Insurance Coverage for Drug and Alcohol Addiction Rehabs

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Having any kind of substance abuse is difficult enough, let alone the overwhelming task of finding the proper rehabilitation facility and making sure you have the proper drug rehab insurance to help cover the cost. Health insurance makes it possible for many people to access treatment that they would not be able to afford otherwise. The majority of health insurance plans offer some addiction treatment coverage.

This page will discuss:

  • Insurance health plan coverage of common types of addiction treatment.
  • The Affordable Health Care Act.
  • Alcohol and drug rehab insurance coverage for inpatient treatment.
  • Drug and alcohol rehab insurance coverage for outpatient treatment.
  • Does insurance cover drug rehab?

Addiction is one of the foremost public health issues the United States has been facing.1 Addiction can create changes in the brain and behavioral patterns and have negative consequences in a variety of areas, including physical and mental health, social life, and occupation.2, 3 Substance use can raise the risk of developing medical and psychiatric disorders.4

Federal laws have changed how insurance mental health coverage is managed, ensuring that addiction treatment is offered through the majority of insurance plans and covered at similar levels as physical issues.1, 4

Did you know though that there are several federal laws out there that limit employers and insurance companies from imposing discriminating decisions against those suffering from substance abuse addiction? There is hope, and we are here to help you. If you or a loved one has a substance abuse problem, give us a call at 1-888-287-0471 and let us discuss your treatment options with you.

Are you concerned about the cost of treatment? Addiction treatment can be expensive, but it doesn’t have to be.


Knowing Your Rights

projectknow-shutter125607485-stethoscopeMany states require employers and insurance companies to offer addiction treatment insurance. As you examine your policy, determine exactly what it covers, as each policy is different dependent upon what your employer has elected to offer. There are also different policies out there, depending on the addiction in question. Whether your substance addiction is to cocaine, ecstasy or heroin, you want to sit down with a loved one and make sure that the policy you have covers this type of addiction, and that it will be sufficient to cover your treatment.

When it comes to examining your drug rehab insurance policy, you want to make sure there are no loopholes that will prevent you from getting the best care. With the Paul Wellstone and Pete Domenici Mental Health and Parity and Addiction Equity Act passed in 2008, insurance companies can no longer discriminate and add higher copays, or differentiate coverage between what is offered in the medical portion of your policy and the mental and health disorders section. If you want further help determining what your policy covers, we are here to help; call us at 1-888-287-0471 and let us discuss your treatment options with you.


Types of Insurance Plans for Addiction Treatment

Addiction is different for everyone, and treatment reflects that. There are various treatment types; some or all of them may be covered by rehabilitation insurance plans, depending on your plan and medical needs. Treatment insurance coverage may include:

  • Inpatient care, as explained below.
  • Outpatient care, as explained below.
  • Medical detox, which involves staying in a facility that is monitored 24/7 by medical staff who can provide medications to ease the symptoms of withdrawal as the body clears itself of alcohol and drugs.3, 5, 6 Detox isn’t the same as treatment, however, and should be followed by another form of care for the best recovery outcome.3, 5
  • Integrated treatment with co-occurring conditions (when mental health disorders occur at the same time as an addiction) involves addressing both conditions at the same time, using therapy and medication if needed for the best results.3 Up to 60% of people with an addiction also experience co-occurring disorders.3

What is the Affordable Health Care Act?

The Affordable Care Act (ACA) reformed healthcare coverage and strengthened mental health parity.1, 7 It requires most insurance plans to cover addiction treatment.1, 4 Mental health parity ensures that coverage for addiction is equivalent to physical health conditions.4, 7, 8 Addiction treatment and rehab insurance coverage are considered essential health benefits under the ACA.1, 7 Health insurance plans are offered through the Marketplace as well as Medicaid and Medicare healthcare programs.1, 8, 9 Federal insurance programs like Medicare offer drug rehab coverage, provided that treatment is shown to be medically necessary.9

The eligibility requirements for the Affordable Care Act are:

  • You have not had health insurance for six months.
  • You have a preexisting condition.
  • You have been denied coverage because of your preexisting condition.
  • You are US citizen.

COBRA Coverage for Treatment

Unemployment can result in worry about continuing your health insurance coverage, but there are options out there. If you have lost your job and lost your job-based coverage, your former employer may offer you COBRA (Consolidated Omnibus Budget Reconciliation Act) continuation. COBRA provides people who have lost their jobs the chance to temporarily retain the group health coverage they had under their employer’s group health plan—for themselves and their families.

To be eligible for COBRA, you must have insurance that is covered by COBRA, a qualifying event (including job loss), and be a qualified beneficiary. Your former employer should let you know if you are eligible to maintain your insurance through COBRA, and you will have at least 60 days to decide if you would like to continue your coverage. Once you have made the decision to continue your coverage, you will sign up for COBRA, and you will be responsible for paying the entirety of your premium (what was previously covered by you and your employer).

Once you are enrolled in COBRA, you will have the same coverage you previously had when you were employed. This coverage includes any mental health and substance misuse treatment that was included in your insurance plan. If you are looking for alcohol or drug abuse treatment while covered by COBRA, you will be responsible for paying your premium. Although it might be slightly more complicated than it was when you were employed, losing your job does not have to mean that you cannot receive the substance abuse treatment that you need.


Insurance Coverage for Inpatient Treatment

Inpatient treatment may be covered according to your need and healthcare benefits. It involves staying in a facility that is monitored 24/7 and participating in intensive group and individual behavioral therapy.3, 6 Psychiatric care can be provided if needed and medications can be prescribed to help manage cravings, treat underlying mental illness, and support sobriety.3

Inpatient programs generally involve a 3-6 week stay, but the length of treatment can vary.3 Participation in self-help meetings is often encouraged and meetings may be held on-site.3 Behavioral therapy can help people develop coping skills, manage stressors, prevent relapse, resolve conflict, and communicate better.3, 6


Insurance Coverage for Outpatient Treatment

Outpatient treatment involves participating in group and individual therapy sessions in an office setting with minimal disruption to your usual daily routine.3 Treatments vary in intensity, allowing care to be customized to individual needs.3 Group counseling makes up a large part of the treatment.3 (p27) Psychiatric care can be offered on an outpatient basis as well.3

Depending on your needs and healthcare plan, Medicare and many insurance companies will cover outpatient services if determined medically necessary.9


Does My Insurance Cover Addiction Treatment?

To ensure that your insurance plan covers treatment, you should check your benefits. This can be done by calling the phone number on the back of your card. There is also an online tool you can use to verify that your insurance is accepted at American Addiction Centers facilities. If you have additional questions, you can refer to our pages on major insurance carriers, including:

Health insurance is complex, especially when you’re trying to access addiction treatment. The ACA has had a major impact on how insurance companies address addiction treatment coverage. Various types of treatment are available and most insurance companies will make it more accessible than ever.


Sources

  1. Abraham, A.J., Andrews, C.M., Grogan, C.M, D’Aunno, T., Humphreys, K., Pollack, H.A., Friedmann, P.D. (2017). The Affordable Care Act transformation of substance use disorder treatment. American Journal of Public Health, 107(1), 31-32.
  2. National Institute on Drug Abuse. (2018). The science of drug use and addiction: The basics.
  3. National Institute on Drug Abuse. (2018). Principles of drug addiction treatment: A research-based guide (3rd edition).
  4. Substance Abuse and Mental Health Services Administration. (2016). Facing addiction in America: The Surgeon General’s report on alcohol, drugs, and health. Washington, DC: U.S. Department of Health and Human Services.
  5. Center for Substance Abuse Treatment. (2006). Detoxification and substance abuse treatment. Treatment Improvement Protocol (TIP) Series 45, DHHS Publication No. (SMA) 06-4131. Rockville, MD: Substance Abuse and Mental Health Services Administration.
  6. National Institute on Drug Abuse. (2019). Treatment approaches for drug addiction.
  7. Substance Abuse and Mental Health Services Administration. (2020). Behavioral health treatments and services.
  8. gov. Mental health & substance abuse coverage.
  9. Centers for Medicare and Medicaid Services. (2019). Medicare coverage of substance abuse services.
  10. Healthcare.gov. Inpatient rehabilitation care.

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