One of the most common questions we get is whether or not drug rehab insurance coverage is part of your health care plan. In many cases, insurance covers substance use disorder treatment, but there’s a bit more to it than that.
Below, we’ll explain what you should know about paying for rehab for drug or alcohol addiction and your treatment options.
How Much Does Rehab Cost?
We cannot give you one figure to tell you how much rehab will cost. Nonprofits and the government sponsor free drug addiction treatment and alcohol addiction treatment options. Then, there are programs costing upwards of thousands of dollars a day. The thing to remember is that regardless of what your budget is, effective substance abuse treatment programs are available.
Unfortunately, the fear of how you’ll pay for treatment is one of the most significant barriers to getting help when it shouldn’t be. Even at a high-end treatment center, there are payment options, and insurance is one of those.
The cost of treatment depends on where you go, the type of facility, and how long your stay is. Whether you do onsite medical detox is also part of the cost. For example, outpatient substance abuse treatment tends to be less expensive than inpatient addiction treatment in a rehab program.
You have to recognize that the cost of not treating your addiction will end up being significantly more expensive than the cost of addiction treatment programs.
For example, if you’re an alcoholic and drink a 12-pack a day over a year, you’re spending thousands of dollars. You might also face legal problems, issues in your career, and medical expenses that can all add up to tens of thousands of dollars annually and potentially the loss of your job.
Other factors that are relevant when determining the cost of going to rehab are:
The center type—if you participate in outpatient programs or have a shorter stay, it will be less expensive than intensive inpatient treatment.
Types of treatment—the level of medical and mental health care you receive is an essential factor in the cost of addiction treatment.
Amenities—you can opt for a higher-end addiction treatment center with amenities similar to a resort, the most expensive programs.
Will Health Insurance Plans Cover Rehab?
Back to our original question regarding insurance providers and paying for treatment at a rehab center, “Will insurance cover rehab for drug or alcohol addiction?” Yes, it will often happen because a substance use disorder is a medical disease. There are caveats to that, though.
If you have a private health insurance provider, a good starting point is to check your policy to determine what type of treatment you have coverage for. The higher your insurance premiums, the more likely you’re going to have comprehensive coverage for rehab. If you have a group insurance plan from your employer, the same is true.
There are exclusions with many private insurance plans, so you’ll need to figure out what those are.
Insurance coverage for addiction treatment was expanded significantly in 2008 with the passing of the Affordable Care Act (ACA).
Under the ACA, insurance plans must offer alcohol and drug addiction coverage with benefits equal to the medical care and surgical benefits the program provides. Insurance, depending on your goal and exclusions, may cover:
Detox and medications during that time
Treatment for a co-occurring mental health disorder
Your insurance may not cover any services that aren’t medically necessary, such as non-medical amenities. There are also limitations on insurance policies if you relapse and return to treatment after your initial program.
Public insurance works similarly to private insurance regarding mental health treatment and drug rehab programs. There is likely some level of coverage for the cost of drug rehab or an alcohol rehab center, but with limitations.
The Affordable Care Act and Coverage for Substance Abuse
We touched briefly on the impact of the Affordable Care Act on addiction treatment. Ten essential health benefits exist under this law. According to the ACA, a vital health benefit must be available with no dollar limit on all health plans.
Substance abuse services and mental health services coverage falls under these benefits.
Also relevant are the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008. Under this federal law, health insurance companies and group health plans that provide substance abuse or mental health benefits can’t impose less favorable limitations on benefits than what they offer for surgical and medical benefits.
To sum it up, limits on treatment for substance abuse and behavioral health conditions can’t be more restrictive than limits on medical conditions that are part of the plan.
How Can You Find Out If Your Insurance Covers Rehab?
While the general answer is yes, insurance treatment facilities, how do you know for sure if you have drug rehab insurance coverage?
The best thing to do is call the provider of your health insurance coverage. When you talk to your insurance company, they can tell you what’s in your plan and figure out what you can afford.
When you contact your insurance company, ask them about your copay and deductible. These are what you’re going to have to pay out of pocket for the drug or alcohol treatment cost.
Ask how many days of treatment you have health coverage for in a drug rehab center.
Determine whether any medications you receive while in treatment are included in the coverage. Medication-assisted treatment is often helpful in a treatment plan.
Talk to your insurance company about detox program coverage for treatment.
If you aren’t sure where to begin, we can help you. We can contact your insurer on your behalf to figure out if our center is in your provider network. We can also get more details like the services and days covered by your plan for substance abuse treatment.
United Healthcare is one of the nation’s largest insurers, and their plans tend to cover at least part of treatment for addiction, including detox and inpatient rehab. United Healthcare operates the United Behavioral Health division, which helps provide policyholders information about substance abuse and mental health services to policyholders.
Cigna is another major insurer in the U.S. Cigna covers many rehab expenses, including inpatient and outpatient rehab. They also have a Behavioral Health division.
Aetna individualizes its policy limits based on the needs of the individual. You may have coverage for inpatient treatment, detox, and even partial hospitalization and continuing care.
Blue Cross Blue Shield provides coverage for almost one in three people in America. They offer rehab coverage with some plans, and they have a comprehensive mobile platform where you can find tools and support.
Other Options Are Available
If you need substance abuse treatment and don’t have insurance or don’t fully cover rehab, other payment options are available, such as a payment plan and financing options.
We encourage you to contact the Silicon Valley Recovery Center team by calling 408-547-4089. As one of the leading rehab facilities in California, our behavioral health services team can not only work with your insurance company, if applicable, but we can also help you explore alternative payment options. Financial assistance may be available too.
If you’re struggling with drug or alcohol addiction, there is no greater priority than getting the help you deserve at a qualified rehab center.