Drug and alcohol addictions wreak havoc on a person’s life and only get worse the longer they go untreated. For many in this situation, the first question asked is “does insurance cover rehab.” Fortunately, recent changes in health care law have made it possible for nearly anyone to afford rehab treatment. While insurance coverage won’t cover all of your treatment costs, they do cover a big chunk, which makes it easier for you or someone you know to get the help they need.
Why Getting Rehab Help Is So Important
As expensive as drug rehab can be, addiction takes a toll of its own that’s not only financial but also life-changing. And the longer addiction goes untreated the more devastating its effects. Once drugs (or alcohol) becomes the centerpiece in a person’s life, everything else falls by the wayside. This includes your relationships, your career, and your overall quality of life.
Overcoming the pull off addiction requires a structured treatment approach that addresses the drug problem as well as the thinking and behaviors that keep it going. Drug rehab programs specialize in helping individuals see the problem for what it is and the damage it caused. From there, they help you develop strategies for coping with daily life on a drug-free basis. Drug rehab insurance coverage can make the decision to get the treatment you need easier to make.
Rehab Insurance Coverage – Legal Provisions
So, does insurance cover rehab? In a way, it always has but some substantial changes have taken place as of late. Prior to 2008, health insurance laws didn’t require insurance companies to provide the same level of coverage for rehab treatment as they did for medical care. Drug and alcohol addiction treatment was not considered medically necessary so companies could choose to offer coverage at their discretion.
With the passing of the Affordable Care Act (ACA) in 2008, coverage requirements were expanded for drug and alcohol rehab. The new provisions provided by the ACA require large group health insurance companies to offer the same level of coverage for rehab-related treatment as they do for medical care. These changes make it possible for more people to be able to afford to get the help they need. Covered treatments and services include:
- Medication-assisted treatments, such as methadone and Suboxone
- Brief interventions
- Drug and alcohol testing
- Clinic visits
- Individual and family counseling
Using Your Insurance to Cover Rehab
No two people enter rehab with the same treatment needs. This begs the question, “is rehab covered by insurance across the board, or are only certain types of programs covered?” Rehab programs vary in the range of services they offer with many programs specializing in treating different stages of addiction. Your insurance plan will likely include benefits that cover most any form of treatment you need as long as it’s deemed medically necessary.
The type of treatment you choose may, however, affect the level of insurance coverage that’s available. Knowing what type of program you need can help you determine how much insurance will cover. The types of programs covered by insurance include:
- Detox programs – provide any medical care you might need during the detox process, along with counseling and 24-hour supervision
- Inpatient treatment – also known as residential treatment, these programs take place within a live-in environment where you’ll receive behavior-based therapies, addiction counseling, and relapse prevention training
- Outpatient programs – offer ongoing behavioral therapy, counseling and support group meetings
Types of Coverage
Individual & Employer-Based Plans
Much like your existing medical coverage, the type of health plan you’re on will determine your drug rehab insurance coverage. Plan types can vary in terms of which doctors are covered, your out-of-pocket expenses, premium payment amounts, and copay requirements. Here are the three most common types of insurance plans:
- Preferred Provider Organizations or PPOs – covers doctors and programs within an assigned network. PPOs will pay for out-of-network providers but at a higher cost to you. Overall, premiums tend to run lower but copays and deductibles may be higher than with other plan types.
- Health Maintenance Organization or HMOs – also covers doctors and programs within an assigned network but has more restrictions than a PPO. You’ll likely need a referral for rehab treatment from your primary care physician to ensure your treatment will be covered. HMOs typically charge the highest premiums but deductibles and copays are lower than the other plans.
- Point of Service Plan or POS – combines the features of an HMO and a PPO. POS coverage requires you to have an in-network primary care doctor who, in turn, must refer you to a doctor or rehab program. You can use out-of-network providers but at a higher cost to you. Premiums tend to run less than HMOs but more than PPOs with deductible and copayment requirements comparable to PPOs.
Public Insurance Plans
If you don’t have an individual or employer-based plan, you may qualify for a public insurance plan. Public plans are funded by state and federal governments. The two most well-known public insurance plans are Medicaid and Medicare. So how does insurance cover rehab with a public insurance plan?
If you receive SSI, are pregnant, or fall within federal-based, low-income guidelines, you might qualify for Medicaid. Medicaid plans use managed-care organizations or MOSs. Managed-care plans only work with rehab programs within their network. They cover all the same services like individual and employer-based plans. Depending on your state of residence, copay and deductible requirements can vary but you don’t have to pay monthly premiums.
If you’re over the age of 65 or have a disability, you might be eligible for Medicare coverage. Rehab treatment is covered under Medicare Part A. Coverage benefits pay for hospital-based rehab and in some cases, rehab offered through skilled nursing facilities. After three days in a hospital-based setting, Medicare will pay for up to 100 days for inpatient rehab within a benefit period.
Don’t Let the Cost of Rehab Keep You From Getting the Help You Need
By now you know the answer to “does insurance cover rehab” is a resounding yes. Since every insurance policy is different, be sure to check the details of your plan to avoid unexpected costs. If you already have a rehab program in mind, you can always check with them to see if they work with your insurance company. Also, many programs will allow you to set up a payment plan for costs that insurance doesn’t cover. Ultimately, not having to worry about treatment costs puts you (or someone you know) one step closer to getting the help you need.
- drugabuse.gov – What is drug addiction treatment?
- cms.gov – The Mental Health Parity and Addiction Equity Act (MHPAEA)
- medicaid.gov – Coverage and Delivery of Adult Substance Abuse Services in Medicaid Managed Care
Sunshine Behavioral Health strives to help people who are facing substance abuse, addiction, mental health disorders, or a combination of these conditions. It does this by providing compassionate care and evidence-based content that addresses health, treatment, and recovery.
Licensed medical professionals review material we publish on our site. The material is not a substitute for qualified medical diagnoses, treatment, or advice. It should not be used to replace the suggestions of your personal physician or other health care professionals.
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