For many people struggling with addiction, the cost of treatment can create a significant barrier to getting the help they need. But does insurance cover addiction treatment?

The good news is that many health insurance plans provide coverage for addiction treatment. In fact, federal laws—such as the Affordable Care Act (ACA) and the Mental Health Parity and Addiction Equity Act (MHPAEA)—require insurance plans to offer coverage for mental health and substance abuse treatment, as they would for other medical conditions.

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But the extent of coverage can vary depending on your specific insurance plan and provider. For instance, how much you need to pay out of pocket or the exact treatments covered can differ. This is why it’s important to understand your specific insurance coverage and options.

Inevitably, this can feel overwhelming—especially when coupled with the cycle of addiction and the drastic impact it has on an individual’s daily life. Whether you’re looking for information for a loved one or wish to understand your treatment options in more detail, the United Recovery Project is here to help. Call us at 888-960-5121. We can save you time and guide you on the next best step. For more information about insurance coverage for rehab, read below.

Options With and Without Insurance

There are various treatment options—with and without insurance coverage. Knowing these options can help you make an informed choice regarding your recovery.

The main types of addiction treatment programs include inpatient rehab treatment, outpatient rehab treatment, intensive outpatient program (IOP), and detox programs. Below, we take a closer look at these rehab treatment and insurance options. If you have any further questions about your options, call us at 888-960-5121.

Popular In-network Insurances at United Recovery Project:

Aetna
Blue Cross Blue Shield

Inpatient Rehab Treatment

Inpatient rehabilitation provides the most extensive level of care. It involves 24/7 medical supervision and structured treatment programs. This means you stay in a facility for a set timeframe (such as 30 days), allowing you to be closely monitored by your medical team. In turn, this can help manage withdrawal symptoms and ensure your safety and success.

In regards to insurance coverage, patients typically pay deductibles and copays. However, these can vary depending on individual plans. Without insurance, inpatient programs can cost much more—depending on the facility and location. This higher cost is also associated with this option’s higher level of care.

Outpatient Rehab Programs

Outpatient treatment, in contrast, allows individuals to receive care while maintaining their daily schedule and responsibilities. Without insurance, you can expect to pay a set amount per session, with variances in program lengths. However, insurance plans often cover a huge portion of this, offering increased accessibility and flexibility.

Intensive Outpatient Programs (IOP)

IOP is an option that falls between inpatient and outpatient care. It involves multiple (sometimes daily) sessions per week, making it very intensive while allowing individuals to attend to their daily obligations.

Due to their effectiveness, many insurance plans cover IOPs—partially or fully. Without insurance, on the other hand, these types of programs can cost thousands of dollars (or even tens of thousands of dollars, depending on the program).

Medical Detox Programs

A medical detox program is essential for those entering rehab as it helps tackle the initial withdrawal; this is the first phase of addiction treatment.

Insurance usually covers these services since they’re considered medically necessary. Without insurance, however, medical detox programs can cost thousands of dollars for a typical five to seven-day program. Yet, the exact cost depends on the substances involved and the medical supervision necessary.

If you don’t have insurance coverage, many treatment centers offer solutions to make care more accessible, such as:

  • Sliding scale payment plans based on income
  • Payment plans with monthly installments
  • Treatment scholarships or grants
  • State-funded treatment programs
  • Faith-based organizations offering free or low-cost treatment
  • Credit options specifically for medical care

Additionally, the Affordable Care Act states that an individual can’t be denied access to health insurance, even if they have a pre-existing substance use disorder.

Either way, before beginning any treatment program, it’s a good idea to understand your financial options and have a plan. As many know, finances can be a major source of stress, which could drive an individual back into a cycle of drug or substance abuse. Many experts in the field understand this and are committed to helping each patient understand their payment options, guiding them down an affordable path toward recovery. If you’re struggling to do this alone, reach out to our caring and compassionate team at 888-960-5121.

Common Types of Healthcare Plans and Benefits

The three most common types of healthcare plans that may cover substance abuse treatment and recovery are Health Maintenance Organization (HMO) plans, Preferred Provider Organization (PPO) plans, and Point of Service (POS) plans. Each offers different advantages and considerations when looking for addiction treatment, as described below.

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HMO (Health Maintenance Organization)

HMO restricts coverage to network providers and usually requires referrals. With HMO, your primary care physician oversees all your medical needs. The benefit of this type of healthcare plan is that you can rely on one provider who knows your medical history. These plans also typically offer lower-cost coverage with minimal or no deductibles.

While HMOs generally have lower monthly premiums, they require you to stay within their network of providers for coverage. If you’re considering rehab treatment under an HMO plan, you need a referral from your primary care physician and must choose from in-network facilities. Unfortunately, treatment sought outside of the HMO network won’t be covered.

PPO (Preferred Provider Organization)

PPOs offer more flexibility in choosing providers but often come with higher premiums. With PPOs, you don’t need a primary care physician’s referral.

While monthly premiums are usually higher than HMOs, PPO plans offer more freedom when it comes to treatment choices. Though you’ll pay less for staying within the network, having the option to choose out-of-network providers can be beneficial when looking for specialized addiction care (such as that from the help of a specialist).

POS (Point of Service)

POS plans combine elements of both HMO and PPO coverage. Like HMOs, they require you to select a primary care physician who coordinates your care. However, they offer more flexibility by allowing you to seek out-of-network treatment in certain situations (which is what “point of service” refers to). The cost structure usually favors in-network care with lower copayments while providing some coverage for out-of-network treatment options. Yet, this can always vary depending on individual plans.

Cost and Coverage

Most insurance plans handle addiction treatment through a combination of:

  • Deductibles: This is the amount you must pay before insurance coverage begins; it can range from a few hundred to several thousand dollars, depending on your plan.
  • Copayments: After meeting your deductible, you’ll typically have copayments (fixed amounts) or coinsurance (percentage of costs) for services. For example, you might pay a $30 copay for each outpatient visit or 20% coinsurance for inpatient treatment.
  • Out-of-Pocket Expenses: Most insurance plans include an out-of-pocket maximum—the most you have to pay in a year for covered services. Once reached, your insurance covers 100% of the remaining costs for covered services. This can provide significant protection against catastrophic expenses for longer-term treatment needs.

Inevitably, all of the above can vary from plan to plan. It’s always important to check your specific plan’s policy and requirements.

There are also some variations between inpatient and outpatient care coverage. Although inpatient treatment offers the most comprehensive care, it generally involves higher costs and stricter coverage requirements. Your insurance may cover a significant portion of a 28-30-day program, but you’ll likely need pre-authorization and proof of medical necessity.

Outpatient services, including therapy sessions and medication management, usually have lower out-of-pocket costs and fewer restrictions. However, the number of sessions per year may be limited.

Insurance Providers and Rehab Coverage

Most major health insurance providers offer coverage for addiction treatment services—but the extent of coverage varies significantly between providers and specific plans. As previously mentioned, this coverage stems from federal requirements under the Affordable Care Act (ACA) and the Mental Health Parity and Addiction Equity Act, which mandate that insurance companies provide coverage for substance use disorders at levels comparable to other medical conditions.

At the same time, variations may exist when it comes to:

  • Pre-authorization requirements
  • Network restrictions
  • Coverage limits for different levels of care
  • Copayment and coinsurance structures
  • Length of approved treatment stays
  • Requirements for continuing care

Ideally, you’ll want to contact your insurance provider directly or work with a treatment center’s admissions team to verify your coverage. They can help determine what services are covered, what documentation is needed, and what out-of-pocket expenses you may have.

Steps to Check Insurance Coverage for Rehab

Before beginning treatment, taking a few key steps can help you maximize your benefits and avoid unexpected costs. Start by locating your insurance card and policy number.

From here, you can then contact your insurance provider directly through their member services line or work with a treatment center’s admissions team, such as the United Recovery Project.

When speaking with your insurance provider, it’s a good idea to ask specific questions about:

  • Coverage levels for different types of addiction treatment
  • In-network treatment facilities in your area
  • Pre-authorization requirements
  • Expected out-of-pocket costs
  • Length of treatment covered
  • Coverage for specific medications or therapies

Rest assured, however, that you don’t have to do this alone. Many treatment centers offer free insurance verification services and can help navigate this process. They can help you determine your coverage levels and requirements, as well as identify any potential coverage gaps and discuss payment options for services not covered by your insurance. At the United Recovery Project, our team can offer a helping hand with all of this; call us at 888-960-5121 for more information.

Rehab Insurance FAQs

If you didn’t find the answers you were looking for above, read through the FAQs below.

Does insurance cover detox programs?

Yes, most insurance plans cover medical detox programs. Since detoxification can be dangerous without proper medical supervision, insurance providers typically classify it as an essential service.

How can I find a rehab that accepts my insurance?

The best starting point is contacting your insurance provider for a list of in-network facilities. You can also search your insurance company’s online provider directory or call treatment centers directly. In fact, many treatment centers have experienced admissions teams who can verify your insurance coverage and explain your benefits.

What types of rehab programs are covered?

Most insurance plans cover a range of addiction treatment services, including medical detoxification, inpatient treatment, outpatient programs, intensive outpatient programs (IOP), and medication-assisted treatment. However, your specific plan will determine the level of coverage for each service.

Does my insurance cover outpatient or only inpatient rehab?

Most insurance plans cover both outpatient and inpatient rehab services. Outpatient treatment often receives more generous coverage with lower copayments since it’s less expensive than inpatient care. The specific coverage levels and requirements vary by plan, indicating the importance of understanding your individual policy.

Are mental health treatments part of the insurance coverage for rehab?

Yes, under federal parity laws, insurance plans must provide equal coverage for mental health and substance use disorder treatments. This includes coverage for dual diagnosis treatment when someone has both an addiction and a mental health condition.

What happens if insurance doesn’t cover the entire treatment?

If insurance doesn’t cover the entire treatment, most rehab centers have other payment options or solutions. This may involve monthly payment plans, adjusting fees based on your income, or helping you apply for healthcare financing. Scholarship programs or additional funding sources may also be available at certain centers or clinics.

Can I get financial help if my insurance doesn’t cover rehab?

Yes, there are various options available for financial assistance. You might qualify for state-funded treatment programs or scholarships offered by treatment centers. Many non-profit and faith-based organizations also provide financial support for addiction treatment. Treatment centers further often offer payment plans and can help you explore your financing options.

Conclusion

No matter where you’re coming from, there’s a solution that can help you with the financial side of rehab. Understanding your rehab treatment and insurance options can help pave the way toward an effective and lasting recovery.

Together, we can ensure the understanding and full usage of your specific insurance policy and help fill any gaps. Recovery, without financial stress, is entirely possible. Often, it comes down to understanding your options and using all the options available to you. Take the first step today and contact one of our representatives at 888-960-5121.