Does Your Medical Insurance Cover Addiction Recovery Treatment Programs: 10 Things To Know?

If you or someone you love is struggling with substance abuse or addiction, there are many treatment options available. One of the most important questions to answer though is: does your medical insurance cover addiction recovery treatment programs? If not, what can be done about it?

Here’s what you need to know about your options and how you can get the help that could save your life or the life of someone close to you.

IMAGE: UNSPLASH

1. Many Insurance Plans Cover Addiction Treatment Programs At Least Partially

You may be surprised to learn that many insurance plans cover addiction treatment programs at least partially. However, not all plans are created equal; some cover more than others.

Your particular plan will determine how much will be covered, especially for substance use disorder and mental health conditions.

2. If You’re Not Sure About Your Medical Coverage, Call Your Health Insurance Company And Ask What Is Covered

If you’re not sure about your medical coverage, call your health insurance company and ask what is covered. Do they cover inpatient treatment? Outpatient treatment? What limits are there on coverage? Do I need to meet a deductible before they cover anything? Are there co-pays or other out-of-pocket expenses that I must pay?

3. There Are Several Types Of Addiction Recovery Programs

There are several types of addiction recovery programs that can help you to get and stay sober.

Inpatient rehab is a type of treatment in which an individual lives at the facility for a period of time, usually 28 days or longer. Outpatient rehab refers to treatment that takes place on an outpatient basis: The patient visits the facility for one or more hours each day but does not stay overnight there.

4. Speak With An Admissions Navigator

If you’re looking for a rehab center, an admissions navigator can help. They can connect you with treatment programs that fit your needs and answer any questions you have about your insurance benefits.

An addiction treatment program is not one-size-fits-all, so it’s important to ask as many questions as possible before deciding on a facility. An admissions navigator at the addiction treatment center in Austin will be able to provide detailed information about each program and their services, including what types of payment arrangements are available and any financial assistance that may be available.

5. Types Of Rehabs Usually Covered By Insurance

Inpatient rehab programs are often the first step to recovery, but they’re not always covered by insurance. Outpatient treatment and dual diagnosis treatment may be funded, while ongoing recovery support and recovery coaching are not.

Treatment programs often covered by insurance include:

Outpatient care (cheaper)
Inpatient care
Medical detox
Medication-assisted treatment
Dual Diagnosis & Co-occurring mental health treatments
Continuing care
Maintenance medication

6. Going To Rehab Without Insurance

If you don’t have health insurance, you can still go to rehab. But there are a few things to consider before making this decision.

You will have to pay for treatment out of pocket or get a loan from a bank or credit union. Perhaps with financial support from family?
Many states offer free or reduced treatment and financial assistance for those without insurance.
Some rehab centers offer payment plans if you’re unable to make one lump sum payment upfront.
Some rehab centers offer discounts for people without insurance—you may be able to get help paying for your recovery by calling them directly (don’t forget that this isn’t just about finances—it’s also about getting yourself better).

7. Affordable Care Act

The Affordable Care Act is a federal law that expanded access to health insurance for millions of Americans. This law was signed into effect in 2010, and it’s also commonly referred to as Obamacare.

If you don’t currently have insurance and are looking for an affordable option, the ACA may be able to help you get coverage at a reasonable price point.

You qualify for insurance coverage even with a pre-existing condition like substance use disorder. Substance use disorder is one of the health benefits that all healthcare insurers must provide. They must provide care for substance use disorder and mental health concerns.

8. Multiple Insurance Providers

If you have health insurance from more than one provider, you may be able to use them all. This is called coordination of benefits. This occurs in a couple of situations:

You are under the age of 26 and either covered under your own insurance and your parents; or covered under both insurance plans of divorced parents.
You are covered under your own insurance and your spouse’s.
You are over the age of 65 and covered under both your own insurance and Medicare.

In these cases, your primary coverage pays first, and then the secondary coverage pays any remaining costs.

9. Drug Addiction Coverage And Cost

The cost of your recovery program really depends on the level of treatment you need, the length of your stay, and other factors like the type of drugs, mental health care, and length of addiction. In the end, your addiction would cost you more than rehab ever will.

10. Mental Health Treatments Covered

How much therapy costs is a big hurdle for many people seeking help. The best way to jump this hurdle is to speak with a therapist or intake specialist and discuss the costs. They can take your insurance information and talk directly with your insurance company to find out what they’ll cover and then discuss the options with you.

Thanks to the ACA, insurance plans are required to provide the same level of care for mental health treatment as they do for physical concerns.

Conclusion

While the cost of treatment can be a barrier, it’s important to remember that many insurance plans cover at least some part of addiction recovery programs. Even if your plan doesn’t cover all costs, you can still get help with a good payment plan. And don’t forget about government-funded programs like Medicaid or Medicare.