Understanding What Health Insurance Covers for Prescription Drug Rehab Treatments
That is, they’re ready to begin the recovery journey but unsure how to kick off the health insurance claims process.
You can find prescription drug addiction treatment at a Mass drug rehab center or anywhere in the nation, but it’s easy to get stuck at the point of figuring out your financial responsibility. It’s actually not hard to get your health insurance to cover prescription drug rehab, but it’s common to need a helping hand to start the claims process.
Before you move any farther along your recovery planning, take the time to understand prescription drug rehab insurance and how it affects you.
Classes of Prescription Drugs
Getting prescription drug rehab insurance coverage depends on the drug in question being addictive or dependency-causing.
The prescription drug classes that cause addiction or dependency include:
- Opioids for severe pain control
- Stimulants for ADHD (attention-deficit hyperactivity disorder)
- Benzodiazepines (or benzos) for anxiety and panic disorders
- Sedative-hypnotics for sleeping disorders
Prescription opioids are powerful medications that manage severe pain. Opioids cause a characteristic euphoria, and that high can lead to misuse.
The most common addictive prescription opioids include:
- Hydrocodone, or Vicodin
- Oxycodone, or OxyContin
Prescription Opioids: Hydrocodone
Hydrocodone is an addictive opioid pain medication. It’s used to treat moderate to severe pain, but it’s a common target for abuse.
It’s also known by the brand names:
- Hysingla ER
- Zohydro ER
Vicodin Rehab Insurance
Most long-term insurance plans cover Vicodin rehab treatment if it’s medically necessary. Vicodin addiction is considered a pre-existing condition as opioid use disorder, which means your insurer covers treatment for it.
Prescription Opioids: Oxycodone
Oxycodone is an opioid medication that treats severe acute or chronic pain that doesn’t respond to other treatments. Like other opioids, oxycodone causes addiction.
You may know oxycodone by the brand names:
OxyContin Rehab Insurance
Your long-term insurance plan most likely covers OxyContin rehab treatment. Substance use disorders are covered for treatment as a pre-existing condition, and OxyContin addiction is considered an opioid use disorder.
Prescription stimulants are medications that increase activity in your central nervous system. They’re used to treat attention-deficit hyperactivity disorder, or ADHD.
Prescription Stimulants: Dextroamphetamine
Dextroamphetamine is an addictive stimulant drug that treats narcolepsy and ADHD. Because it causes physical dependence and euphoria like other stimulants, dextroamphetamine addiction is common with abuse.
Dexedrine Rehab Insurance
Most Dexedrine rehab programs are covered by insurance. Dexedrine addiction requires intensive treatment because of the high risk of relapse, so covered programs might include:
- Detox programs to support you through Dexedrine withdrawal
- Inpatient programs to treat Dexedrine addiction in an intensive environment
- Outpatient programs for flexible treatment that accommodates your schedule
Prescription Stimulants: Amphetamine
Amphetamine is a prescription stimulant medication that causes dependence and treats ADHD and narcolepsy. Like other stimulant drugs, it can cause addiction when it’s misused.
Prescription Stimulants: Dextroamphetamine-Amphetamine Combination
Dextroamphetamine and amphetamine are a stimulant combination that treats ADHD and can cause addiction. The combo is more commonly known as amphetamine salts or the brand name Adderall.
Adderall Rehab Insurance
Your long-term insurance plan probably covers rehab for amphetamine salts, so check your coverage as soon as you can. Adderall rehab coverage might include:
- Detox care during Adderall withdrawal
- Inpatient care for Adderall addiction, including therapy
- Outpatient care for flexible, long-term recovery
Prescription CNS Depressants
Prescription central nervous system (CNS) depressants are medications that treat anxiety disorders or sleep disorders. Because they cause euphoria and physical dependence, CNS depressants can cause addiction.
Prescription Depressants: Benzodiazepines (Benzos)
Benzodiazepines are addictive prescription drugs that treat anxiety, seizure, and panic disorders, also known as benzos. Some commonly-prescribed benzos include clonazepam or Klonopin, and alprazolam or Xanax.
Prescription Depressants: Clonazepam (Benzos)
Clonazepam is a benzodiazepine that treats panic disorder and seizure disorders and can cause addiction. It’s also known as Klonopin.
Klonopin Rehab Insurance
If you have a long-term insurance plan, it’s most likely required to cover Klonopin rehab in part or in full (but be sure to check). Klonopin addiction is considered a substance use disorder, which is a pre-existing condition.
Prescription Depressants: Alprazolam (Benzos)
Alprazolam or Xanax is an addictive benzodiazepine that treats anxiety disorder, panic disorder, specific phobias, and anxiety with depression.
Xanax Rehab Insurance
If your insurance policy is a long-term one that went into effect after 2010, then it’s required to cover Xanax rehab in part or in full.
Prescription sedative-hypnotics are dependence-causing drugs that treat sleep disorders by slowing down brain activity.
Prescription Sedative-Hypnotics: Zolpidem
Zolpidem is a sedative-hypnotic drug that treats insomnia by reducing brain activity, which causes drowsiness and euphoria. Along with tolerance, these effects make zolpidem addiction common.
Ambien Rehab Insurance
Almost all insurance plans cover Ambien rehab. That’s because Ambien addiction is a pre-existing condition under the diagnosis substance use disorder.
What is Precertification and Prior Authorization for Prescription Drug Treatment?
Precertification and prior authorization are both types of paperwork that your treatment provider and your insurance company use to decide to cover your prescription drug rehab.
What Are Deductibles for Prescription Drug Treatment?
A deductible is the amount you must spend on your own healthcare out-of-pocket before your health insurance covers treatment, including rehab.
What Are Copays for Prescription Drug Treatment?
A copay is a set amount that you pay for medical treatment, including prescription drug rehab. Your copay is the same no matter what the actual cost of the rehab is, since your insurance company covers the difference.
What Are Lifetime Limitations for Prescription Drug Treatment?
Lifetime limitations are a cap on your medical coverage, including prescription drug treatment coverage.
Most commonly, there’s a lifetime limitation on the number of days you attend rehab. After a certain number of days (e.g. 90), your insurance company stops covering treatment.
What Factors Into the Cost of Prescription Drug Addiction Treatment?
The cost of prescription drug treatment depends on factors that include:
- The rehab facility
- Treatment programs
Types of Rehab Centers
It’s normal for the listed cost of rehab to reflect the treatment facility and its programs. For instance, your rehab cost (or the cost after prescription drug rehab insurance) scales based on:
- Program size and length
Prescription Drug Rehab Treatments Offered
Prescription Drug Detox
Detox treatment programs are the shortest type, so their cost is often lower compared to residential or long-term outpatient programs.
What is Prescription Drug Detox?
Prescription drug detox programs support you through withdrawal. Withdrawal is the first (and often hardest) phase of recovery, and detox programs help reduce your relapse risk during this vulnerable time.
How Long Does Prescription Drug Detox Treatment Take to Complete?
The length of prescription drug detox depends on the type of drug you’re stopping. The most common drug types may have the following detox lengths:
- 4-10 days for opioids
- 7-10 days for stimulants
- 7-14 days for sedative-hypnotics
- 5-28 days for benzodiazepines
Why Prescription Drug Detox Plays a Critical Role in Addiction Recovery
Prescription drug detox is critical in addiction recovery because it reduces the risk of relapse. Without detox help, the vast majority of people relapse within a year, if not before the end of withdrawal.
Prescription Drug Inpatient Rehab
Prescription drug inpatient rehabs are the longest type of rehab program (and often the costliest). They also provide the most intensive care, which can be more costly than outpatient programs.
What is Prescription Drug Inpatient Rehab?
Prescription drug inpatient rehab is a residential treatment program in a recovery-friendly environment. These live-in programs include rehab education, recovery skill workshops, therapy, counseling, group sessions, and more.
How Long Does Prescription Drug Inpatient Rehab Treatment Take to Complete?
The length of prescription drug inpatient rehab depends on the program but can range from 14 to 90 days or even longer.
Why Prescription Drug Inpatient Rehab Plays a Critical Role in Addiction Recovery
Inpatient rehab is critical in prescription drug recovery because it significantly reduces the risk of relapse. With rehab, your relapse risk dips up to 50%.
Prescription Drug MAT Rehab
Prescription drug MAT rehab can be inexpensive compared to other programs. Even though medication-assisted treatment is long-term, you only pay for appointments, bloodwork, therapy, and medication, not everything else that comes with a rehab stay.
What is Prescription Drug MAT Rehab?
Prescription drug MAT is medication-assisted treatment, or the use of medications to treat withdrawal symptoms and cravings in long-term recovery. MAT is available for opioid recovery, but not other types of prescription drugs at this time.
How Long Does Prescription Drug MAT Rehab Treatment Take to Complete?
The length of prescription drug MAT depends on your needs. Some people attend MAT for a few months, while others get treatment indefinitely.
Why Prescription Drug MAT Rehab Plays a Critical Role in Addiction Recovery
Prescription drug MAT rehab supports long-term recovery by addressing some of the biggest challenges that you face. Those include:
- Post-acute withdrawal syndrome, or withdrawal that lasts months or years after discontinuing substance abuse
- Long-term cravings that can lead to relapse
Prescription Drug Outpatient Rehab
Outpatient rehab for prescription drug addiction is another lower-cost option compared to residential treatment. These programs include regular appointments and care, but outside of a live-in facility.
What is Prescription Drug Outpatient Treatment?
In prescription drug outpatient treatment, you receive flexible care on a schedule that works for you. That care can include:
- Check-in appointments
- Medication appointments
- Therapy and counseling
- Group programs
- Long-term relapse prevention
How Long Does Prescription Drug Outpatient Treatment Take to Complete?
Prescription drug outpatient treatment lasts as long as you need it to. Some people attend outpatient treatment for 30 to 90 days, while others attend for much longer.
Why Prescription Drug Outpatient Treatment Plays a Critical Role in Addiction Recovery
Prescription drug outpatient treatment supports long-term addiction recovery by offering a flexible alternative to live-in care. Many people attend outpatient when childcare or work would have prevented them from getting care otherwise.
Addiction Rehab Amenities at Bedrock Recovery Center
The amenities at a facility can affect the total cost. At Bedrock Recovery Center, the amenities include:
- A recent homelike remodel
- 5-star nutrition with gluten-free and vegetarian options
- In-house movie theater
- On-site fitness center and yoga studio
- Outdoor recreation options
- Laundry services
What Types of Health Insurance Cover Rehab Treatments?
All current, long-term insurance policies must offer prescription drug rehab coverage, including:
- Employer group
Do Private Health Insurance Plans Cover Rehab?
All private health insurance plans must cover rehab as long as they’re under the Affordable Care Act and the rehab meets requirements.
What is a PPO?
Preferred Provider Organizations or PPOs are healthcare plans that offer flexibility in choosing your provider. That means you can pick a rehab that’s out of network and still receive at least partial coverage.
Do PPO Insurance Plans Cover Rehab?
PPO insurance plans cover medically necessary drug rehab treatment for prescription drug addiction as long as it meets Affordable Care Act requirements.
What is an HMO?
An HMO is a Health Maintenance Organization, a healthcare plan that offers lower costs in exchange for less flexibility in provider choice. With an HMO, you must pick an in-network rehab, or your prescription drug rehab insurance coverage won’t count.
Do HMO Insurance Plans Cover Rehab?
Almost all HMO plans cover rehab; the only exceptions are old plans from before 2010 or emergency, short-term plans.
What is a POS?
A POS is a Point-of-Service plan that combines elements of HMO and PPO insurance. With POS insurance, you have fewer choices in your network for rehab options, but in exchange for lower costs.
Do POS Insurance Plans Cover Rehab?
POS insurance plans must cover prescription drug rehab that’s medically necessary. The only exceptions are non-ACA plans or plans that are temporary.
What is an Employer Group?
Employer Group plans are discounted insurance plans that you get through your employer. They can be HMO, POS, or PPO plans.
Do Employer Group Insurance Plans Cover Rehab?
Your Employer Group plan most likely offers prescription drug rehab insurance coverage. Check with your insurance provider to find out whether that coverage is partial or full.
Do Federal and State Health Insurance Plans Cover Rehab?
Federal and state health insurance plans cover rehab as long as they’re not gap plans (most aren’t). That means both Medicaid and Medicare cover prescription drug rehab.
What Are Medicare Insurance Plans?
Medicare is a federal healthcare program that offers low-cost insurance coverage to certain people, including:
- People over 65
- People with certain chronic health conditions or disabilities
Do Medicare Insurance Plans Cover Rehab?
Medicare plans offer full rehab coverage up to a threshold, at which it becomes partial. Check with your Medicare provider to find out the most recent coverage details for your plan.
What Are Medicaid Insurance Plans?
Medicaid is a state healthcare program that provides low-cost healthcare for some people, including:
- People who earn less than a certain amount
- Families, pregnant people, and children
- Emancipated teenagers
- People with certain disabilities and health conditions
Do Medicaid Insurance Plans Cover Rehab?
Your Medicaid insurance plan covers rehab, but the exact coverage is different based on the state you live in. Check with your state Medicaid office to learn about your prescription drug rehab insurance coverage.
What is the Average Cost of Prescription Drug Addiction Treatment With Insurance?
It’s not possible to estimate the average cost of prescription drug addiction treatment with or without insurance. There are so many factors affecting inpatient rehab insurance coverage that it’s completely different for each person.
What is the Average Cost of Prescription Drug Rehab with Private Insurance?
The cost of prescription drug rehab depends on too many factors to predict what the cost might be after private insurance. Your insurance provider can help you determine your actual rehab cost, including deductibles, copays, and coinsurance.
The types of private insurance plans that cover prescription drug rehab (in part or in full) include:
- Preferred Provider Organization (PPO) plans
- Health Maintenance Organization (HMO) plans
- Point-of-Service (POS) plans
- Employer Group plans
How Long Does Private Insurance Cover Prescription Drug Rehab?
Your plan may offer prescription drug rehab insurance coverage for 30, 60, or 90 days, the most common lengths for rehab programs.
The most common coverage schedule is:
- Days 1-60 with maximum full or partial coverage
- Days 61-90 with reduced full or partial coverage
What Rehab Treatments Are Covered by Private Insurance?
Private insurance plans cover prescription drug rehab treatment that is:
- Medically necessary, and
- For a pre-existing condition such as opioid use disorder or stimulant use disorder
The treatment program you choose must be approved by your private insurance provider to get coverage. That usually means rehab treatments must be evidence-based to get coverage.
Is Prescription Drug Detox Rehab Covered by Private Insurance?
Prescription drug detox rehab is covered by private insurance. Your detox insurance coverage might include services like 24/7 supervision, symptom management, and more.
Is Prescription Drug MAT Rehab Covered by Private Insurance?
Prescription drug MAT rehab is covered by private insurance if you have opioid use disorder. Currently, opioids are the only addictive prescription drugs that have an approved MAT treatment.
Is Prescription Drug Outpatient Rehab Covered by Private Insurance?
Private insurance almost always covers outpatient rehab for prescription drug addiction. Your outpatient rehab treatment could be completely covered or partially covered.
What is the Average Cost of Prescription Drug Rehab with Medicare Insurance?
With Medicare, your cost of prescription drug rehab insurance coverage is the plan deductible up to 60 days. If you haven’t met the deductible yet, then the amount remaining is your rehab cost.
If you’ve already met your deductible by paying for other medical care this year, then you pay nothing out-of-pocket for prescription drug inpatient rehab. Most people pay nothing for rehab under Medicare.
How Long Does Medicare Insurance Cover Prescription Drug Rehab?
Medicare covers prescription drug rehab at maximum coverage for 60 days. From days 61-90, Medicare covers rehab at partial coverage.
What Rehab Treatments Are Covered by Medicare Insurance?
Medicare insurance plans cover medically necessary treatment for pre-existing conditions, including prescription drug use disorders. The programs must be evidence-based and approved by Medicare for coverage.
Is Prescription Drug Detox Rehab Covered by Medicare Insurance?
Prescription drug detox rehab is covered by Medicare insurance. It’s typically billed as a short-term inpatient stay, so you should receive full coverage for a typical detox program.
Is Prescription Drug MAT Rehab Covered by Medicare Insurance?
Medicare includes medication-assisted treatment insurance coverage for opioid use disorder only. The treatment isn’t evidence-based for stimulants, benzodiazepines, hypnotics, or other prescription drugs besides opioid pain medications.
Is Prescription Drug Outpatient Rehab Covered by Medicare Insurance?
Medicare covers prescription drug outpatient rehab in nearly all cases. Your coverage may include:
- Appointments for follow-up, routine care, and medication
- Behavioral treatment such as counseling and therapy
- Lab services including urinalysis and bloodwork
- Prescription medications for opioid MAT
What is the Average Cost of Prescription Drug Rehab with Medicaid Insurance?
The average cost of prescription drug rehab with Medicaid insurance varies from state to state. The only way to estimate your prescription drug rehab insurance coverage is by calling your Medicaid provider or your state’s Medicaid office.
How Long Does Medicaid Insurance Cover Prescription Drug Rehab?
The length of Medicaid insurance coverage for rehab is different in every state. Contact your state’s Medicaid office to get the most current information for prescription drug rehab coverage near you.
What Rehab Treatments Are Covered by Medicaid?
Medicaid typically covers all medically necessary prescription drug rehab treatment. That includes evidence-based detox, inpatient, MAT rehab, and outpatient programs.
Is Prescription Drug Detox Rehab Covered by Medicaid?
Detox is a medically necessary service for prescription drug addiction, so Medicaid covers it. The coverage details are different in each state, so check with your local Medicaid office for accurate information about your plan.
Is Prescription Drug MAT Rehab Covered by Medicaid Insurance?
Medicaid only covers medication-assisted treatment for prescription opioids, not other prescription drugs. The program only covers evidence-based treatment, and MAT isn’t proven to work for stimulants, benzodiazepines, or sedative-hypnotics.
Is Prescription Drug Outpatient Rehab Covered by Medicaid Insurance?
Medicaid covers outpatient treatment for prescription drug addiction, including stimulants, benzos, and sedative-hypnotics. Your coverage may include appointments, labwork, prescriptions, and behavioral care.
What if You Don’t Have Insurance That Covers Prescription Drug Rehab?
If you don’t have insurance that covers prescription drug rehab, there are other resources you can look into.
Talk to Your Employer
If you’re employed but don’t have a health insurance plan, talk to your employer. They can let you know how to qualify for an Employer Group plan. They can also redirect you to company resources for addiction and mental health.
Talk to the Addiction Rehab Center
Your addiction rehab center can help you with treatment resources. Some treatment centers offer discounted care for cash payments, while others offer rehab scholarships or can refer you to local services for treatment assistance.
Talk to Family and Friends About Your Struggle With Addiction
When you’re honest about your prescription drug addiction with your closest loved ones, you might be surprised at the resources they can find. Crowdsourcing treatment funding is often much more effective than looking for resources alone.
The True Cost of Prescription Drug Rehab vs. the Cost of Prescription Drug Addiction
What is the True Cost of Prescription Drug Abuse?
Prescription drug abuse costs more than you think—it’s not just the cost of the substances. It costs you time spent getting drugs, using them, and recovering from them. You lose relationships and opportunities when your entire world revolves around getting prescription drugs.
What is the True Cost of Lost Income From Attending Rehab for Prescription Drug Treatment?
You may worry that rehab will cost you too much in terms of missing work, but the truth is, prescription drug rehab doesn’t have to cost your income.
Outpatient rehab programs let you recover from prescription drug addiction on your own terms so you can keep working and paying your bills.
What is the True Cost of Health Problems From Prescription Drug Addiction?
Prescription drug addiction can cause lifelong health problems, and the cost of treating those problems can be steep. That’s not to mention the quality of life cost when you’re living with chronic illness that was caused by prescription drug addiction.
For instance, long-term stimulant addiction can cause heart problems, including heart attack, stroke, blood vessel problems, and heart rhythm problems.
Addiction Treatment Admissions Can Help You Understand Prescription Drug Rehab Coverage
The treatment admissions team at Bedrock Recovery Center wants to help you understand your prescription drug rehab coverage.
It’s critical to understand what’s covered when it comes to prescription drug rehab insurance. Even more, you should know your coverage before entering rehab so you’re not worrying about your financial responsibility when you should be worrying about recovery.
At Bedrock Recovery Center, our admissions specialists go above and beyond by reaching out to your insurance company to confirm coverage. All you need to do is call Bedrock Recovery Center at (877) 264-0976 for 24/7 assistance!
- Prescription opioid use is a risk factor for heroin use
- Oxycodone vs. Hydrocodone for Pain Relief
- Adderall vs. Dexedrine: ADHD Drug Uses, Side Effects & Interactions
- List of Common Benzodiazepines + Uses & Side Effects
- Sleep Disorder (Sedative-Hypnotic) Drug Information
- How long does drug addiction treatment usually last?
- Affordable Care Act (ACA) – HealthCare.gov Glossary