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Is Cocaine Rehab Covered by Insurance?

  • Reviewed by: Dr. Carl Williams, Ph.D., LCADC
  • Modified:
  • Reading Time: 9 minutes
  • Reviewed by: Dr. Carl Williams, Ph.D., LCADC
  • Last Update:
  • Reading Time: 9 minutes

Learn about insurance coverage for cocaine rehab, including treatment services and support for recovery.

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Those who want help often worry about the cost of addiction treatment. However, those with health insurance may drastically cut the cost of treatment for drug use disorders and, in certain situations, even totally cover it.

Cocaine rehab may be expensive, but health coverage is the most practical way to ensure that money isn’t a significant issue throughout recovery. Once funding is in place, people and their families can concentrate on locating a program that will help them recover.

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ACA Mandates Rehab Coverage for Cocaine

Does Insurance Cover Cocaine Rehab?

According to Affordable Care Act-ACA (Obamacare) regulations, health insurance companies must pay for treatment for substance use disorders, including cocaine addiction.

It is important to remember that most healthcare plans provide coverage for outpatient and inpatient/residential addiction treatment as part of a cost-sharing arrangement. It means that you may be responsible for paying a portion of the total cost of your cocaine rehab services.

In the United States, people may shop for and enroll in private individual and family health insurance policies via a health insurance marketplace, sometimes called a health insurance exchange, and get subsidies depending on their income. About 11 million people are enrolled in this program.

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Variety of Rehab Services Covered by Insurance

What Types of Cocaine Rehab Services Will My Insurance Cover?

You want to make sure you have the proper coverage and at the right price before you sign up for a package in the marketplace. It would be best to search for a plan that offers comprehensive protection for the treatments and therapies you anticipate needing.

Your health insurance may pay some or all of the following expenses if you enter a drug rehabilitation program for cocaine use disorder:

  • Inpatient care.

  • Residential care.

  • Partial Hospitalization Programs (PHPs).

  • Intensive Outpatient Programs (IOPs).

  • General Outpatient Programs (OPs).

Does Health Insurance Cover Medication-Assisted Treatment for Cocaine?

Medication-assisted treatment may or may not be explicitly covered by your health insurance plan, depending on the wording of your policy documents. However, most insurance plans will cover the cost of any prescription medications you may need as part of your MAT program for treating cocaine addiction.

Most health plans cover the following categories of prescription drugs:

  • Specialty drugs.

  • Preferred brand prescription drugs.

  • Generic prescription drugs.

  • Non-preferred brand drugs.

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Most Major Insurance Will Help Cover the Cost of Treatment
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Coverage Options for Cocaine Rehab

Which Kinds of Health Insurance Will Pay for Cocaine Rehabilitation Services?

In most situations, rehabilitation services for cocaine addiction are covered by PPO (Preferred Provider Organizations) health insurance policies. However, to acquire full or partial coverage for the treatment of your cocaine addiction, you may need to get a referral from a doctor or have prior approval from the insurance company.

A Preferred Provider Organization health plan will allow you to see a therapist not part of your insurer’s network. The out-of-pocket expense might be more significant, however.

Some Health Maintenance Organizations (HMOs) could also pay for the treatment of your cocaine addiction. If you have an HMO, you must see a doctor who is part of the HMO’s provider network. If you go with a service provider not part of your network, you’ll be responsible for possibly paying all the costs involved.

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Do Point-of-Service (POS) Insurance Plans Cover Rehab?

Cocaine treatment programs that are deemed to be medically essential are covered by POS insurance. You can use in-network or out-of-network providers with your POS plan, but the cost of out-of-network rehabilitation will be higher.

Another standard option for receiving care is through a Point-of-Service (POS) plan. It is a hybrid between preferred providers and health maintenance organizations. A POS  plan offers greater leeway for flexibility than a PPO and comes at a more reasonable price than most HMO plans.

Do Employee Group Health Insurance Policies Cover Cocaine Rehabilitation Services?

If treatment for cocaine addiction is deemed medically essential, it will be covered by all long-term employer-based insurance policies. In addition, you may be eligible for partial or whole reimbursement for cocaine treatment if you have an employer-sponsored group plan.

An employer’s group insurance is a kind of health insurance coverage in which the premium payments are split between the employee and the company. It may be an HMO, it could be a PPO, or it could even be a POS plan.

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State and Federal Health Insurance Plans For Cocaine Rehabilitation Services

Healthcare plans that the government finances provide coverage for cocaine addiction treatment that is deemed medically essential. This includes Medicaid plans paid by the state and Medicare plans that the federal government sponsors. However, your coverage for cocaine treatment may, like other forms of insurance, demand that you get prior permission before beginning treatment.

People over 65 or suffering from specific disabilities are eligible for Medicare, a government healthcare program. Depending on your financial position, you may be able to get one of these programs for free.

Your cocaine use problem may qualify you for coverage under the medically required rehabilitation programs offered by Medicaid health insurance, which are designed specifically for low-income Americans. However, the level of protection provided varies widely from one state to the next.

Other groups eligible for Medicaid include pregnant women, adolescents, emancipated young adults, and people with significant medical needs or impairments.

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Does Insurance Pay For The Cost Of Cocaine Sober-Living Homes?

Sober living homes provide a safe and supportive environment for recovering addicts to continue their lives after finishing a drug rehabilitation program. Your plan may include sober living facilities in your plan’s covered rehabilitative treatments.

In the case of health maintenance organization (HMO) plans, a forty percent coinsurance contribution is often expected for a selection of covered treatments. In addition, a patient may need to go through preauthorization before their insurance can fund sober living.

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Understanding Your Insurance Coverage

Verify Your Health Insurance to Understand Your Cocaine Rehab Benefits

Health insurance opens the door to medical care for individuals who otherwise couldn’t afford it. Insurance verification is about checking whether an insurance plan covers a specific service. The Rolling Hills Recovery Center team works hard to confirm that you are covered by your insurance so that you may begin the admissions process as quickly as possible.

The following terms are often asked about insurance documentation:

Out-of-Pocket Maximum

Your annual limit for “out-of-pocket” expenses is the most that you will be responsible for paying for treatments covered by your insurance. Once you’ve reached your threshold, your insurance provider will begin paying for your covered expenses.

Coinsurance

The part of your medical expenses for which you are obligated to pay is known as coinsurance. It’s often a certain percentage of the final price, but the exact amount may change based on the specifics of the services you received. For example, coinsurance rates are typically 20% of the cost of outpatient care.

Lifetime Limitations

There may be a limit on the number of times your policy covers cocaine treatment. A lifetime maximum is the maximum cash amount or number of days of treatment for which you will be covered.

Insurance companies often stop paying for drug therapy after several lifetime claims have been submitted. However, you may still get help for your cocaine addiction by switching to an insurance provider that will continue to pay for your treatment.

In-Network

Being “in-network” means that a therapist, rehab center, or other professionals accept your specific health insurance plan. They are also referred to as participating providers, and in most cases, they charge a discounted cost.

Out-of-Network

Providers not in your health insurance network may charge you more than the predetermined amount. Therefore, there is a chance that you may incur higher costs if you seek medical attention from a provider who is not part of your insurance plan’s network.

Deductible

The deductible is the fraction of medical costs you are liable to pay out-of-pocket before your insurance begins to pay for the covered service. For instance, you will be responsible for the first $300 of your cocaine rehab costs if your deductible is $300.

Conclusion

Rolling Hills Recovery Center Treats Cocaine Addiction

If you’ve decided to seek treatment for your cocaine addiction, you’ll be relieved to learn that your insurance may cover all, or at least some, of the costs associated with recovery. The Affordable Care Act mandates that all Medicaid, marketplace and private health insurance plans include essential health benefits, including substance use disorder coverage.

Rolling Hills Recovery Facility is a New Jersey-accredited drug and alcohol treatment center that believes that recovery programs should improve the lives of people suffering from SUD and equip them with the skills they need to build a more satisfying and joyful future. We are committed to turning the misery of addictive behavior into a life of purpose, self-esteem, and fulfillment.

Contact us immediately for further answers to your query, “does insurance cover cocaine rehab?” and get started on your cocaine addiction therapy. We want to help people who have been grappling with an addiction to drugs like cocaine get clean and do well in life.

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Written By:

Geoffrey Andaria

Geoffrey Andaria mental health writer at rolling hills recovery center
Rolling Hills Recovery Center

Mental Health Writer

About Author:

Geoffrey Andaria is an experienced mental health content writer and editor. With a B.A. in English and Journalism, Geoffrey is highly educated in freelance articles and research. Having taken courses on social work, Geoffrey is adamant about providing valuable and educational information to individuals affected by mental health and the disease of addiction.

Medically Reviewed By:

Dr. Carl Williams Ph.D., LCADC

Carl Williams, medical content reviewer at rolling hills recovery center
Rolling Hills Recovery Center

Expert Contributor

About Reviewer:

Dr. Williams presently serves on the board of Directors for two non-profit service organizations. He holds a Master’s degree in Human Services from Lincoln University, Philadelphia, Pa, and a Ph.D. with a concentration in Clinical Psychology from Union Institute and University. In Cincinnati, Ohio. He is licensed to practice addictions counseling in both New Jersey and Connecticut and has a pending application as a practicing Psychologist in New Jersey.

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