The decision to become sober means going through addiction treatment. As you look through quality rehab centers for substance abuse, you might be asking yourself the question, does insurance cover drug rehab? The good news is that the Affordable Care Act (ACA) made insurance coverage for addiction treatment available.
When Does Insurance Cover Drug Rehab?
Insurance coverage for drug rehab depends on the situation. When you look into treatment for substance abuse, it’s important to verify insurance coverage before you sign up. You have a few options when it comes to finding out if your insurance covers addiction treatment. You can call your insurance provider and talk to them about the coverage they provide for rehab. You can also call the rehab center that you’re considering and talk to their staff about what insurance they take.
How Does Insurance Cover Drug Rehab?
It’s important to find out exactly what your insurance covers for substance abuse treatment. There are a few different ways that insurance can cover rehab for addiction:
• A percentage of the total cost
• The full amount after a deductible
• A specific amount indicated in your coverage
• Certain types of treatment indicated in your coverage
Once you know how much your insurance actually covers, then you can look into other options such as financing at the rehab center, health savings accounts or taking out a loan. Many insurance providers won’t cover absolutely everything for rehab treatment, but the only way to find out is to confirm with your provider and the rehab center.
Does Insurance Cover Drug Rehab Detox?
Detox is often a part of addiction rehab treatment. Depending on the severity of your substance abuse, it might be the very first step before you start other rehab programs. Does insurance cover detox as well? Again, it will depend on your provider. Most providers cover some amount of drug rehab treatment, but they may have specific things they cover and a specific amount or percentage. You may have to pick up some of the cost for addiction treatment, whether detox or anything else.
Why Does Insurance Cover Drug Rehab?
The reason that insurance generally covers drug rehab is due to the 2014 Behavioral Health Parity and Addiction Equity Act. This act is part of the ACA, which requires insurance coverage for addiction and behavioral health issues. That usually means that your insurance provider has to cover substance abuse rehab programs just like they cover your doctor visits for physical health problems. What your insurance covers depends on the provider. Your insurance coverage for addiction treatment may mirror your coverage for other medical issues. For example, if your insurance only pays part of your medical costs, then they likely will only cover the same amount for drug rehab.
How the ACA Changed Drug Rehab Coverage
Before the ACA changed the insurance landscape, having enough coverage was a common barrier to people seeking help through rehab. It’s still somewhat of a barrier due to stigma and due to soft coverage from some providers. The hard truth is that only one in 10 people get the help they need with substance abuse treatment. Lack of money and lack of insurance coverage can still be a problem.
However, before the ACA, very few companies covered any type of drug rehab treatment. Not only that, but companies previously were able to deny coverage for drug rehab due to the person having a pre-existing condition of a mental disorder or substance use disorder. The ACA now requires that all plans under it cover treatment for substance abuse and behavioral health conditions. How much it covers still depends on your individual plan and the drug rehab program that you choose. You might also need to get a referral from your primary care doctor in order to get insurance coverage for substance abuse treatment.
It’s also common for people with a substance use disorder to have another behavioral health condition. The ACA allows for treatment of both without calling either one a pre-existing condition. It’s possible to get coverage for medication, therapy and even inpatient treatment.
What About Medicaid and Medicare For Drug Rehab?
If you have Medicaid or Medicare, the ACA should also assist you in getting treatment for substance use disorder. Medicaid is a federal health insurance program for low-income individuals. Around 12% of adults who have Medicaid have a substance use disorder. Medicare is federal health coverage for people 65 and older, or of any age with a disability. Medicare also covers some treatments for substance use disorders. The coverage follows these conditions:
• Services provided must be medically necessary
• Services must be performed at an in-network center approved by Medicare
• Care plan set up by the provider
Not all treatment centers accept Medicare or Medicaid, so it’s still important to find out from your desired care provider whether they accept these insurances.
Does Insurance Cover Inpatient Treatment?
Even though insurance companies must offer some form of coverage for rehab, they don’t have to cover specific types of treatment. This means that some companies might cover only outpatient treatment. Sometimes it’s possible to get coverage when inpatient treatment is deemed medically necessary due to a failure to get results with outpatient treatment. This judgment must be made by a physician and determined by the insurance provider.
How Long Is Rehab Covered?
The other question you might have is how long can you use your health coverage for substance use disorder treatment. Your provider will consider several factors in determining how much coverage you need and how long the coverage should last. Treatment programs often have several levels of care, and your health coverage provider might only cover some of them. During treatment, you will be regularly assessed for your progress and if you’re experiencing improvement. Your provider might decide to extend coverage if it’s deemed medically necessary.
Coverage At a Dual Diagnosis Treatment Center
New Method Wellness accepts a wide range of health coverage plans, and we have a full staff of experts ready to assist you in determining your coverage for our programs. In most cases, 100% of our treatment programs can be covered. We accept many major insurance carriers, including the following:
• Aetna
• Emblem Health
• United Healthcare
• Human
• Cigna
• And many more!
If your health coverage provider requires pre-certification before beginning rehab treatment, we can help with this as well as ongoing authorization. Even if they aren’t currently on our approved list of health coverage providers, we can work to bring them on board.
We can also contact your provider on your behalf to cut down on the confusion.
Get in touch with us at any time through our 24/7 support line or the insurance verification forms here on our website.
Take the first step towards getting sober today!
