Does Insurance Cover Drug and Alcohol Rehab Treatment?

Written By: Geoffrey Andaria, Mental Health Writer
Reviewed by: Dr. Carl Williams, Ph.D., LCADC
April 6, 2024
Modified:September 1, 2024
Reading Time: 9 minutes

Written By: Geoffrey Andaria, Mental Health Writer
Reviewed by: Dr. Carl Williams, Ph.D., LCADC
April 6, 2024
Last Update:September 1, 2024
Reading Time: 9 minutes

Learn how healthcare insurance covers addiction treatment, including impacts from the Affordable Care Act and private insurance options.

Understanding Insurance Use in Rehab Funding

Using Healthcare Insurance to Cover Drug and Alcohol Rehab

Most people don’t consider insurance or other financial arrangements until they or a loved one is desperate for addiction treatment. Can insurance pay for it? Addiction rehabilitation advocacy organizations have made the case that some addictions are diseases.

These organizations recognize that insurance coverage for treating addiction is essential and that insurance companies will not pay for such care if it is not recognized as a disease. Thus, they argue that we must maintain that substance use disorders and mental illnesses like depression are diseases and that our insurance companies must fund their treatment.

However, many non-disease conditions are already covered by insurance. Most insurance policies cover bone fractures, pregnancy complications, and the treatment of genetic flaws, even though these are not considered diseases. The word that is pertinent to an insurer is “medical necessity.”

For the insurers, it makes no difference whether your alcoholism, for example, is a disease. Depending on your insurance policy’s restrictions and exemptions, your insurer may pay for your therapy to help you quit alcoholism if it is deemed medically necessary.

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Families & Addiction

Understanding Insurance for Rehab Services

Will Insurance Cover Your Addiction Treatment?

Luckily, your insurance plan will cover some or all of the costs associated with your drug treatment. Another form of insurance coverage is expressly created for rehabilitation therapy. It is generally not included in your standard medical insurance policy, but you may buy it separately as an add-on.

Unlike basic insurance, this option may cover a broader range of treatment and rehabilitation services. People at risk of becoming addicted or with family members who are at risk of becoming addicted often buy this drug treatment program.

If your insurance plan covers addiction treatment, you may be eligible for a variety of programs, including:

Inpatient or residential rehabilitation
Outpatient programs
Medical detox and medication-assisted therapies (MAT)
Treatment for Dual Diagnosis and co-occurring mental conditions like depression, anxiety, PTSD, and panic attacks.
Continuing care

Impact of ACA on Rehab Coverage & Access

The Affordable Care Act and Addiction Coverage

pay for a significant number, if not all, of your rehabilitation costs. Thanks to the efforts of private lobbyists and the government, rehabilitation for drug and alcohol addiction is now a mandatory benefit under insurance after the passage of the Affordable Care Act (ACA).

You may purchase from the government the cost of your stay in a rehabilitation institution per the ACA Act. As a result of the Act, insurance companies are now responsible for paying addiction fees. Society has slowly started recognizing the negative repercussions of persistent, obsessive alcohol and drug use. Most of us now understand how addiction can take a toll on our psychological and physical well-being and the social and economic well-being of the entire family.

Thanks to the ACA, insurance companies are now required to cover behavioral and mental health issues, including drug and alcohol addiction, to nearly the same extent as physical ailments. It’s a significant and encouraging step in the right direction for needy people. In addition, there is Medicare and Medicaid. They may also assist in subsidizing the cost of both inpatient and outpatient rehabilitation services.

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Understanding Your Coverage

Private Insurance and Addiction Treatment

Private insurance policies can include employee insurance plans, insurance plans purchased by individuals from private insurance companies, or any insurance programs the federal government does not subsidize.

Private insurance plans are now expected to cover the treatment of mental illness and drug abuse on the same basis as any other chronic ailment. According to the Mental Health Parity and Addiction Equity Act (MHPAEA), if your plan provides coverage for mental health services, such coverage must be comparable to the cost of other therapies covered by your plan. However, an insurance company is not obligated to provide mental health coverage, so double-check your policy.

Private insurance is more expensive than a government-sponsored insurance plan. However, with increased costs comes a greater variety of treatment choices regarding therapy, facilities, and length.

Many insurance plans operate in conjunction with specific healthcare facilities or providers part of a network. Managed care is the term used to describe this arrangement. Managed care programs are often classified into three categories:

Health Maintenance Organizations (HMOs):

often only cover treatment received from health providers who are members of their network. As a result, they are usually cheaper than other options.

Preferred Provider Organizations (PPOs):

are mainly focused on in-network providers, although they can still cover certain expenses associated with out-of-network services. If you choose to visit a healthcare provider, not in your insurance policy network, you could be required to pay out-of-pocket and then seek reimbursement from your insurer.

Point of Service (POS):

implies that you may choose between an HMO or a PPO whenever you want medical attention. POS is the most adaptable plan.

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Leveraging Group Insurance for Addiction Care

Group Health Insurance Plans

Members of a professional body, society, or the workers of a particular (generally large) company are examples of groups that qualify for group insurance coverage. Insurance for groups may include life coverage, medical coverage, and other individual ranges.

Because many customers share the insurance provider’s risk, group health coverage often has lower premiums.

One of the primary benefits of group insurance is that it provides insurance policies to all group members, regardless of their age, gender, economic status, or occupation.

In many circumstances, insurance covers the whole expense of addiction treatment. Because of this, you will only have to pay copayments or deductibles if that is the case.

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Understanding Your Financial Obligations

Deductibles and Copayments

A copayment (or copay) is a defined amount of money you spend out of your pocket for a given service. In most cases, copays are applied to doctor’s appointments, specialist visits, and repeat prescriptions. Mainly, copayments vary from $10 to $45, sometimes more. The exact amount depends on your health insurance plan.

The deductible is the portion of your out-of-pocket medical expenses you are responsible for paying before your insurance kicks in. For example, if your deductible is $1,000, you may be responsible for the first $1,000 of covered medical expenses.

A person’s insurance policy may differ in how much coverage they give for alcohol or drug treatment and the length of time they are covered. Check with your physician or the treatment facility you’re interested in attending to see if they have information on this topic.

To find out whether Rolling Hills Recovery Center accepts your insurance, you may fill out our online form and call us.

The cost of detox and treatment varies based on the following factors:

The finer details of your situation
The sort of therapy used, as well as
The sort of facility that offers the required services

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Coverage for Continuing Care

Aftercare and Insurance Coverage

A wide range of insurance plans covers outpatient therapy and follow-up services. However, many insurance plans include time restrictions on inpatient and outpatient treatment.

Insurance plans that prolong treatment coverage for up to six months or a year may be available from specific carriers. Other companies may only cover a few days or weeks of therapy. Before agreeing to a treatment regimen, double-check your insurance plan’s coverage and the rehab or health facility’s policies.

It is not usual for a person to achieve long-term wellness via detoxification. In the absence of follow-up treatment, even short-term inpatient admissions may not be enough.

Treatment for drug misuse and addictions includes outpatient therapies and long-term treatment planning. Many persons in recovery from drug addiction benefit from these programs by enabling them to abstain for an extended period. Aftercare services are usually covered by insurance, but you should double-check the details with your insurance carrier.

Among the most often used techniques for addiction treatment and aftercare services are:

Most insurance companies cover the therapy methods listed above and others as long as the APA (American Psychological Association) has authorized it.

Insurance companies may not cover holistic programs and activities like guided meditations. As a result, this doesn’t indicate that these treatments aren’t beneficial or successful for some persons with drug abuse problems.

The integration of a 12-step program is another possible option for continued treatment. Addiction is a sickness, not a moral flaw, and 12-step programs teach addicts to embrace this fact. Also, a 12-step program encourages a participant to help others when they are still in recovery or active addiction.

Conclusion

Maximizing Insurance Benefits for Addiction Treatment

Health insurance often covers some or all of an individual’s drug and alcohol addiction treatment expenditures. Addiction is a chronic condition that needs treatment in the same way that hypertension, stroke, and cancer do.

However, most insurance plans cover alcohol addiction treatment to differing degrees. Before making treatment decisions, learn more about your specific insurance coverage and options.

Sources

https://obamawhitehouse.archives.gov/ondcp/healthcare

https://medicareadvocacy.org/medicare-info/medicare-coverage-of-mental-health-services/

https://www.cms.gov/CCIIO/Programs-and-Initiatives/Other-Insurance-Protections/mhpaea_factsheet#:~:text=The%20Paul%20Wellstone%20and%20Pete,favorable%20benefit%20limitations%20on%20those

https://medlineplus.gov/managedcare.html

https://cga.ct.gov/2015/rpt/2015-R-0160.htm

https://www.apa.org/monitor/2013/06/addiction

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3753023/

Written By:

Geoffrey Andaria

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

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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Does Insurance Cover Drug and Alcohol Rehab Treatment?

Understanding Insurance Use in Rehab Funding

Using Healthcare Insurance to Cover Drug and Alcohol Rehab

Table of Contents

Levels of Care

Popular Topics

Families & Addiction

Understanding Insurance for Rehab Services

Will Insurance Cover Your Addiction Treatment?

Impact of ACA on Rehab Coverage & Access

The Affordable Care Act and Addiction Coverage

Did You KNow?

Most Major Insurance Will Help Cover the Cost of Treatment

Check Your Coverage

You Could Be Covered 100% for Treatment

Understanding Your Coverage

Private Insurance and Addiction Treatment

Did You Know Rolling Hills Recovery Center Works With A Variety Of Healthcare Providers?

Leveraging Group Insurance for Addiction Care

Group Health Insurance Plans

Our Patient Navigators Are Here When You Need Them

Find Out Why We Have a 4.9 Rating on Google

Testimonials & Stories of Hope

Understanding Your Financial Obligations

Deductibles and Copayments

Your Path to Freedom Begins Today

Don't Wait Any Longer. Transform Your Life Today.

Get a Callback Now

Request a Confidential 100% Confidential Callback

Coverage for Continuing Care

Aftercare and Insurance Coverage

Conclusion

Maximizing Insurance Benefits for Addiction Treatment

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