Once a person decides they no longer want to struggle with an addiction, access to the necessary resources should be readily available. The road to recovery is difficult and should not be encumbered with worries about paying for treatment.
Expensive professional rehabilitation services may deter some from seeking the care they need. Fortunately, alcohol and drug rehab insurance coverage is available through marketplace plans.
Typically, health insurance includes coverage for substance abuse recovery programs. These plans also cover various forms of mental health treatment. The extent of coverage may vary based on specific policy benefits, a person’s needs, and the rehab treatment provider.
Table of Contents
- 1 The Cost of Drug Addiction Coverage
- 2 The Cost of Rehab Treatment Versus The Cost of Addiction
- 3 Common Healthcare Plans and Benefits
- 4 Comparing Rehab Coverage from Insurance Providers
- 5 Drug Rehab Insurance Coverage Under the Affordable Care Act
- 6 What Types of Rehab Services Does Insurance Cover?
- 7 What Mental Health Disorders are Covered by Insurance?
- 8 Are Treatment Medications Covered?
- 9 Frequently Asked Questions
- 10 Going into Rehab Without Insurance
- 11 Take the First Step Toward Relief
- 12 FAQ
The Cost of Drug Addiction Coverage
The cost of a rehab program for drug addiction varies depending on several factors such as:
- Type of addiction
- Level of required treatment
- Length of stay
- Insurance coverage
- Out-of-pocket expenses
Recent laws such as the Affordable Care Act consider addiction treatment one of 10 essential health categories. With this provision, insurance companies must provide treatment to participate in the insurance marketplace.
Since addiction treatment is a covered benefit, anyone under the policy that has an addiction can receive care. The type of drug does not change the decision to provide care. This model mirrors what is used to treat other medical issues.
The Cost of Rehab Treatment Versus The Cost of Addiction
When considering the cost of drug rehab insurance, the cost of not seeking treatment is crucial. Addiction costs more than monetary losses. The individual, their family, community, and society at large pay a price.
Taxpayers foot the bill for law enforcement, the judicial system, incarceration and public health care for prevention and treatment programs. The prices for goods and services increase for consumers. Employers and their employees pay higher insurance rates.
Nevertheless, rehab treatment is worth the investment because it saves lives. Whether a person has full coverage or no insurance for drug treatment, getting help is the best decision with the right treatment for long-term sobriety.
Common Healthcare Plans and Benefits
Part of the decision for drug abuse treatment and recovery includes understanding the three common healthcare plans: HMO (health maintenance organization), PPO (preferred provider organization) and POS (point of sale).
- HMO plans let individuals choose a primary care physician, or PCP, that treats most medical needs. An individual forms a relationship with this physician. Also, the PCP refers their patients to a specialist or doctor outside the HMO network as needed. These plans usually have a low premium and low deductible or no deductible.
- PPO healthcare plans allow individuals to see healthcare providers whether or not the providers are within the PPO network. These plans offer more flexibility since referrals are not required before seeking care. However, the cost of staying within the network is less than seeking care outside of the network. Additionally, PPO plans come with low co-pays and high monthly premiums.
- Similar to HMO plans, POS plans also have the flexibility of seeing out-of-network providers in some cases. The rules of these plans can vary among insurance providers.
Comparing Rehab Coverage from Insurance Providers
Generally, each plan offered by different insurance providers outlines which type of drug rehab program gets covered. In addition to marketplace insurance plans and private insurance, Medicaid must also cover addiction treatment.
Exceptions to this rule might be having coverage for what is considered luxury rehab expenses. This area of rehab service is where patients receive treatment and amenities in an upscale, resort-style facility.
While offering traditional evidence-based treatments like cognitive behavioral therapy, these facilities also offer innovative experiences. Patients may receive art therapy, equine therapy, and alternative treatments such as meditation and massages.
Drug Rehab Insurance Coverage Under the Affordable Care Act
One way to pay for drug rehab is with the Patient Protection and Affordable Care Act, which was passed in March 2010. This health care system law makes health insurance an accessible and affordable option for more people in the United States.
Under the law, insurance providers cannot deny access to health insurance for preexisting conditions. Drug and alcohol addictions are considered preexisting conditions.
Substance use disorder is an essential health benefit that must be covered. This applies to rehabilitation services for an addiction or a mental health condition.
Through an online marketplace platform, individuals can find addiction treatment that is similar to private insurance plans. Individuals covered by Medicare and Medicaid are also eligible to receive treatment options. However, costs and requirements differ from marketplace plans.
Addiction treatment that is covered by insurance plans under the ACA includes:
- Evaluation of addiction
- Clinic visits
- Home health visits
- Drug and alcohol testing
- Medications for addiction treatment
- Family counseling
Insurance plans under the ACA can also provide inpatient services for medical detox.
What Types of Rehab Services Does Insurance Cover?
Various types of treatment programs exist for anyone struggling with an addiction. Depending on the specifics of individual drug rehab insurance plans, a person living in the United States can enroll in addiction treatment programs such as:
- Inpatient care
- Outpatient care
- Intensive outpatient care
- Medication-assisted care
- Continuing care through ongoing counseling
- Maintenance medication
- Dual diagnosis treatments (for addiction and mental disorders)
What Mental Health Disorders are Covered by Insurance?
In addition to drug and alcohol addiction treatment, the ACA also requires insurance plans to offer the same level of care for mental disorders given to physical health concerns.
Another layer of protection for mental health disorders comes with the Mental Health Parity and Addiction Equity Act (MHPAEA).
This federal law prevents health insurance providers and group health plans from decreasing the level of benefits provided for physical health reasons. The care and cost must be the same.
Known as parity laws, these rules do not explicitly state which mental health disorders should be covered. However, plans are written with the same rules that apply to drug addiction. Essentially, specifying which illnesses may or may not be covered is a time-consuming task.
Therefore, plan administrators can explain that insurance plans will cover all types of mental illnesses. This dispels the myth that some issues are worse than others and cannot be covered.
Are Treatment Medications Covered?
An important aspect of drug and alcohol addiction treatment is medication-assisted treatment. While the obvious goal is full recovery, this type of treatment has also:
- Increased survival and retention rates
- Decreased criminal activity
- Increased opportunities for gainful employment
There are several FDA-approved medications that insurance plans cover. These include Buprenorphine, Naltrexone, and Methadone. As part of an aftercare treatment plan, individuals may receive these prescriptions based on their recovery needs.
Frequently Asked Questions
People suffering from an addiction should use every aspect of their drug rehab insurance coverage for recovery. Getting the care they need is critical to living a healthy and sober life. Nevertheless, many may have questions related to specific programs and coverage.
How are Insurance Providers Billed for Substance Abuse Treatment?
A conversation with the insurance plan administrator before enrolling in a treatment program can help to alleviate concerns. This way, the person and their family can focus solely on healing, knowing that the insurance company will be billed accordingly.
Addiction treatment facility staff can also help since they have experience dealing with insurance providers.
Are financial assistance programs available for substance abuse treatment?
Generally, federal, state, and local governments may offer financial assistance for addiction rehab treatment. SAMHSA offers grants.
Additionally, certain populations, such as low-income families and veterans, may have access to insurance options.
How Much Does Outpatient Substance Abuse Treatment Cost?
There are different levels of care and services that an individual may receive through outpatient treatment for addiction. Specific plan coverage and potential out-of-pocket expenses will vary based on the rehab facility and insurance provider.
Intensive outpatient programs are instrumental in going from addiction and dependence to wellness and recovery. This important part of the continuum of care can be a pivotal treatment option for a person who cannot commit to inpatient rehab.
Yet, the cost is still a concern that is only answered through individual plans. Generally, treatment costs are calculated per day and can range from $250 to $350.
Going into Rehab Without Insurance
A person who does not have private health insurance may feel that getting help for their drug or alcohol addiction is out of reach. However, they do not need to accept this temporary barrier to accessing the care and treatment they need to get well.
There are options for free and state-funded rehabilitation services. States across the country offer financial assistance for a person without insurance. A quick online search in their respective state, city or county can lead to a list of low-cost programs and services.
Other ways to enter a treatment program without drug rehab insurance include:
- Financial support from family and/or friends. Asking for help, particularly at this time, might seem difficult. However, people who want to see their loved ones improve might be willing to support the person financially and emotionally.
- Financing options. Some treatment centers provide options for loans or payment plans to help a person receive immediate care while incrementally paying for the costs after treatment.
- Facility scholarships. Additionally, many treatment centers offer scholarships that will cover all or a portion of treatment costs.
Take the First Step Toward Relief
Garden State Treatment Center is the right place for authentic relief if you or a loved one has an alcohol or addiction and needs treatment. We have highly trained and experienced treatment professionals ready and willing to help.
Our staff knows about most health insurance providers’ drug rehab insurance plans. They will work to ensure that the financial cost of your addiction does not hinder the importance of accessing the care you need today. Contact our treatment facility today.
Does life insurance cover drug addicts?
Typically, life insurance companies will pay your beneficiaries if you die from any accident, including an accidental drug overdose. However, if it’s proved that your drug overdose was intentional, there may be some cases in which your beneficiaries wouldn’t get the death benefit.
What is rehabilitation insurance?
Rehabilitation benefit is the feature of a workers’ compensation policy that gives someone who has been injured at work access to rehabilitative treatments that will give them a chance to regain their full physical or mental capacity.
What is the success rate of rehab in the US?
An estimated 43 percent of all people who go to drug rehab successfully complete their treatment programs, while another 16 percent are transferred to other rehab centers for additional treatment. Rehab success rates for those who complete drug and alcohol detoxification are a combined 68 percent.