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Can Insurance Cover Drug & Alcohol Rehab?


It's a national public health issue that affects every demographic and every part of the country. From seniors to teens, veterans to college students, anyone can be affected by addiction.

Insurance Coverage for Drug and Alcohol Addiction Treatment

Congrats on making the most important decision of your life—choosing to seek treatment for substance use disorder!

Like any type of medical care, addiction treatment may be covered by your insurance plan. In fact, most insurance plans do cover treatment for substance use disorder under the Affordable Care Act.

Whether you have an active insurance plan now or you’re considering shopping for an insurance plan to fund your treatment, knowledge is power!

Here’s the very basics on insurance coverage for drug and alcohol addiction treatment:

Addiction Treatments Covered by Insurance

Under the Affordable Care Act, most types of addiction treatment are covered.

How Does Health Insurance Work for Addiction Treatment?

The process for using your health insurance coverage for addiction treatment tends to be fairly similar from provider to provider. However, there are important differences based on the insurance provider and plan.

When you use your health insurance, you (or more likely, your rehab provider) submit a claim asking the insurance company to pay for the service that you need. From there, what happens depends on your provider and plan.

Pre-certification and Prior Authorization

For some services, including addiction rehab, your insurance company is likely to request a pre-certification or a prior authorization. The two are similar, but not quite the same. Talk to your provider to learn which one is required before your rehab stay.

Deductibles

You may need to meet a deductible before your insurance company begins covering services, including addiction treatment stays. That simply means that you’ll have to pay a certain amount out-of-pocket first, but the actual amount depends on your plan and provider.

Copays

You might be responsible for a copay related to your addiction treatment. Some insurance plans offer no copay for substance use treatment, but it’s impossible to guess without contacting your insurance company.

Understanding Your Health Insurance Plan for Addiction Treatment

Your health insurance plan determines where you can get treatment. If you don’t have a thorough understanding of what’s covered, you could end up financially responsible for a larger portion of treatment than expected.

Private Insurance Plans

PPO

A Preferred Provider Organization lets you choose your provider from a network of approved healthcare professionals. Your copays may be lower if you stay within the network.

HMO

A Health Maintenance Organization offers less flexibility in which provider you see. The premium may be lower and the copays and deductibles may be higher.

POS

A point-of-service plan has features from both PPOs and HMOs. The cost of this type of plan tends to be lower.

Employer Group Insurance Plans

Group health insurance offers a reduced premium rate to people who belong to an organization with a group plan and opt-in. The health insurance you get from your employer is a group plan.

State & Federal Insurance Plans

Medicare

Medicare federal insurance allows inpatient rehabilitation care via medicare Part A (hospital insurance) covers medically essential care you get in an inpatient rehab facility or unit, residential recovery center, or rehabilitation hospital. Your primary physician must certify that you have a medical condition that requires intensive inpatient rehab, sustained medical supervision, and regulated care that comes from rehab treatment doctors and evidence-based behavioral therapists working together.

Medicaid

Medicaid is a state insurance program for low-income households. Under the 2010 Affordable Care Act (ACA), insurance providers must cover all essential alcohol & drug dependency recovery programs. State Medicaid insurance includes substance abuse treatment; however, not all facilities accept Medicaid insurance plans. Medicaid beneficiaries don’t have co-payments for addiction treatment in the majority of states.

What Types of Substance Addiction Are Covered By Insurance?

There are certain types of substance use disorders that are covered by insurance companies.

Insurance Providers That Cover Addiction Treatment

There are dozens of insurance providers in the United States that offer healthcare coverage, including coverage for addiction treatment. Here is a list of some of the top providers where you can learn more about their specific coverage options.

FAQ

Does Insurance Cover Prescription Drug Treatment?

Prescription drug addiction is a condition that requires treatment. The Affordable Care Act dictates which types of addiction treatment insurance companies must cover. 

Does Insurance Cover Meth Treatment?

We can help verify if your insurance company covers meth addiction treatment.

Does Insurance Cover Heroin Treatment?

Insurance companies decide what to cover based on whether it’s medically necessary. The Affordable Care Act lays down the guidelines for whether heroin addiction treatment is covered.

Does Insurance Cover Cocaine Treatment?

Many insurance companies have similar policies about covering treatment for addictive drugs like cocaine. Your insurer or your treatment provider can help you figure out if you’re covered for cocaine addiction treatment. 

Does Insurance Cover Alcohol Treatment?

Insurance companies cover most types of drug treatment, and alcohol is actually considered a drug. You should get in touch with your insurance company to get the specifics on alcohol rehab treatment coverage.

Does Insurance Cover Medication-Assisted Treatment?

MAT is considered medically necessary for some people with substance use disorders. Your insurance company can help you understand your coverage.

Does Insurance Cover Inpatient (Residential) Treatment?

Most forms of drug and addiction treatment are considered medically necessary since 2010. Your insurance provider can help you figure out what’s covered, including inpatient rehab programs.

Does Insurance Cover Detox Treatment?

The Affordable Care Act considers most types of addiction treatment medically necessary for people with substance use disorder. Your provider can give you more detail about coverage for detox treatment programs.

What Types of Addiction Treatment Are Covered?

Under the Affordable Care Act, most types of addiction treatment are covered.

What Should You Know About State-Funded Options?

State-funded drug and alcohol treatment may be more affordable, but it comes at a trade-off. These treatment centers are often overloaded, which leads to problems.

What Should You Know About Public Assistance Help?

There aren’t any major public assistance options for drug rehab specifically that operate across the nation. Instead, check with your local government for options.

What is the Cost of Outpatient Substance Abuse Treatment?

Outpatient treatment can be more affordable than inpatient treatment. The cost varies depending on the type of program and how often you attend.

How Do You Get Financial Assistance for Substance Abuse Treatment?

There are some private organizations that offer financial assistance for substance use treatment. You might also try local resources like churches or the Salvation Army. 

How Much Does Drug Rehab Cost With Insurance?

The cost of drug rehab treatment after insurance depends on your policy, whether you’re attending an in-network treatment center, and more.

Does Insurance Cover Rehab?

Health insurance is required to cover rehab under most circumstances because of the Affordable Care Act. The level of coverage depends on your insurance policy.

How Much Does Rehab Cost?

You can’t predict the cost of rehab because it can be very different between two facilities. The cost depends on the amenities and treatment offered, as well as the location.

Ready to make a change? Talk to a specialist now.