Rehab Centers That Accept Insurance

Rehab can improve your quality of life and set you up for future wins. Unfortunately, it can also be very costly, especially if you’re uninsured or don’t understand how to get the most out of your benefits when seeking drug or alcohol treatment.

Having insurance coverage can offset the costs of drug and alcohol addiction treatment. While it may be the last thing you want to think about, it’s an integral part of getting into rehab. It’s better to understand what’s covered under insurance and what you’ll owe before you commit to a program. Knowing your options gives you more control and allows you to make better choices for your care.

Even if you don’t have medical or mental health benefits in place, you may be eligible for a policy before entering rehab. This guide will help you understand the costs associated with rehab, where to seek insurance coverage, and how to determine what your current policy may cover for substance abuse treatment. Use this information to choose the rehabilitation facility that best meets your specific needs.

Yes, most insurance policies generally cover treatment for drug rehabilitation related to substance use disorders (SUDs). Coverage can vary significantly by plan type, facility location, state and federal laws, and other factors explained below. Insurance covers drug rehab at the same rates it covers other medical care, if it offers any coverage for mental health or substance abuse care.

Various factors, including state and federal benefits and employment laws, can affect the offerings of your insurance plan. If your insurance is provided through your employer, it may include mental health services as part of an Employee Assistance Program (EAP). It’s important to note that each insurance plan is unique, and the specifics of its coverage and usage can vary significantly.

Insurance companies send an Explanation of Benefits (EOB) that tells you what your plan will cover for treatment programs, whether a particular service requires pre-approval, or if you must meet your deductible for insurance to cover it. Additionally, please note that most insurance policies do not cover 100% of the treatment costs. You may need to pay a copay and meet your deductible upfront, and you may also incur additional fees that are your responsibility.

Benefits under most plans should cover most types of rehab services, which may include:

• Detoxification
• Inpatient rehab
• Outpatient rehab
• Individual and group therapy
• Medication-assisted treatment (MAT)

Other types of treatment, such as holistic or alternative therapies, may not be covered by insurance at all, even though many of them take evidence-based approaches. You should speak with your provider or use a service like RehabNet to determine what is included in your specific plan.

Different insurance plans and coverage types will have distinct advantages and disadvantages. The laws that apply to your insurance coverage, your treatment center options, and what you’ll pay out-of-pocket are all impacted by what type of insurance you have. Private insurance can be self-paid or provided through your employer. Public insurance options, such as Medicaid and Medicare, are offered by the government.

Private insurance may offer better treatment options, quicker access to services, and a greater ability to choose a plan tailored to your family’s needs. However, these plans may come at higher costs with set coverage areas and a for-profit mindset.

Medicare and Medicaid may be less costly, cover preventive services more effectively, and be available to many who might otherwise be uninsured. Unfortunately, it can take longer to access services, you may not be able to get the treatment that you need covered, and your in-network provider options may be fewer than with a private plan.

It’s essential to weigh these factors before deciding on an insurance policy. Know what care you need and research what’s available through any given plan in your area. If you get stuck, RehabNet can help you determine what might best fit your rehabilitation needs.

Under the Mental Health Parity and Addiction Equity Act (MHPAEA), enacted in 2008, insurance companies must cover substance use disorder treatment and mental health care services at the same rates they cover any other services for treatment of illness or following an accident.

In 2010, the Affordable Care Act (ACA), also known as Obamacare, augmented the MHPAEA to provide wider access to substance abuse treatment for the masses. This is due to coverage expansions and requirements of existing health benefits plans to cover addiction treatment. It makes millions of previously uninsured people eligible for insurance. As a result, more people can access alcohol and drug rehab.

The ACA has also helped people access rehab programs by requiring insurance companies to:

• Cover SUD screening and interventions
• Use the same parameters for SUD treatment as those for medical and surgical services
• Integrate SUD treatment into mainstream health care

Any insurance plan offered through the Health Insurance Marketplace must include treatment for SUDs as one of the ten essential health benefits (EHBs) required by federal law. It also prevents companies from penalizing or denying care to individuals with pre-existing conditions. In other words, your current treatment must be covered even if you have a history of drug addiction. Before the ACA, insurance companies could deny many of these claims.

With a few exceptions, most insurance companies offer benefits for SUD treatment, which typically include rehabilitation and behavioral health services. The types of coverage can differ heavily between companies and even policies within the same company. If your insurance provider doesn’t cover what you need, you may be able to supplement with additional policies or financial assistance options.

AmeriHealth is a New Jersey-based company that offers insurance plans for state residents. It also provides third-party administrator (TPA) services through AmeriHealth Administrators, workers’ compensation TPA with AmeriHealth Casualty Services, and coverage for five million in 13 states, plus D.C., with AmeriHealth Caritas. Plans include EPO, HMO, HSA, and Medicare.

Blue Cross Blue Shield (BCBS) covers patients in all 50 U.S. states and territories, serving approximately 118 million members. The Blue Cross Blue Shield Association (BCBSA) comprises 33 BCBS companies nationwide. Plans are available for individuals and families through the Health Insurance Marketplace, employers, and Medicare.

Centene offers plans for Medicare, Medicaid, and the Health Insurance Marketplace. The company is the largest carrier for Medicaid managed care and the Health Insurance Marketplace. It’s also the longest-running on the marketplace. It has 28 million customers across the U.S.

Cigna Healthcare serves over 178 million customers with plans offered through U.S. employers, the U.S. government, and other entities worldwide. Their plans cover medical, dental, vision, and prescription needs, depending on what option you choose. Their HMOs offer Open Access (OA), Point-of-Service (POS), and Open Access Point-of-Service (OA-POS) options. Individuals and families may be eligible for group plans, Medicare, or Medicaid through Cigna. PPO, HRA, and HSA plans are also available.

CVS Health bought Aetna in 2018. Aetna is a health insurance provider for an estimated 36 million policyholders in the United States. Aetna offers HMO, POS, PPO, EPO, and HDHP insurance plans, each providing varying levels of coverage for addiction treatment.

Elevance Health companies include Anthem Blue Cross Blue Shield, Wellpoint, and Carelon. These insurance providers in the U.S. can help cover the cost of your addiction rehab. Anthem BCBS offers health coverage through Bronze, Silver, and Gold plans.

Health Care Service Corporation (HCSC) is independently licensed through the Blue Cross Blue Shield Association and has several smaller companies under its umbrella. It’s the largest customer-owned insurance company in the U.S. and insures patients in five states: Illinois, Montana, New Mexico, Oklahoma, and Texas.

Humana plans focus on Medicare, Medicaid, dental, and vision offerings. Medicare Advantage, Tricare, and veterans’ benefits are all offered through Humana.

Kaiser Permanente is one of the largest not-for-profit insurance providers in the U.S., covering over 12.6 million people. Under its umbrella is Risant Health, a nonprofit organization that serves health needs with a focus on value-based care.

Tricare is a health care program offered to uniformed service members, veterans, and their families. Plans with Tricare can help you access substance abuse treatment through varying levels of coverage.

UnitedHealth Group is the parent company of Optum and UnitedHealthcare. Collectively, the companies have approximately 148 million members. With a range of individual plans, Medicare, and Medicaid, this provider offers another option for covering your addiction treatment.

Medicaid is a government-sponsored insurance program that covers individuals with lower incomes, children, the elderly, pregnant individuals, and those who meet specific disability criteria. Eligibility for coverage varies by state, but because it’s a federal program, Medicaid does cover SUD treatment.

Medicare health insurance plans cover those 65 and older or who meet other eligibility requirements, such as having a disability. Some people may be automatically enrolled, but you can be eligible and still need to sign up to receive benefits.

The list above is not comprehensive of all of the insurance plans or other options that can help cover the cost of substance abuse treatment. Other insurance plans that may cover treatment include:

• VA benefits
• Medi-Cal
• Student insurance plans
• COBRA

The Substance Abuse and Mental Health Services Administration (SAMHSA) offers grants to U.S. states and territories to help cover the costs of community-based SUD treatment. If you are unable to afford your out-of-pocket expenses for drug addiction treatment, you may be eligible for assistance through one of these programs. Additionally, there may be state-funded options or resources available through your community or employer that can help.

By giving your insurance provider a call, you should be able to find out fairly easily if they cover drug and alcohol rehab. If you’re struggling to get through to a representative or can’t find what you need through your member portal, remember that RehabNet is here to help.

Insurance plans can be categorized into several types. Important factors to consider include the treatment facilities and providers with which each insurer has contracted for your care, known as in-network. Providers outside of your coverage area are considered out-of-network. Some policies may offer partial coverage for these out-of-network services, but it is usually less than what is provided for in-network providers.

When you’re looking into rehab, it’s important to understand what factors can affect whether your insurance will cover the cost.

Your plan: Some plans offered by your company may provide more coverage. In other words, you will pay less for your treatment. However, these plans often require higher premiums or copays. Some plans may offer less coverage with lower premiums or copays.

Your coverage level: This can also affect how much you’ll pay. Some plans cover a certain percentage of services based on whether you’ve met your deductible or if you receive services at particular facilities.

Premiums and deductibles: These numbers can be challenging to understand. Your premium is the amount you pay upfront, usually per paycheck or monthly, to receive coverage. Deductibles are the out-of-pocket amounts you must pay before the insurance company will cover certain treatment types. Once you have met your out-of-pocket deductible, most insurance plans will then cover a higher percentage of your service costs. The most common annual deductible for employer-sponsored individual plans in the U.S. typically falls between $1,500 and $2,000.

Other factors that may play a role in insurance coverage are the level of care you receive and the treatment provider you receive it from.

Your plan EOB should outline what percentages of treatment are covered for each type of facility and provider. Sometimes it will list an up-front copay, and then you may have additional bills once treatment costs are calculated and billed to your insurer. Your policy will have a deductible, which impacts what you may owe on drug addiction rehab. If you’ve met your deductible, then your costs may be lower. Conversely, they may be higher if you still have to meet a deductible.

You may have a coinsurance payment, meaning your insurer has covered a percentage of your bill, and you’re responsible for the remaining percentage. Your policy may also define out-of-pocket maximums, which means you may not owe anything for parts of treatment once you’ve hit those amounts for treatment services.

Pre-approval may be required for specific treatments or providers, even when they’re considered in-network. This depends on the type of insurance plan you have and the particular details of your policy. To find out what steps to take for approval, contact your insurance company or read through your EOB.

Some services and providers may require preauthorization before insurance will cover the associated costs. Your EOB should outline the types of pre-approvals needed, and RehabNet or your insurance provider can help if you get lost in the technical jargon.

Certain plans may also require referrals from your primary care physician (PCP) before treatment is approved. Again, it’s best to review your specific policy, contact your provider, and ask questions about these details to ensure your needs are met.

If you have dual insurance, or coverage with two or more insurance providers, the coverage for addiction treatment may look different. Whatever the reason for dual insurance, it’s essential to understand the coordination of benefits. This process allows your insurance providers to work together to ensure they’re not paying more than 100% of your medical costs.

Any bills will go to your primary insurance provider first. Once that policy has paid, the bill will go to your secondary insurance company, and so on. If there is still a balance with the treatment facility after your claim has been processed through all insurance companies, the bill will be sent to you for payment.

Having dual insurance can mean that you have more coverage options, and in turn, more options when it comes to addiction treatments. With two or more insurance policies, you may get better coverage for treatment costs as long as both companies approve all drug addiction services.

Most insurance companies offer a range of plan options to suit varying needs and budgets. Whatever needs you have, you should be able to find a suitable coverage option. In cases where the available options exceed your ability to pay, assistance is available. The most crucial factor is to get the help you need for treating your addiction.

Private insurance options can be part of your employment benefits or something you purchase individually. Many employers will cover at least a portion of the insurance, and providers often offer discounts for groups of employees. If paying on your own, you may find options through the Health Insurance Marketplace, which provides subsidies to help pay insurance costs.

As mentioned above, Medicaid covers lower-income individuals and families, while Medicare is for those 65 years old or older, or who meet other eligibility criteria. Both are government-sponsored and have low to no cost for members. Many larger insurance companies include policy choices for one or both programs, and you can also find them through the Marketplace.

The ACA established a baseline for insurers offering plans through its Health Insurance Marketplace website. All plans must cover some level of 10 EHBs, including SUD treatment, and any mental health benefits must be covered at the same level as surgical or other services for other illnesses per the MHPAEA.

Short-term health insurance solutions for addiction treatment can include short-term disability, which will help with paying for treatment and other expenses during rehab. This may be included in your coverage already, or you may be eligible for a policy if you don’t have one. While the coverage percentage and time frame may be limited, it can be helpful for immediate needs.

There are numerous health insurance plans that most providers offer. These are some of the standard options. Your insurance provider may not offer all of these options, or they may provide additional options not listed here. You’ll have to go over your choices with your company’s Human Resources or Benefits department or your insurance provider. You can also compare plans through the Health Insurance Marketplace.

Health Maintenance Organization (HMO) plans offer coverage for providers in a specific network area and may require pre-approval for certain treatments. An HMO plan lists approved providers (doctors, hospitals, labs) from which you can receive care. HMOs typically involve copays, which are small fees you pay for each service. They often also have deductibles, which must be paid out-of-pocket before certain services are covered.

Preferred Provider Organization (PPO) plans cover in-network care and some out-of-network care, albeit with higher out-of-pocket costs, and typically don’t require pre-approval for services. A PPO still has a network, but you have the option to see providers outside of the network. Out-of-network treatment typically incurs higher costs. These plans also usually have a deductible and require you to pay a percentage of each service.

A Point of Service (POS) plan is similar to a PPO in that you can receive care outside of the network, but at a higher cost. However, you will most likely have to be referred to an out-of-network provider by your primary care provider. Additional fees may apply once insurance has paid its portion.

Exclusive Provider Organization (EPO) plans share traits with both HMOs and PPOs. Like with an HMO, only in-network care is covered. However, as with a PPO, referrals are usually not required for treatment. You may still be responsible for paying deductibles, coinsurance, or other out-of-pocket costs.

There are many types of addiction that your insurance may cover. A good rule of thumb is that substance-related addictions that fall under the category of drugs or alcohol are typically covered.

Types of addiction may include:

• Alcohol addiction
• Opioid addiction
• Heroin addiction
• Fentanyl addiction
• Methadone addiction
• Cocaine addiction
• Benzodiazepine addiction
• Meth addiction
• Marijuana addiction
• Prescription drug addiction
• Sleeping pill addiction

Most insurance providers that cover rehab treatment don’t specify what kinds of addiction can be treated, but rather the kind of treatment you must receive or where.

The types of addiction treatment your insurance may cover will vary. However, it’s good to have an understanding of some standard treatment options your insurance might pay for you to receive.

Insurance may cover:

• Medical detox or detoxification
• Inpatient treatment or residential treatment
• Outpatient treatment
• Partial hospitalization programs (PHP)
• Intensive outpatient programs (IOP)
• Aftercare
• Medication-assisted treatment (MAT)

Your plan may cover various types of programs offered by healthcare providers. With insurance, you may not have to take on the full brunt of the cost.

The term polysubstance abuse is often used for taking multiple types of drugs, which is a dangerous practice. Treatment for polysubstance abuse requires individual plans for each substance taken. There are concerns about the use of the term due to its ambiguity, as it can be applied in many cases without specifying which drugs or types of alcohol usage it encompasses. It also fails to distinguish the timeline of usage, which can be challenging in treatment.

If you’re diagnosed with polysubstance abuse, make sure all providers know exactly which substances you need treatment for, as such behaviors can create complexities in a treatment plan. It may also impact your insurance coverage, depending on how your treatment is coded and billed to your provider. Therefore, review all statements carefully and contact your insurer if you find any discrepancies.

Dual diagnosis treatment is another type of service that your health insurance may cover. Dual diagnoses, or co-occurring disorders, are mental health conditions, such as depression, anxiety, PTSD, etc., that occur alongside addiction. To appropriately treat your issues, recovery must address all of them. Dual diagnosis treatment provides mental health care as part of your addiction recovery.

This is relatively common, as mental health disorders often cause addiction or are the result of addiction. Most insurance providers that cover addiction treatment will also cover dual diagnosis treatment, as they go hand-in-hand. Double-check this information with your provider to understand exactly what they cover. Your mental health benefits may exist under multiple parts of your insurance policy, as behavioral therapy, for example, often falls under EAP first, then shifts to medical insurance once the benefits run out.

You can receive addiction treatment without insurance coverage, but your out-of-pocket costs may be much higher, depending on the treatment you require and where you’re located. Options such as federal and state assistance may help pay for the costs of care.

According to the National Center for Drug Abuse Statistics (NCDAS), drug addiction rehab averages $13,475 per person. Rehabilitation costs can range from around $1,500 to as high as $141,000, but the price varies significantly because each individual receiving treatment has different needs. The severity of an addiction, as well as the type and how long you’ve been addicted, will all factor into what treatment you need and its cost.

While the number may seem alarming, remember that higher costs are often associated with longer treatment periods, residential facilities, and other components that may not be necessary for effective treatment.

Additionally, some rehab facilities offer sliding scale pricing or even scholarships to help you pay for substance abuse treatment. You can set up a payment plan at most addiction centers to pay for your treatment over time.

Typical costs of rehab without insurance:

• Detoxification (7-day period): $1,750-$5,600
• Rapid detox: $5,000-$10,000
• Inpatient rehab (30-day program): $5,000-$20,000
• Inpatient rehab (60- to 90-day program): $12,000-$60,000
• Outpatient rehab: $5,000-$80,000
• Sober living (per month): $1,500-$2,000

RehabNet can help you locate treatment centers in your area that fit your financial ability, whether they accept your insurance, offer payment plans, or have low-cost options as a non-profit organization.

Finding a rehab facility that accepts your insurance requires a few steps to ensure you receive the care you need and avoid issues, such as unpaid medical bills and insurance coverage denials. The first step is to contact your insurance company by calling the number on your insurance card or the company’s website. You may also find what you need by logging into your member portal.

Once you have access to your EOB, review your policy for information on SUD treatment, including any mental health benefits. You can use your insurer’s provider directory to locate rehab options in your area and find out if they treat your type of addiction. You’ll also want to verify that the treatment center accepts your insurance by calling them directly.

To keep out-of-pocket costs as low as possible, be sure to choose a rehab facility that’s in-network for your insurance plan. If locating a rehab facility feels like too many hurdles to jump on your own, you can contact RehabNet using our helpline. We’re available 24/7 to verify your insurance coverage, confirm that local facilities accept it, and guide you through the process of entering a rehab facility. We’ll connect you with licensed professional counselors as well.

Here are a few of the most frequently asked questions about alcohol and drug addiction treatment coverage.

While it’s possible to enter drug or alcohol rehabilitation without insurance, having coverage can make the burden much lighter on your stress levels and wallet. It may also be easier to locate a nearby rehab center that has an opening available when you need it. Sometimes, lower-cost facilities have longer waiting lists.

Even if you think you have the right coverage with your insurance company, it’s always a good idea to review your EOB or speak with your provider before seeking treatment. Then, contact your chosen facility to verify that they accept your insurance plan. While it may seem silly, an insurance plan can cover a center that won’t accept that policy, and a center may accept an insurance company that doesn’t have the facility in-network for whatever reason.

If you’re finding it to be a lot to do all of this on your own, remember that you don’t have to. Services like RehabNet can handle the details for you and connect you with a drug rehab center after verifying your insurance and its acceptance.

You may also find help for addiction treatment with insurance using these resources:

• SAMHSA’s National Helpline
• Veterans Crisis Line
• FindTreatment.gov

Start your addiction recovery journey today, and get the care you or your loved one needs. Most importantly, remember that it’s not something you have to do on your own. Recovery is hard work, but there is support available from services like RehabNet and your treatment providers.