is replaced with a less harmful drug to help manage withdrawal symptoms and reduce cravings. The individual is slowly weaned off the replacement drug. Not all insurance companies cover this form of treatment, so it’s best to check with your carrier before pursuing drug replacement.
- Inpatient Rehab Programs — This is the most intensive form of drug and alcohol addiction treatment and requires the patient to live at the rehab facility for an extended period of time. Some insurance providers require individuals to attempt outpatient treatment before covering the cost of inpatient rehab.
Insurance Plans For Addiction Treatment
There are three main types of insurance: public, private, and group insurance. Each carrier is different and provides different insurance plans. If you do not know what type of insurance plan you have, you can simply call your insurance provider or a treatment specialist and ask.
Group insurance is the type of insurance commonly offered by employers or member associations. You may be able to select from a number of different benefit packages and have some or all of the package paid for by your employer.
Group insurance plans can vary greatly. For example, an employer with less than 50 employees may only offer a select number of benefits, while an employer with more than 50 employees may be able to provide a variety of insurance options.
Because of the 2008 MHPAEA, most if not all group insurance plans should provide some form of coverage for substance use disorder treatment. Each plan will vary, so it’s important to speak with your employer or insurance provider to fully understand what kind of coverage you are eligible to receive.
If your current insurance plan does not offer coverage for drug and alcohol addiction treatment or if you do not currently have insurance, you may be able to receive public insurance. Public insurance plans are offered through the government to individuals who qualify.
There are two different types of public insurance: Medicare and Medicaid. Medicare is mostly for individuals ages 65 and older, while Medicaid is available to anyone who meets the qualifications for coverage.
While these two types of public insurance plans provide comprehensive coverage for nearly all medical services, not every healthcare provider accepts these plans. This means that you will have to ensure that the rehab facility you plan on attending accepts Medicare or Medicaid ahead of time to avoid paying excess out-of-pocket fees.
Private insurance carriers offer insurance plans on an individual or family basis. You may get private insurance through your employer or you may seek an insurance provider on your own. Many private insurance providers require higher monthly premiums than group or public insurance carriers, but often offer better coverage and a wider network of healthcare providers.
Some private insurance carriers offer plans within a certain network, often referred to as managed care plans. These may include:
- Preferred Provider Organization (PPO) — This is often considered one of the best private insurance plan options and typically allows individuals to seek medical services that are both in-network and out-of-network. Out-of-network providers may require patients to pay more out of pocket than in-network providers.
- Health Maintenance Organization (HMO) – This type of plan typically only offers coverage for providers that are in-network.
Common Insurance Carriers That May Cover Addiction Treatment
The following private insurance carriers may provide coverage for some or all of drug and alcohol addiction inpatient treatment:
- Blue Cross Blue Shield
- Kaiser Permanente
- United Healthcare
Identifying Your Insurance Coverage For Drug And Alcohol Rehab
To get the most out of your rehab insurance plan, you will first need to understand what type of insurance you have as well as the network your insurance provider covers. You will also need to understand your rehab insurance plan and any requirements or prior authorizations you must meet to receive coverage for drug and alcohol addiction rehab.
Contact us to learn more about what kind of rehab insurance coverage you have and how you can use it to seek treatment for a substance use disorder.