Does Insurance Pay for Drug Rehab?January 5, 2023 10:43 pm -
Does insurance pay for drug rehab? Not knowing the answer to this question can make your search for substance abuse treatment incredibly overwhelming. Even when you’re well, dealing with health insurance companies is a hassle; when you or a loved one is sick, it can seem downright hopeless. But the cost of substance abuse treatment without coverage can be prohibitive, so it’s important to understand what your options are when it comes to health insurance for rehab.
In this article, we’ll cover popular questions such as “does health insurance cover rehabilitation,” “do rehab centers take insurance,” and other questions you may have.
Does Insurance Pay for Drug Rehab?
Under the Affordable Care Act (ACA) health insurance companies provide coverage for addiction treatment and rehabilitation. However, that doesn’t mean all addiction treatment insurance coverage is the same. There’s no guarantee that your plan will fully cover your treatment.
Factors that influence how extensive your drug or alcohol rehab insurance is can include:
- The state in which you reside
- If your insurance is private or public
- Whether your program is in-network or out-of-network
- Your particular health insurance plan
Disclaimer: the information on this web page does not replace or supplement information provided by your health insurance provider. Each insurance provider, plan, and policy can have different coverage for drug and alcohol rehabilitation. Please consult with your health insurance provider for information about your specific plan. Alternatively, our admissions department is able to view your insurance coverage for our programs if you provide us with your provider, member ID, and/or group number. Any information you provide us with is strictly confidential.
The most important factor by far will be what health insurance plan you have. Because plans vary wildly in their drug rehab coverage, it’s important you review the details of your plan when considering treatment. In doing so, you will be able to answer the question, “Does insurance pay for drug rehab?”
Aside from your coverage itself, the cost of your substance abuse treatment itself can also vary wildly. Things that can influence this include what type of treatment facility you choose, the length of your stay, and any additional services.
How Does Health Insurance Work?
Simply put, health insurance is a way to pay for your healthcare. Like other forms of insurance, it works by members paying a premium, or portion of their earnings, each month. When a member of an insurance plan needs healthcare they file a claim, or, request for the insurance company to pay the costs for their care. The extent to which a particular expense is covered primarily on the details of your particular plan.
Here are a few terms for different types of out-of-pocket payments your drug rehab health insurance coverage may involve:
- Deductible — The amount you pay each year before your health insurance plan begins paying for covered services
- Copay — A flat fee you pay to see a doctor or receive other covered services, such as an emergency room visit.
- Co-insurance — A percentage of the cost of some covered services. For example, if you’re co-insurance is 20%, your plan will pay 80% of the cost for a service or treatment and you will be responsible for the rest.
- Out-of-pocket maximum — An out-of-pocket maximum is the most you will be required to pay for your medical costs for covered services during a plan period, which is typically a year. Once you hit this maximum, all remaining services will be covered 100% by your plan.
- Network — This is a group of healthcare providers across multiple types of medicine that are contracted with a certain health plan. If you want the services of a provider who is “out of network,” this will be more expensive.
Aside from different types of payments, the type of your insurance plan is also important.
Private Health Insurance
Also known as individual health insurance, private health insurance is health coverage that is purchased on your own, rather than through the government or an employer. The best way to purchase private health insurance is through the Affordable Care Act’s many marketplaces or “
“Exchanges.” You can also buy insurance directly from insurance companies, but this may be more expensive.
Commercial Health Insurance
This is private health insurance purchased by companies or organizations to provide coverage for their employees. Most Americans have this type of insurance. Popular commercial health insurance providers include Aetna, Blue Cross Blue Shield, Cigna, Humana, and UnitedHealthcare.
State Health Insurance
As the name implies, state health insurance is provided by the state, usually in the form of that particular state’s Medicaid program. The program is run by state and federal governments working together. Eligibility and coverage for Medicaid vary by state.
Government Health Insurance
There are several government-run health insurance programs:
- State Children’s Health Insurance Program (SCHIP)
- Veterans Health Administration (VHA)
- Indian Health Service (IHS)
Medicare provides health insurance coverage to retirees (those aged 65 or older). Medicaid and SCHIP provide subsidized health insurance to poor families and children. TRICARE and the VHA provide healthcare to active-duty military personnel, veterans, and their families. The IHS is responsible for providing healthcare to Native Americans who reside on tribal reservations.
Does Insurance Cover Addiction Treatment?
As stated earlier, because of the ACA, health insurance for rehab is now the norm. But the extent to which a particular treatment is covered will depend heavily on your particular plan.
Questions such as “how long does insurance pay for rehab” or “does insurance cover detox” are best answered by speaking with your health insurance provider directly.
The following is a list of prominent health insurance providers and their member benefits phone lines:
- Aetna — 1-(888)-632-386
- Blue Cross Blue Shield — 1-(800)-531-4456
- Cigna — 1-(800)-997-1654
- Humana — 1-(800)-777-6330
- Magellan Health — 1-(800)-327-7390
- United Healthcare — 1-(855)-780-5955
If your provider isn’t listed here, know that you can usually find the member benefits phone line for your plan on the back of your insurance card. To avoid getting hit with an unexpected bill it’s crucial to verify your coverage before starting treatment.
Insurance for Rehab Centers
Health insurance for rehab centers will differ from plan to plan but most health insurers will provide at least some extent of coverage. Speak to your provider to learn the details about your insurance policy.
Rehab centers that accept insurance include:
- Royal Life Detox
- Royal Life Centers at Chapter 5
- Royal Life Centers at the Haven Detox
- Royal Life Centers at Spokane Heights
- Royal Life Centers at Sound Recovery
- Royal Life Centers at Puget Sound
- Royal Life Centers at Cascade Heights
- Royal Life Centers at Seaglass
We understand that addiction treatment insurance coverage can be confusing. If you would like assistance in verifying your drug rehab health insurance benefits, please call us at (877)-732-6837. You can also find the answer to “does insurance pay for drug rehab” by filling out our confidential insurance verification form.
Substance Abuse Treatment at Royal Life Centers
Deciding on treatment is not easy, especially when you’re unsure if your provider will pay. Keep in mind, however, that the cost of addiction treatment is nothing compared to that of the addiction itself. Don’t let fear prevent you from getting the care you need.
Royal Life Centers is committed to providing holistic and human-centered care that empowers those under our care to lead healthy and fulfilling lives. If you are unsure if you can afford treatment, call us at 877-RECOVERY. Our specialists are available 24/7 to answer your questions.
- Does the Affordable Care Act cover individuals with mental health problems? (HHS)
- How Health Care Works (IBX)
- National Academies of Sciences, Engineering, and Medicine. 2003. Leadership by Example: Coordinating Government Roles in Improving Health Care Quality. Washington, DC: The National Academies Press. https://doi.org/10.17226/10537.