Does Insurance Cover Inpatient Rehab Treatment?
If you have an upcoming inpatient rehab stay on your mind, you’re probably wondering (and researching) how to get inpatient rehab covered by insurance.
It’s not hard to find health insurance that covers substance abuse treatment in an inpatient setting.
In fact, if you already have health insurance, the chances are good that it covers inpatient rehab in part or in full.
Paying for rehab without insurance is an obstacle that stops many people from seeking treatment, so it’s common to enroll in a new policy some time before going to an inpatient program.
If you’re shopping for a new insurance plan, you should know that any long-term health insurance plan must cover inpatient drug rehab treatment, since it’s an essential medical service.
There are a few exceptions—plans from before March 2010 are grandfathered in if they haven’t changed since that date; and short-term or emergency plans don’t typically cover inpatient rehab or any addiction services.
However, those are not the majority of health insurance plans that people want to use for inpatient rehab coverage.
If you got your insurance from any of these sources, then you’re most likely covered for residential rehab:
- Your employer
- The Healthcare Marketplace
Understanding Inpatient Rehab Coverage
Health insurance coverage for inpatient rehab works the same way as getting coverage for any other medical service.
To get insurance to cover your inpatient treatment, you’ll need to follow their process for submitting claims and showing that your treatment is medically necessary.
How to Use Your Insurance Coverage on Inpatient Rehab
Your primary care doctor can handle the first parts of the process by providing a referral to substance abuse treatment. They’ll also take care of the prior authorization process, which is additional paperwork justifying your need for treatment.
After that, your insurance company will reach out to you and your treatment provider to confirm your coverage. If your coverage is partial, they’ll let you know your portion of financial responsibility.
Using your insurance to cover inpatient treatment is surprisingly hands-off. The most time-consuming part is finding your insurance coverage details before choosing a treatment center, which can require a phone call.
Does Insurance Cover Inpatient Rehab in Full?
Health insurance can cover inpatient rehab programs in full, but that’s not always the case. Many people have partial coverage for addiction services on their plan or policy.
If that’s the case for you, there will be an out-of-pocket cost associated with going to inpatient rehab. That cost typically comes in the form of:
- A copay: A set amount that you pay for treatment; or
- Coinsurance, the remaining portion of financial responsibility after insurance pays theirs
Some health insurance plans do offer full inpatient rehab coverage. Certain types of insurance plans have lower out-of-pocket costs than most. In some cases, the out-of-pocket cost is nothing!
If you’re not sure about your own plan’s coverage, call the Member Services phone number on your health insurance ID card. They can locate your plan and advise you on your residential rehab coverage.
How Does HMO Coverage Work for Inpatient Rehab?
A Health Maintenance Organization is a low-cost type of health insurance plan that covers inpatient addiction treatment.
If you have an HMO plan, you need to see your primary care doctor before setting up treatment.
With an HMO plan, you’re required to see a family doctor any time you need specialized care.
Your family doctor will provide you with a treatment referral, which helps let your HMO know that the inpatient rehab program is medically necessary.
The only care providers (including treatment centers or inpatient rehabs) that you can see with an HMO plan are in-network. This means they’re part of a curated group of approved healthcare providers.
If you have an HMO, you can’t get coverage for out-of-network addiction treatment centers at all. You must get a referral for an in-network addiction program or go without insurance to attend an out-of-network program at your own cost.
Most HMOs have lower out-of-pocket costs for inpatient rehab, including copays and coinsurance.
How Does PPO Coverage Work for Inpatient Rehab?
A Preferred Provider Organization is a type of health insurance plan that covers inpatient addiction treatment and offers flexible rehab choices.
With a PPO, you don’t have to see a doctor or get a referral before you go to inpatient treatment. You can simply choose your treatment center and get in-network or out-of-network coverage.
You can choose an inpatient rehab program that’s out-of-network with a PPO. You might have a higher out-of-pocket cost for doing so, but you’ll still get partial coverage. Going out-of-network can open up your inpatient treatment possibilities.
All of the out-of-pocket costs for a PPO tend to be higher. That includes:
- Deductibles: The amount you must pay out-of-pocket for healthcare before insurance starts covering treatment
- Copays: The set amount that you pay out-of-pocket for treatment (regardless of the program’s actual cost)
- Coinsurance: The balance that you must cover out-of-pocket after insurance covers their portion
What Factors Affect Inpatient Rehab Program Costs & Insurance Coverage?
It’s hard to predict your financial responsibility for inpatient rehab without seeing details, since there are so many factors that go into the cost and coverage of rehab.
For instance, your end cost depends on:
- The inpatient rehab program cost
- The amount of your deductible and whether you’ve met it
- Following the referral process with your family doctor if applicable to your plan
- Following the prior authorization process
- The type of treatment program, PPO or HMO
- The in- or out-of-network status of your inpatient treatment provider
- Whether your policy has full or partial coverage
How Much Does Insurance Pay for Inpatient Rehab?
Before insurance, the listed cost of inpatient rehab programs can range from $10,000 to $50,000 or more.
Your insurance policy could reduce that cost by thousands of dollars—some people pay under $5,000 for a month of inpatient rehab; others pay under $1,000; and it’s even possible to get full coverage and pay nothing for inpatient treatment.
It’s impossible to guess what your coverage and costs might be, but knowing the factors that affect inpatient rehab insurance coverage can help you know what to expect.
You can get an accurate estimate of your inpatient rehab costs and coverage by checking with Member Services for your insurance company.
How Long Does Insurance Cover Inpatient Rehab?
Most insurance companies cover inpatient rehab programs for at least 30 days. Some insurance plans, like Medicare Part A, cover up to 90 days of inpatient treatment.
The National Institute on Drug Abuse (NIDA) says that 90 days is the shortest length of inpatient rehab proven effective.
That doesn’t mean a shorter stay is not worth your time—it’s important to attend rehab for as long as you can get coverage, even if it’s only 4 or 6 weeks. Short inpatient stays teach you valuable coping skills that can help improve your long-term outcome.
It does mean that you should shop around for an insurance plan that covers at least 90 days of inpatient rehab if you’re in a position to do so.
You can only change insurance policies during certain times of the year or after a life event. If you can’t shop for better inpatient coverage right now, then you should attend rehab for the longest period you can get covered, even if it’s 30 days.
Verifying Coverage and Finding the Best Inpatient Rehab Services
You shouldn’t try to guess at your insurance coverage, since there’s no way to predict the end cost without checking multiple factors like:
- Your plan type, HMO or PPO
- Your policy
- The cost of the inpatient treatment program
- The in- or out-of-network status of the treatment center
However, you can find out your exact coverage details relatively quickly. Your options include:
- Asking your insurance provider: Calling your insurance provider is the way to get the most detailed answer possible about your coverage. You can find their contact information on your Member ID insurance card.
- Talking to your primary care provider: Your family doctor already checks your insurance details to give you a treatment referral, so you can ask them (or their office) to help you understand.
- Checking the online portal: Your insurance provider’s website has an online portal for member self-service. There, you can locate details about inpatient rehab coverage without making a phone call or an appointment!
- Calling your treatment center: Most treatment centers’ admissions teams are happy to check your inpatient rehab coverage for you.
What Substances Does My Health Insurance Cover for Inpatient Rehab?
Most health insurance covers inpatient rehab for any substance that can cause:
- Substance use disorder
- Substance dependence
- Substance abuse
- Substance withdrawal
That includes many common addictions, including:
The exact treatment insurance coverage (and experience) can vary depending on the drug that affects your substance use disorder.
For instance, medication-assisted treatment is effective for treating prescription painkiller addiction, so many inpatient treatment facilities use it and most insurance companies cover it.
However, that same treatment isn’t effective for treating prescription stimulant addiction, so your insurance probably won’t cover it during your inpatient stay for amphetamine (Adderall) or methamphetamine (Desoxyn) addiction.
How to Cover Inpatient Rehab When Insurance Won’t
It’s common for insurance providers to cover inpatient addiction treatment on a partial basis, which means you’ll pay a copay, coinsurance, or deductible.
If you’re working with your insurance company and treatment provider and still have out-of-pocket costs, you’ll need to make a plan to cover them.
You should think about this before you make plans to enter treatment.
The process can move quickly once it gets started. Once you begin your inpatient stay, you’ll want to focus 100% of your attention on recovery, not waiting on hold with the insurance company.
You won’t want to spend time figuring out how to cover your rehab bill after you come home, either. That time should be spent transitioning back to home life and into recovery.
When your insurance company sends the Explanation of Benefits after processing your treatment coverage, you can reference that document for your financial responsibility.
After you find out the costs you must cover, you can make a plan to tackle the balance.
Your options vary based on your location, but might include:
Rehab scholarships are grants or gifts that pay for inpatient substance use disorder treatment, usually from a private organization.
When you receive a scholarship, the funds go straight to the treatment center. Some organizations let you choose the rehab as long as they approve it. Others partner with specific treatment centers and programs.
Because they’re not loans or payment plans, or any form of financing, you don’t have to repay a rehab scholarship.
The most famous rehab scholarship is 10,000 Beds, though they often limit application availability. Check back often if you find applications closed.
Local Recovery Communities
If your city or county has programs like Alcoholics Anonymous or 12 Steps, there’s most likely a tight-knit local recovery community. Those communities are always helpful to people new to treatment or recovery.
Being part of a recovery community can open up local resources that you didn’t know existed. Even if you can’t find a group that directly helps people pay for treatment, you can always find someone in recovery who knows a resource you haven’t tried.
Local Religious Organizations
Not all religious communities are recovery-friendly, but many are! Many spiritual groups have “friendly neighbor” funds to help a human in need, including Christian churches and some East Asian religious communities.
Check with your dogma’s local mosque, church, or grotto and let them know that you’re looking to better yourself, but need help doing so. Many religious admins are happy to tap into the community aid fund to help you make recovery a reality.
Start Inpatient Rehab at Bedrock Recovery Center
Your inpatient rehab experience can start in scenic Massachusetts at Bedrock Recovery Center, and it can begin with checking your inpatient rehab coverage.
Our trained admissions team can navigate your insurance to let you know exactly what to expect in terms of cost. Once we confirm it, we can handle the claims process for you so you’re free to focus on recovery.
Call Bedrock Recovery Center today to schedule your free consultation!
Bedrock Recovery Editorial Team
©2023 Bedrock Recovery Center | All Rights Reserved
This page does not provide medical advice.