When seeking addiction treatment at a rehab center for drug and alcohol abuse, one of the first questions people ask is whether their insurance will cover the cost of rehab. It’s a valid question, as you navigate this serious and difficult journey to recovery.
Fortunately, most health insurance plans are now required to cover mental health and addiction treatment services under the Affordable Care Act (ACA). This means that if you have insurance, it is likely that your plan will offer some coverage for rehab. However, there are still some important things to keep in mind when trying to figure out how much your insurance will cover.
At Legends Recovery Center in Green Springs, Ohio, we empower those seeking treatment with the knowledge they need to make the best decisions for their unique situation. If you’re wondering whether your insurance will cover rehab, read on for more information.
Does Insurance Cover Substance Abuse and Mental Health Treatment?
The short answer to this question is that it will depend on your health insurance plan. It’s important to note that every insurance plan is different, so it’s always a good idea to check with your provider to see what is and is not covered under your particular plan.
Insurance Providers & Rehab Coverage
The benefits that are included in your health insurance plan are designed to make healthcare accessible through affordability. According to the U.S Department of Health & Human Services, “health insurance is designed to protect you from high, unexpected medical costs. It is a contract between you and your insurance company.”
Your premiums are the monthly payments that you make to keep your health insurance policy active, and your deductible is the amount of money that you have to pay out-of-pocket before your insurance company starts to pay for covered services.
What is included in your health insurance policy depends on the type of plan that you have chosen. For example, if you have a PPO (Preferred Provider Organization) plan, then you will be able to see any doctor that is in-network without a referral from your primary care physician. If you have an HMO (Health Maintenance Organization) plan, then you will need to see a primary care physician to be referred to a specialist.
Health Insurance and Medical Necessities
Every insurance provider is different, and each has its own rules and regulations regarding what it will and will not cover. That said, there are some general things to keep in mind when it comes to insurance coverage for rehab. For example, most insurance providers will only cover treatment that is deemed “medically necessary.” This means that if your doctor feels that you need treatment to recover from your addiction, then there is a good chance that your insurance will cover at least some of the costs.
However, it’s important to remember that just because treatment is considered medically necessary does not mean that your insurance will cover the entire cost. In many cases, you will be responsible for paying a portion of the bill, and this is something you should discuss with your treatment center before you commit to anything. It’s also important to keep in mind that not all insurance companies are created equal. Some plans will cover more of the costs associated with treatment than others, so it’s important to do your research and find out what is covered under your particular plan.
What Types of Rehab Does Insurance Cover?
When it comes to substance abuse treatment and insurance coverage, many insurance policies will cover the various forms the various available forms of treatment and mental health treatment programs covered by insurance include the following:
- Detoxification services: Medical detox may be deemed as a medical necessity and therefore covered by your insurance policy
- Inpatient treatment: Most inpatient treatment programs will be covered by insurance.
- Outpatient treatment: Many outpatient programs will also be covered by your insurance policy, though the coverage may not be as comprehensive as it is for inpatient treatment.
- Partial hospitalization program (PHP): Some insurance policies will cover partial hospitalization programs, also known as PHP.
- Intensive outpatient program (IOP): An intensive outpatient program is typically covered by insurance to a lesser extent than inpatient or outpatient treatment.
- Sober living: While sober living is not considered treatment per se, some insurance policies will cover the cost of rent and other associated expenses.
- Addiction therapy: Both individual and group therapy are generally covered by insurance, though the coverage may vary depending on your policy. Many forms of therapy are also considered to be continuing care, meaning that they are covered even after you have completed your initial treatment.
- Psychiatry: psychiatric services are usually covered by insurance, though the extent of coverage may vary.
- Medication: prescription medication is typically covered by insurance, though the coverage may vary depending on your policy.
Going to Rehab Without Insurance: What if My Insurance Doesn’t Cover Rehab?
If you don’t have insurance or if your insurance doesn’t cover rehab, there are a few options available to you.
- You may be able to get help from government programs like Medicaid or Medicare.
- You may be able to find sliding scale programs that offer reduced rates based on your income.
- You may also be able to find crowdfunding campaigns or charity organizations that can help you cover the costs of rehab.
Don’t let lack of insurance coverage stop you from getting the treatment you need. There are options available to help you afford rehab even if your insurance doesn’t cover it. If you’re not sure where to start, call us at Legends Recovery Center
The Affordable Care Act & Health Insurance Coverage
In March 2010, the Patient Protection and Affordable Care Act (ACA) was passed, which is also known as Obamacare. Among other things, the ACA requires that all health insurance policies offer coverage for mental health and addiction treatment services. Overall, the law states that no one can be denied access to health insurance coverage despite having a preexisting condition.
This is true for people with a substance use disorder as well. So, if you’re seeking addiction treatment and worried that your insurance won’t cover it, know that the ACA requires all policies to offer this coverage. It is important to note that while the ACA requires this coverage, individual policies may differ in how much they cover. Some may have higher deductibles or copays, for example.
Still, the ACA is a major step forward in ensuring that people with addiction can get the treatment they need without facing prohibitive costs. Further, individuals can have both primary and secondary coverage when it comes to health insurance. This means that even if your employer-sponsored health insurance doesn’t cover addiction treatment, you can still get coverage through a government-sponsored program like Medicaid.
Common Types of Healthcare Plans & Benefits
There are three common types of healthcare plans. These include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Point-of-Service (POS) plans. Here is a brief overview of each:
- Health Maintenance Organizations (HMOs): HMO plans typically have lower monthly premiums but higher out-of-pocket costs. With an HMO plan, you will need to select a primary care physician (PCP) from the insurance company’s network. Your PCP will then coordinate your care with specialists in the HMO network. If you receive care outside of the HMO network, you may need to pay for services out-of-pocket.
- Preferred Provider Organizations (PPOs): PPO plans typically have higher monthly premiums but lower out-of-pocket costs. With a PPO plan, you will have the flexibility to see any provider that is in the insurance company’s network. However, you will pay less for services if you use a provider that is considered “in-network.”
- Point-of-Service (POS) Plans: POS plans are a mix of HMO and PPO plans. With a POS plan, you will select a PCP from the insurance company’s network. Your PCP will coordinate your care with specialists in the network. However, you also have the flexibility to receive care outside of the network. If you do receive care outside of the network, you will likely have to pay more for services.
The Cost of Rehab vs. The Cost of Addiction
While the cost of addiction treatment can seem high, it is important to remember that the cost of addiction is even higher. The cost of addiction includes the financial cost as well as the toll it takes on your physical and mental health, your relationships, and your overall quality of life.
If you or a loved one is struggling with addiction, don’t let the cost of treatment be a barrier to getting the help you need. There are many ways to finance addiction treatment, and most insurance plans will cover at least some of the cost.