Insurance Coverage for Alcohol and Drug Rehab Programs

When it comes to drug and alcohol addiction treatment, payment options and insurance coverage can often be the main point of stress for many people.

Understanding insurance coverage can easily become overwhelming when starting your journey toward recovery.

Keep reading to learn more about insurance coverage for substance abuse in this comprehensive guide to covering addiction treatment.

Whether you’re curious about what you can get covered by your insurance, how much addiction treatment will cost, what kind of rehab centers your insurance might approve, or what treatment options you may have, you’ll learn the ins and outs below.

In short, yes, insurance does cover alcohol and drug addiction rehab. However, it’s important to note that the level of coverage as well as what is covered varies greatly between different companies.

One factor that may influence how much your insurance company will cover is the type of plan you have. Different plans with the same company can provide different coverages.

For example, some plans may cover more of a particular service or require a co-pay. Your best bet is to ask your insurance company the specific details of your plan coverage for addiction treatment.

Another factor that affects insurance coverage is requirements from your company. Some insurance companies require a referral or a specific type of rehab program in order to cover addiction treatment or a list of pre-existing conditions.

The Affordable Care Act (ACA) has provided 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.

The ACA helps with coverage expansion by making millions of previously uninsured people eligible for insurance coverage. As a result, more people are able to access alcohol and drug rehab since they are now insured.

Other ways the ACA has helped people access rehab programs is by requiring insurance companies to cover substance use disorder (SUD) screening and interventions, SUD treatment within the same parameters as medical and surgical services, and integrating SUD treatment into mainstream health care.

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

Insurance may cover: 

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

Many different kinds of programs offered by healthcare providers may be covered by your plan. With insurance, you may not have to take on the full brunt of the cost.

If you have dual insurance, or two or more insurance providers, you may still receive coverage for addiction treatment, it may just look a little bit different.

Whether you have dual insurance between you and your spouse or for another reason, it’s important to understand 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.

Based on which provider is considered your primary insurance, your bills will go to this provider first. After going through your first provider, 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 gone through your insurance companies, the bill will come back to you for payment.

Having dual insurance also affects your coverage. Because you have two or more plans, you may have more coverage options, and in turn, more options when it comes to addiction treatments.

However, it’s important to keep in mind that if you want both of your insurance companies to help cover treatment costs, the treatment must be approved by both.

Though the list of insurance providers is endless, we’ve put together a list of some major insurance companies that offer addiction treatment coverage below.

Aetna is a health insurance provider for an estimated 39 million policyholders in the U.S. Aetna provides HMO, POS, PPO, EPO, and HDHP insurance plans, all of which provide a level of coverage for addiction treatment.

Insuring approximately 5 million people in the U.S., Amerihealth is a private insurance provider that offers EPO, HMO, HSA, and Medicare plans. Each of these may help cover addiction treatment.

Anthem Blue Cross Blue Shield is another insurance provider in the U.S. that will help cover the cost of your addiction rehab. Anthem BCBS is a little different from other providers, offering health coverage through bronze, silver, and gold plans.

Blue Cross Blue Shield is an insurance provider that is a part of Anthem BCBS. Offering several different healthcare plans, this insurance company is another provider that you can use to access addiction treatment.

Cigna is a health insurance provider in the U.S. that helps cover nearly 86 million individuals. Cigna provides OAP, PPO, HRA, and HSA plans, all of which will help cover addiction programs in some capacity.

Medicaid is a federal program that provides health insurance for low-income people, elderly people, and people with disabilities. Medicaid plans also offer some coverage for drug and alcohol abuse treatment.

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.

Over 27 million Americans receive insurance coverage through UnitedHealthcare. With individual plans, Medicare, and Medicaid, this provider is another option for getting your addiction treatment covered.

As mentioned above, this list is not comprehensive of all of the insurance plans that help cover substance abuse treatment. There are plenty more that may cover the rehab you need.

Other insurance plans that may cover treatment:

• Kaiser Permanente
• VA benefits
• Medi-Cal
• Medicaid
• Student insurance plans
• COBRA

By giving your insurance provider a call, you should be able to find out if they cover drug and alcohol rehab fairly easily.

Aside from your provider, there are other factors to keep in mind when it comes to getting substance abuse rehab covered.

Your plan is one of them. Some plans with your company may offer 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 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 can be difficult to wrap your head around. Simply put, once you pay a certain amount out of pocket, most insurance plans cover more of your services. These factors vary between plans.

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

For example, detox programs without further treatment will be less costly than inpatient rehab. Inpatient programs will be more costly than outpatient programs, and so on.

Without insurance, it’s still possible to receive addiction treatment. Though cost varies based on location and type of treatment, the average cost of treatment for addiction can range anywhere from $1,600 to about $45,000.

While the number may seem scary, it’s important to remember that higher costs are associated with longer treatment periods, residential facilities, and other components that may not be necessary.

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

There are numerous health insurance plans most providers offer. Let’s take a look at some of the common options.

One type of insurance policy is a Health Maintenance Organization (HMO). This kind of plan has a list or network of providers (doctors, hospitals, labs) that is approved, allowing you to receive care from these providers. HMOs typically involve copays, which are small fees you pay for each service. They often also have deductibles.

Another type of plan is a Preferred Provider Organization (PPO). PPOs still have a network, but you have the option to see providers outside of the network for a higher cost than those in-network. These plans also typically have a deductible and require that you pay a percentage of each service.

You may also have the option of a Point of Service plan (POS). POS plans are similar to PPOs in that you can get care outside of the network for a higher cost, however, you will most likely have to be referred to the out-of-network provider by your primary care provider.

Exclusive provider organizations (EPO) are another kind of plan. Similar to HMOs, these plans have a network of providers that you cannot receive care outside of. EPO networks have written agreements with the insurance provider ensuring coverage.

These are not the only kinds of treatment plans, but they are the most common plans you’ll come across.

There are many types of addiction that may be covered by your insurance. 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
• 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.

Dual diagnosis treatment is another kind of treatment service you may be able to get covered by your health insurance. Dual diagnoses or co-occurring disorders are mental health conditions such as depression, anxiety, PTSD, etc., that occur alongside addiction.

Dual diagnosis treatment provides mental health treatment in addition to addiction recovery to start recovery at the source.

This kind of treatment is fairly 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.

As with everything else, it’s important that you double-check this information with your provider to understand exactly what they do and do not cover.

There is a lot that goes into understanding substance abuse treatment and the ways it interacts with health insurance. However, by understanding some baseline concepts and checking in with your provider, it can be pretty straightforward.

If you’re ready to take the next step in finding a treatment program covered by your insurance for you or your loved one, give our helpline a call today.

Though we’ve covered the general concepts of insurance coverage and substance abuse treatment, you may have a couple more questions.

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