How to Pay for Rehab: Does My Insurance Cover Addiction Treatment?

For people who struggle with a substance use disorder, an addiction program may be a good way to begin recovery and achieve long-term sobriety. While the value of rehab is undeniable, many people have concerns about the cost of these programs.

The National Institute on Drug Abuse confirms that the longer a person stays in treatment, the better the outcome. For residential or outpatient treatment, 90 days is often recommended.1 But when considering the cost of a three-month stay, many people might initially feel overwhelmed.

Fortunately, rehab is within reach for those who need it. Read on to learn how:

  • To figure out if your insurance covers your treatment.
  • You can pay for treatment through private insurance, public insurance, cash, or other options.
  • To find the right treatment program for you.

Does My Insurance Cover Rehab Programs?

As of 2014, the Obama Administration enacted the Mental Health Parity and Addiction Equity Act (MHPAEA). This part of the Affordable Care Act, often referred to as Obamacare or the ACA, was passed by Congress in 2008 and requires insurance companies to cover mental health and substance abuse treatment programs to the same extent that they cover other healthcare services.2

This means that insurance companies must cover at least part of a person’s substance abuse treatment. For now, companies are not allowed to deny coverage due to pre-existing conditions, including substance abuse disorders.3

Private Insurance for Addiction Treatment

For people who have private insurance, or who have insurance through their employers, the ACA mandates at least partial coverage of these services. However, know that insurance won’t often cover 100% of your treatment.

It’s also important to understand that your insurance most likely won’t cover every single treatment facility or option—you’ll likely need to make sure that the rehab program is in network (meaning accepted by your provider) with your insurance.

From there, you’ll probably need to first cover a co-pay, deductible, and/or out-of-pocket maximum, and then your insurance may cover the rest. Know that your insurance provider may still only cover a percentage of certain treatments.

We know that this all can seem overwhelming and confusing; luckily, you have some helpful resources at your disposal, including:

  • Your insurance company. Their phone number should be on your insurance card, or they often have “contact us” options on their website. They’ll be able to help you break down what is in network and out of network and may be able to get the ball rolling on approvals for the beginning stages of treatment, like detox.
  • An admissions navigator at the facility you’re interested in attending. These people should know the ins and outs of how insurance works with their programs and can let you know what to expect in terms of cost.

Facilities like Recovery First accept private insurance and have compassionate admissions navigators to help you figure out. Currently, Recovery First accepts the following health insurance providers:

  • Cigna Behavioral Health, Inc.
  • ComPsych Corp.
  • Corphealth, Inc. (Lifesynch).
  • Humana.
  • First Health Group.
  • Magellan Behavioral Health, Inc.
  • Managed Care Concepts.
  • Managed Health Network, Inc.
  • Mental Health Network.
  • New Directions Behavioral Health, LLC.
  • Seminole Tribes of Florida.
  • United Behavioral Health.
  • ValueOptions, Inc.

If you’re interested in attending treatment at Recovery First and would like to verify your insurance benefits, you’ll find a form at the end of this page for this purpose.

COBRA in the Event of Job Loss

If you lose your job but still want to retain your health insurance, the consolidated Omnibus Budget Reconciliation Act (COBRA) has got your back. Your ex-employer will let you know if you are eligible for the program. If you sign up, you’re responsible for paying for the entirety of your health insurance plan, even the portion your company used to cover.

Unless your old employer changes the healthcare plan at the company, you’ll be able to continue to receive the same benefits. This means that you should still have access to mental health and substance abuse treatment care under your insurance.

Although the Affordable Care Act (ACA) has made mental health and substance abuse treatment essential benefits of health insurance, make sure you know exactly what your insurance covers. You can learn more about COBRA on their website, and you can look into what exactly your insurance would cover on your insurer’s website, or just call the number on your health insurance card.

Using Public Insurance Like Medicaid

For people eligible for Medicaid coverage, it is likely that substance abuse treatment is covered by the state-level program.

However, federal Medicaid coverage lists basic medical services, while the state programs will offer more specifics. Contact state Medicaid programs for further help regarding substance abuse treatment.

Other Payment Options for Substance Abuse Rehab

We’ve already covered how to use private insurance—such as through your work—or public insurance—such as Medicaid—to pay for a portion of your treatment. But these aren’t the only way you can cover treatment costs.

  • Options for Military. If you’re a military veteran, make sure you’re registered with the Veterans Administration to receive their benefits, which includes help for substance abuse and mental health concerns. Some VA hospitals offer addiction treatment. If there isn’t space available, the VA will work with outside treatment facilities and help to cover the cost of treatment through them.
    Recovery First has a treatment program specifically for military veterans. Many of the staff members who work on the program are also veterans, which creates an atmosphere of understanding and camaraderie from the get-go.
  • Health Savings Accounts or Flexible Spending Accounts. These accounts are money earmarked specifically to help a person with a high-deductible insurance plan to pay for out-of-pocket costs, copays, deductibles, and other health-related expenses.
    Although these are specifically for “qualified medical expenses,” thanks to the enactment of MHPAEA, substance abuse treatment qualifies.
  • Paying with Cash. If you don’t have insurance, the facility you want to go to doesn’t accept your insurance, or you just don’t want to use it, you can also pay in cash. If you do not have the cash on hand to cover treatment, consider using your emergency savings or retirement to help offset the costs.
    This may seem counterintuitive, but addiction treatment can help you plan for a future when you can use the rest of that retirement plan. Not paying for treatment might have more somber results.
  • Financing or Private Loans. For people who will be able to pay a loan back, there are financing options through small lenders. These loans may have a high interest rate, so it is important to have a plan in place to pay these loans back over time.
  • Free or Reduced-Cost Programs. There are a handful of free and reduced-cost programs for people who need substance abuse help, but who are at very low-income levels. The SAMHSA website offers a search feature, allowing a person to search for local programs with sliding scale or payment assistance. Some religiously affiliated charities also offer counseling services, including residential treatment.

Choosing the Right Substance Abuse Treatment for You

Thanks to changes from the Affordable Care Act, payment plans, and how society thinks about addiction, there are more ways than ever to get help overcoming addiction and substance abuse.

It doesn’t mean it’s easy for everyone, though. Money plays a big part in deciding which treatment facility is right for you. When choosing, try to choose based on your direct needs, and make sure to consider the financial ramifications.

Do not be afraid to discuss financial challenges and options with any prospective treatment center. Finances should not be barrier to anyone getting the help they need.

That being said, below is a way for you to verify your insurance benefits for treatment at an American Addiction Centers facility.

Verify Your Benefits

 

References:

  1. National Institute on Drug Abuse. (2018). How long does drug addiction treatment usually last?
  2. Dahr, M. & HuffPost. (2014). How Obamacare is changing addiction treatment coverage.
  3. gov. (n.d.). Mental health & substance abuse coverage.