Rehab Centers That Accept COBRA Insurance

Addiction affects individuals no matter where they are in their lives, including after job loss and during job transition. Because healthcare is essential and conditions like substance abuse disorders require continuous treatment, maintaining an insurance plan like COBRA while between jobs is necessary to ensure you have coverage. COBRA, or the Consolidated Omnibus Budget Reconciliation Act, allows individuals to maintain temporary health benefits after losing a job or while between jobs.

If you have COBRA and are considering attending a substance abuse treatment facility for help with addiction, turn to RehabNet for confidential and committed assistance. We are a trusted resource that helps people like you find the right addiction center for their unique needs, and that is covered by their insurance.

You may have heard of COBRA plans, but you may never have needed to use them. So, what is COBRA? The Consolidated Omnibus Budget Reconciliation Act of 1985 provides employees with a temporary extension of their employer-provided health coverage during situations such as job loss or job transition. This extension is limited and typically lasts between 18 and 36 months. After this period, the insurance plan is no longer available.

In many cases, individuals must pay most or all of the monthly premium to receive COBRA coverage. This is true even if your employer originally paid some or all of your monthly insurance premium cost.

Common eligibility for COBRA coverage includes:

• Recent job loss
• Reduced hours in a full-time position
• Divorce from the insurance holder
• Job transition
• Death of the covered employee
• Medicare or Medicaid eligibility becomes available for the covered employee

You must be considered a qualified beneficiary to receive COBRA benefits.

Examples of insurance companies that COBRA continuation applies to include:

• Cigna
• Aetna
• UnitedHealthcare
• Blue Cross Blue Shield
• Humana
• Kaiser Permanente
• Anthem

COBRA may also be provided through a third-party administrator such as Optum Financial or Medcom Benefit Solutions. Your employer’s human resources department can provide more detailed information on COBRA, your eligibility, and payment options and requirements for this coverage.

Yes, COBRA maintains the same benefits you had under your employer’s plan, including mental and behavioral health and substance use treatment. In most cases, you can expect the same coverage level as you had while employed or before the qualified life change.

Coverage for addiction treatment options may include inpatient rehab, outpatient programs, detox, and behavioral therapy. If you or a loved one is searching for substance use disorder treatment programs, it’s important to verify what specific services your COBRA plan covers. You can do this by calling the customer representative line on the back of your insurance card or using the RehabNet treatment search tool on our website.

Most COBRA insurance plans cover standard drug addiction and mental health treatment programs. Some of these include:

A detox program is often the first step in addiction recovery, especially if you are struggling with dependence on alcohol or benzodiazepines. A medical detox facility provides comfortable and round-the-clock care to ensure your withdrawal process is as easy as possible. Trained healthcare providers and other addiction specialists assist you throughout this time and may provide medication to help ease withdrawal symptoms.

Inpatient or residential treatment is the most intensive type of drug and alcohol addiction care and requires individuals to live at a facility for a set period. Common lengths of stays are 30 to 90 days, depending on the person’s needs and required level of care. Many COBRA insurance plans offer at least partial rehab coverage.

A partial hospitalization program is another type of intensive rehab treatment option that allows individuals to return home each day. For example, you may attend treatment from 9 am to 5 pm Monday through Friday.

IOPs are a good option for those who need less intensive treatment services or who cannot commit to a residential stay. This form of outpatient treatment requires individuals to attend various types of therapies several times a week. For example, you may attend group therapy for three hours three times a week and an individual therapy session once a week.

Medication-assisted treatment is a common treatment plan component for those struggling with opioid use disorder. It combines the use of medications like methadone or suboxone with other evidence-based therapies for substance use disorder recovery. Not all insurance programs cover this option, so be sure to check with your insurance representative to verify eligibility.

Some addiction treatment programs that may or may not be covered by COBRA plans include aftercare and sober living options. These treatment modalities follow the successful completion of a rehab program and work to support a person’s sobriety.

No matter which treatment option is best for you, it’s important to obtain necessary medical documentation to ensure maximum coverage for the cost of rehab or other addiction programs. You can get medical documentation through a primary care physician or other medical professional who is aware of your condition and needs. Medical documentation supports your ability to receive coverage and can impact copays and other out-of-pocket expenses.

It’s important to understand the various factors that can impact COBRA rehab costs and eligibility. Here are a few important components that affect COBRA rehab costs:

• In-Network vs. Out-of-Network: Whether the addiction treatment center you wish to attend is in-network or out-of-network can play a significant role in coverage. In most cases, in-network facilities require fewer out-of-pocket fees due to better insurance coverage. You can use the rehab search tool on RehabNet’s website to find out if a rehab center is within your COBRA insurance’s network.
• Pre-Authorization Requirements and Referrals: Some insurance plans require pre-authorization from a medical professional before providing coverage for addiction treatment. A referral may also be necessary depending on the type of treatment.
• Length of Treatment: Many addiction programs are several weeks in length, depending on the program type and the individual’s unique treatment needs. Not all insurance companies offer unlimited coverage. For example, your provider may only cover a 30-day stay in a residential program.
• Medical Necessity: This refers to the level of care a medical professional has deemed necessary for your unique condition. For example, some individuals may only require outpatient treatment, while others need a lengthy stay in a residential program for the best recovery outcomes.
• Deductible Status: Most insurance plans have a deductible that must be met before the plan will provide maximum coverage. Depending on whether your deductible is met, you may have higher out-of-pocket costs.

To learn more about COBRA rehab eligibility and specific out-of-pocket costs for treatment programs, reach out to your insurance customer representative center or work with a dedicated RehabNet professional today.

Some COBRA insurance plans may offer a set amount of coverage for out-of-network rehab programs. This will largely depend on the type of insurance plan you have.

There are two primary types of health coverage plans: Preferred provider organization (PPO) plans and health maintenance organization (HMO) plans.

PPO plans have a network of providers that work with the insurance company to provide the lowest rates possible. They typically have the largest selection of in-network healthcare providers, making it easy to find treatment that’s covered by your plan. Many PPO plans provide some coverage for out-of-network services as well.

HMO plans also have a network of providers, but this network is typically smaller. Out-of-pocket costs and premiums may be more expensive as well. Many HMO plans do not offer out-of-network coverage unless it’s for emergency services. Most HMO insurance plans also require referrals for specialty services like addiction treatment.

You can confirm whether a provider is in-network by reaching out to an insurance representative. You can also use the free rehab search tool on RehabNet’s website to verify in-network coverage for an addiction program.

If you require treatment and there is no suitable rehab center in your area, you may be able to appeal an out-of-network denial from your insurance company. An appeal requires the company to do a second review of the coverage request and can potentially help you get treatment coverage.

The first step is to submit an internal appeal. This includes contacting your insurance company and informing them that you want to refute the denial. If the internal appeal is still denied, you may wish to perform an external appeal, which means involving a third party to look at the claim.

There are various types of COBRA health insurance plans. COBRA itself is not a standalone plan but rather an extension of the plan you had through your employer.

Types of plans included in COBRA are:

• PPO: This plan typically offers lower out-of-pocket costs with higher monthly premiums. PPOs also have a vast network of providers from which to choose services.
• HMO: Health maintenance organization plans often require services to be in-network for coverage. Referrals and a primary care physician are also required for this plan.
• Point of Service (POS): POS plans require referrals for specialist services and only cover in-network providers.
• High-Deductible Health Plans (HDHP): This type of plan requires you to pay higher out-of-pocket costs until your deductible is met. Once it’s met, your plan will pay the majority or all of your health expenses.

Each plan will provide varying addiction rehab treatment access and cost structures. For example, you may get coverage for out-of-network addiction treatment with a PPO plan, while a POS plan won’t offer coverage unless the service is in-network.

COBRA insurance plans provide coverage for substance use disorders recognized by DSM-5, including:

• Alcohol use disorder
• Opioid use disorder (heroin, fentanyl, oxycodone)
• Prescription drug abuse
• Cannabis use disorder
• Inhalant use disorder
• Hallucinogen use disorder, such as LSD addiction
• Sedative or hypnotic use disorder, such as addiction to benzodiazepines
• Stimulant use disorder, such as cocaine and methamphetamine addiction
• Polysubstance use, such as addiction to multiple types of drugs

Your insurance may also offer dual diagnosis treatment for co-occurring mental health conditions, such as alcohol use disorder that coincides with depression.

Finding the right rehab program for you is the first step on the road to recovery. The following are steps you can take to locate a center near you that’s in your insurance provider’s network or eligible for coverage through your plan:

• Contact your insurance provider. Get in contact with your former employer’s insurance provider to verify your coverage and learn specific details about out-of-pocket costs and expenses. You can also have the customer service representative check to see if the rehab center you’re interested in is in network with your plan.
• Use your insurance portal. Many insurance companies offer search portals that allow you to look for in-network rehab centers near you. Log on to your insurance provider’s website to utilize this tool.
• Contact local mental health and addiction hotlines. You can also contact local mental health and addiction hotlines to gain rehab center referrals in your area. You can also call the National Drug Helpline 24/7 at 1-844-289-0879 for referrals or to get contact information for centers in your area.
• Use RehabNet’s free directory to find facilities near you. RehabNet offers a confidential and free online directory that allows you to discreetly search for addiction treatment centers in your area. You can specify your insurance plan and treatment type for the best search results.

Here are some frequently asked questions related to COBRA insurance coverage and rehab treatment:

RehabNet is a comprehensive and confidential service that supports individuals seeking addiction recovery in various ways, including through insurance verification and treatment program matching. We only offer rehab center suggestions that have been thoroughly vetted through our meticulous process, which includes verifying accreditation and positive reviews. This way, you can trust that no matter which facility you select, it’s one of the best available for your unique needs and situation.

Additionally, our free rehab search tool allows you to look for centers by ZIP code, addiction type, insurance plan, and your necessary level of care. You can use this tool on your own accord or with the help of one of our licensed advisors who can walk you through the rehab selection and insurance process. We can also verify your coverage so you know what to expect in terms of out-of-pocket expenses.

Reach out to us today for free and confidential support on this journey to a new life.