If you’re considering treatment for substance abuse, one of your first questions is probably about cost. The good news is that most insurance plans do cover drug rehab. The Mental Health Parity and Addiction Equity Act requires insurers to treat addiction treatment the same way they treat other medical conditions. That means if your plan covers hospital stays or doctor visits, it likely covers rehab too.
But coverage varies widely between plans. Some policies pay for the full continuum of care, while others limit the number of days or types of services. Getting clear answers about your specific benefits takes some work, but it’s worth the effort. Knowing what your insurance will pay helps you plan for treatment without financial surprises.
What Types of Insurance Pay for Addiction Treatment?
The type of insurance that you have can affect your ability to find coverage for addiction treatment. Fortunately, multiple types of insurance can provide help. For example, you may find coverage in:
- Most major insurance categories
- Private health insurance through your employer
- Medicare Part A pays for inpatient rehab
- Medicare Part B covers outpatient services
- Medicaid, though the specific services vary by state
If you have insurance through the Health Insurance Marketplace, your plan must include mental health and substance abuse services as essential health benefits. Military insurance like TRICARE and veterans’ benefits through the VA also cover addiction treatment. Even some supplemental insurance policies help with rehab costs.
What Rehab Services Does Insurance Typically Cover?
Based on the type of insurance that you have, certain services will be covered, and some may not. In general, services that are usually covered by insurance include:
- Medical detox is usually covered when medically necessary
- Inpatient or residential treatment up to 30 days of residential rehab
- Partial hospitalization programs (PHP)
- Intensive outpatient treatment
Individual services may also be covered, such as:
- Individual therapy
- Group counseling
- Medication-assisted treatment
- Family therapy
Aftercare services like sober living referrals and alumni programs may have limited coverage or none at all. However, there may be ways to afford those services, and some facilities include programs like Aftercare planning as a part of their services.
In-Network vs. Out-of-Network Treatment Centers: What’s the Difference?
In-network providers have contracts with your insurance company. They’ve agreed to accept negotiated rates for services. When you choose an in-network facility, you typically pay less out of pocket. Your insurance covers a higher percentage of the costs.
Out-of-network centers don’t have contracts with your insurer. You might still have coverage, but you’ll usually pay more. Some plans don’t cover out-of-network care at all. Others cover it but apply a separate, higher deductible.
Quality of care isn’t determined by network status. Many of the best treatment centers in the country simply aren’t in-network with insurance providers that aren’t willing to pay the rates needed to provide the highest quality of care.
If you find a program that’s perfect for your needs but out of network, ask about single-case agreements. Sometimes insurers will cover out-of-network care at in-network rates if you can show medical necessity.
Start Recovery With One Phone Call
You don’t have to figure out insurance coverage alone. Call us right now, and we’ll verify your benefits while you’re on the phone. We’ll explain exactly what your insurance covers and what you’ll need to pay. Our admissions team answers questions every day and makes the process simple.
The hardest part is making that first call. After that, we handle the details so you can focus on getting well. Your new life is waiting. Pick up the phone and let’s start this journey together.
Sources:
- Mental Health and Substance Abuse Coverage — HealthCare.gov
- Mental Health and Substance Use Disorders — Medicare.gov
