There are several different ways to pay for an addiction program; however, the majority of individuals who seek treatment for drug or alcohol addiction use some form of insurance. In this article, we will discuss the different types of insurance plans as well as the most common insurance carriers that offer coverage for substance abuse treatment.
Insurance Options and Coverage for Alcohol and Drug Addiction Treatment
Making the decision to seek treatment for a drug, alcohol, or other addiction can be a difficult choice that often comes with several additional factors to consider. A primary factor many people find themselves concerned with is how they will afford an addiction treatment program. While substance abuse treatment can certainly be expensive, there are several ways to fund the help that just may save your life. One of the most common ways to afford treatment is through insurance.
There are several different types of insurance plans as well as a number of insurance carriers that offer partial or full coverage for drug and alcohol addiction treatment. The most common types of insurance plans that may cover a treatment program include private, public, and group insurance.
The Most Common Insurance Plan Types Used for Substance Abuse Treatment
While most insurance carriers offer some form of coverage for addiction treatment, the type of plan that a person has will largely determine how much coverage they will receive. The following are the three types of insurance plans as well as the types of coverage typically offered by each:
Private insurance is insurance in which a person seeks out an insurance carrier and signs up to carry their insurance independently. This type of insurance is often the most expensive; however, it often offers the highest level of coverage and flexibility. People who have private insurance can typically choose what their insurance program covers, enabling them to elect a higher level of substance abuse treatment coverage if necessary.
The following are the two most common types of plans that are offered to individuals with private insurance:
A Preferred Provider Organization (PPO) is an insurance plan in which medical providers work with the insurance carrier to provide clients of that insurance carrier with special prices for medical services. Using a provider within the PPO network means that you will pay less compared to choosing a doctor outside of your insurance’s PPO network.
A Health Maintenance Organization (HMO) is a more limited plan compared to a PPO and typically only offers coverage for medical providers within the insurance carrier’s network. This means that seeking treatment from a provider outside of your insurance carrier’s network will typically cost you full-price out-of-pocket.
Group insurance plans are most commonly offered through an employer. Employers receive a special price from the insurance carrier in order to offer the insurance plan to a certain number of people. Companies that have more than 51 employees typically have the most flexible plans, while those with less than 51 employees may have fewer options when it comes to offering workers insurance. If you have insurance through your employer, you are under a group insurance plan and can discuss what level of coverage you are eligible for with your HR department or by calling the number on the back of your insurance card.
Public insurance plans are health insurance plans that are offered through the government. The two primary types of public insurance plans are the following:
Medicare is a public health insurance plan offered by the government to individuals who are 65 and older. This plan is also available to individuals who are receiving social security disability benefits or who are under the age of 65 and have end-stage renal disease. Medicare often provides some level of coverage for a number of different addiction treatment programs.
Medicaid is a government-funded insurance program for low-income individuals and families. This form of insurance is also provided to those receiving social security income as well as qualified pregnant women. Medicaid offers varying levels of addiction treatment coverage.
Private Insurance Companies That Frequently Offer Addiction Treatment Coverage
The following are the most popular private insurance companies that typically offer partial or full coverage for drug and alcohol addiction treatment:
- Blue Cross Blue Shield
- Kaiser Permanente
- Molina Healthcare
Each insurance provider offers different types of insurance coverage as well as a number of insurance plan options.
What Kind of Coverage Can an Insurance Plan Provide for Addiction Treatment?
The exact level of coverage that an insurance plan will provide for drug and alcohol addiction treatment will depend on the type of plan and the insurance carrier. Most plans offer at least partial coverage for a variety of addiction treatments including inpatient and outpatient programs. The primary factors that can affect how much coverage you are eligible to receive under your insurance plan include:
- The type of treatment you are seeking: Inpatient treatment will typically cost individuals more money out-of-pocket regardless of their insurance carrier. This is because this type of addiction treatment is highly intensive and therefore often the most expensive option. On the other hand, outpatient programs are often less expensive for individuals with insurance.
- Prior approval: Some insurance plans require individuals to seek prior approval from the insurance carrier before providing coverage for addiction treatment. Without prior approval, a person may receive little to no coverage from their plan.
- Whether treatment is medically necessary: Some insurance plans may require treatment to be considered medically necessary before they will provide coverage. Individuals may have to receive a clinical assessment and be referred by a doctor for addiction treatment in order to have an addiction program be seen as a medical necessity by their insurance carrier. An example of when treatment may be considered medically necessary is when a person requires medical detox from drugs or alcohol or when the person cannot function without medical help when not taking substances.
- How long a person is in treatment: Many insurance carriers will provide some level of coverage for a set amount of time, such as 28 days, in treatment. Once this limit has been reached, the insurance carrier may no longer provide coverage for addiction treatment.
All insurance plans are different and the level of coverage offered by your insurance carrier will vary based on a number of things. Being familiar with what your plan offers is an important step in making the decision to seek addiction treatment.
How to Find an Addiction Treatment Program That Accepts Your Plan
If you are ready to make the leap and seek treatment for drug or alcohol addiction, the best way to find a treatment program that accepts your insurance is to speak with an insurance representative for your particular carrier. They can inform you of your coverage options as well as help you find addiction treatment that both meets your needs and that is in your insurance carrier’s network. To learn more about insurance coverage for addiction treatment, contact RehabNet.com today.