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Using Insurance to Pay for Drug and Alcohol Treatment

Understanding how to use insurance to pay for drug detox or rehab is critical if you are seeking addiction treatment. This article will walk you through the details of insurance coverage for detox and rehab care. You’ll learn how to check your insurance coverage, what drug addiction treatments are covered, and more.

Does Insurance Cover Drug and Alcohol Treatment?

Under the Affordable Care Act (ACA), mental and behavioral health benefits, such as substance use disorder (SUD) treatment, are considered essential to your well-being.1 This means that your insurance must cover drug and alcohol treatment in some way.1

In addition, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is a federal law that ensures you get the same level of treatment options for SUD treatment as you do for other medical conditions.2

So while your plan may not cover the full cost, your insurance can’t deny you coverage for addiction treatment or put a dollar limit on your care.1 But always check with your insurance company to see what is and isn’t covered and how much you might have to pay.

Which Treatment Types are Covered?

The types of treatment generally covered by insurance include, but are not limited to:

  • Medical detox: this helps you manage withdrawal symptoms and get ready for the next phase of treatment.
  • Inpatient rehab: this treatment involves staying at a treatment center 24/7 for the length of treatment.
  • Outpatient rehab: you’ll go to set appointments during the day and return home at night. The length and number of appointments will vary based on your needs.
  • Aftercare: this can include individual or group counseling or peer support groups such as AA or NA.

Using Your Insurance to Pay for Detox and Rehab

The first step in getting SUD treatment is often talking to your doctor. They can help assess your unique treatment needs. Then, you’ll need to find a detox or rehab center that takes your insurance. You may also need to get approval before starting treatment, which is called a “prior authorization.”

woman talking to insurance company about detox treatment optionsBefore you start treatment, it’s also a good idea to double check what is and isn’t covered with both the treatment center and your insurance plan. You can check this a few different ways:

  • Visit the insurance web portal and log in to your online account. There, you’ll be able to check your benefits, co-pays, deductibles, and more.
  • Call the insurance company. The phone number should be on the back of your insurance card.
  • Verify your benefits with the treatment center that you plan to attend.

Private Insurance

Many people get insurance through their jobs. But some people, especially those who are self-employed, have private insurance purchased directly through an insurance company. Other people buy health insurance through the Health Insurance Marketplace. Anyone can buy insurance plans and get healthcare benefits through this program.

Once you select a plan that is right for you, you’ll pay a monthly premium for coverage that gives you access to the healthcare benefits spelled out in your plan. In most cases, you’ll have office co-pays and a yearly deductible to meet.

If you want to buy private insurance, it could be helpful to know a bit more about the different types of plans.3

  • Health maintenance organization (HMO): this type of plan works within a network of providers. For out-of-network service, you’ll usually have to pay the full costs of care, unless it’s an emergency.
  • Exclusive provider organization (EPO): this managed care plan covers services, but you must use the doctors and hospitals within the plan’s network unless it’s an emergency.
  • Point of service (POS): in this type of plan, you need a referral from your doctor before you can see a specialist.
  • Preferred provider organization (PPO): this health plan has fewer out-of-pocket costs if you use providers in the network. You can also see out-of-network providers if you pay the additional cost.

 

 

In-Network vs. Out-of-Network Treatment Centers

It is helpful to understand what is meant by in-network vs. out-of-network insurance coverage. In-network refers to providers—that is doctors, hospitals, clinics, and other care settings—within the insurer’s network. You’ll often pay less if you see an in-network provider, because they have agreed to charge less to the insurance companies they have contracts with.4

Out-of-network service refers to providers who are not within the insurer’s network. Since the provider has not signed an agreement with the insurance company to offer lower costs, you often pay more out-of-pocket costs if you see a doctor out of network. You may also have higher deductibles with these doctors.5

COBRA Coverage

The Consolidated Omnibus Budget Reconciliation Act (COBRA) is another option for health insurance.6 This healthcare solution is managed by the U.S. Department of Labor and allows employees and their families to continue their group healthcare plan after they lose benefits under certain conditions. These include:6

  • Losing your job for reasons other than misconduct.
  • Reduced hours, resulting in the loss of employer-covered benefits.

COBRA extends benefits for a limited amount of time. The time depends on the conditions under which the benefits were lost.6

COBRA insurance covers SUD treatment at the same level as your previous insurance. It is an extension of the insurance you had before, so you’re covered while you’re out of work or between jobs. This means you will need to contact the insurance company you had to find out about the deductibles or co-pays they have for SUD treatment.

Public Insurance

Public insurance includes programs such as Medicare and Medicaid. These government-sponsored programs offer free or low-cost health benefits to people who meet certain conditions.

Medicare

Medicare is a federal insurance program that offers insurance to people 65 and older or younger people with certain disabilities. Medicare is split into the following parts:7

  • Medicare Part A covers inpatient care.
  • Medicare Part B covers preventative care, doctor’s care, outpatient services, and supplies.
  • Medicare Part C bundles together parts A and B, and often D
  • Medicare Part D covers prescription drugs.

Medicaid

Medicaid is state-sponsored health insurance for low-income families, people with disabilities, and pregnant women. Who can get it and what it covers may vary by state. You can find out your state’s details by visiting the Substance Abuse and Mental Health Services Administration’s Directory of Single State Agencies. Find your state and then click on the link to your state’s agency.

How to Find Drug and Alcohol Treatment Centers that Take My Insurance

You can begin your treatment journey by finding a drug detox or rehab center that accepts your insurance. Search online for treatment centers and research what types of coverage they have. If you know which treatment center you plan on going to, check with them directly.

Finally, if you want answers now, you can verify your insurance online immediately with American Addiction Centers.

Note: We try to offer the most updated information available about insurance. But insurance health plan information does change quickly. Please check with your insurance company to ensure that you have the most recent and correct information about your coverage.

Sources

  1. Healthcare.gov. (n.d.). Mental health & substance abuse coverage.
  2. CMS.gov. (n.d.). The Mental Health Parity and Addiction Equity Act (MHPAEA).
  3. HealthCare.gov. (n.d.). Health insurance plan & network types: HMOs, PPOs, and more.
  4. Health insurance.org. (n.d.). What does in-network mean?
  5. Health insurance.org. (n.d.). What does out of network mean?
  6. Benefits.gov. (2020). Facts to help determine your COBRA eligibility.
  7. Medicare.gov. (n.d.). Your Medicare coverage choices
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