Understanding Insurance Coverage for Drug and Alcohol Rehab
Insurance coverage for rehab is an extremely important part of being prepared for treatment. Considering that a lack of financial assistance is what stops a large majority of individuals from seeking help for their addictions, obtaining an insurance provider that covers rehab is vital.
The chances of the average person coming up with the thousands of dollars needed to cover the cost of substance abuse treatment are highly unlikely. Without insurance, individuals suffering from addiction will have a higher likelihood of continuing their destructive patterns.
Does Health Insurance Cover Rehab for an Alcohol or Drug Addiction?
Thanks to legislation regarding insurance during the Obama administration, obtaining insurance benefits is as simple as filling out the necessary documents online. However, a person’s specific insurance plan often dictates the number of available treatment facilities.
Typically, a private health insurance provider through employers and other sources provides more options when it comes to treatment. It is important to note that Medicaid and more standard insurance providers do not disqualify individuals from receiving quality treatment.
It simply means that private insurance allows individuals to expand their options. Normally, your particular plan will dictate how much of the cost your insurance plan will cover. In certain cases, a portion of the cost of addiction treatment has to be covered out of pocket.
There are several forms of drug and alcohol addiction treatment that are available today. The type of health insurance plan you have dictates the types of rehab that are covered.
What Types of Substance Abuse Treatment Does Insurance Cover?
Individuals with a drug or alcohol addiction have multiple options in terms of treatment. The types of rehab facilities and other addiction treatment services that are generally covered under most health insurance plans are listed below:
- Inpatient and outpatient services
- Medically assisted detox
- Medication-assisted treatment
- Dual-diagnosis treatment for co-occurring disorders
- Continued recovery care
- Medication-Assisted Treatment
It is important to check with your insurance provider directly to ensure what addiction treatment programs and mental health benefits are covered under your specific plan. This can help you find a treatment provider that will be able to serve all of your care needs, at an affordable price.
Can I Go to Rehab Without Insurance?
Many individuals struggling with a substance use disorder may allow a lack of health insurance to become a roadblock on their path to recovery. However, many of these individuals may be unaware of alternative options when insurance is not in the picture.
Several free and state-funded facilities provide rehab options for individuals when an absence of insurance exists. There are also financial assistance programs that provide funding for individuals seeking substance abuse treatment.
Other options exist that provide avenues of assistance that make treatment possible, without having to pay out-of-pocket, including:
- Certain treatment centers provide payment plans or billing based on a sliding scale that factors in the income of potential patients.
- Scholarships and grants are available directly from certain treatment centers or through the state.
- If no other options exist, asking for financial assistance from family members or loved ones could be a potential option.
It is important to investigate every avenue for covering the cost of treatment. However, one of the best places to start is by signing up for insurance via the ACA marketplace.
The ACA (Obamacare) Marketplace for Rehab
The Affordable Care Act provides all American citizens the opportunity to obtain insurance at rates that are suitable based on income. This also ensures that nobody can be denied coverage based on preexisting conditions like drug and alcohol addiction.
According to the ACA, there are ten essential healthcare benefits that all health insurance companies must provide. Addiction treatment coverage is listed as one of these benefits. Additionally, mental health treatment is included as an element that providers must cover.
Because of this, the possibility of long-term recovery from drug abuse is increased because of access to aftercare services. One of the best ways to obtain more options in terms of treatment and rehab is by having multiple providers.
Can I Have Multiple Providers?
It is completely legal to have multiple healthcare providers. However, certain rules exist surrounding an individual having dual health insurance coverage. The following situations allow the presence of multiple providers:
- If you are married, have an individual plan, and are covered by your spouse’s plan
- You are under 26 and have an individual plan in addition to being listed on your parent’s plan
- If you are under 26 with divorced parents and listed under both plans as a dependent
- If you are over 65 and have Medicare as well as coverage through your employer
When an individual has dual coverage, one of the policies is considered the primary policy, and the other is secondary. Once coverage limits are met on the first policy, the secondary policy will pay the remaining cost of any treatment or medical services.
It is important to note that different policies have different benefits and types of substance abuse treatment coverage. The characteristics and specifics of these plans are important when it comes to choosing treatment and healthcare options.
Common Types of Plans and Benefits
There are three primary types of healthcare plans provided for individuals covered by insurance. The following section highlights these three plans and the benefits they provide.
HMO (Health Maintenance Organization)
These plans allow individuals to choose a primary care physician that will provide most of their medical care. These physicians must be included within the network of the HMO. If a form of specialized treatment is needed, a referral from their primary doctor should grant this coverage.
Normally, an HMO will have very low or no deductibles at all and a low monthly premium. These types of plans benefit individuals that are not seeking a specialized area of treatment, but rather require a more standardized drug or alcohol rehab program.
PPO (Preferred Provider Organization)
PPOs make it possible for clients to see healthcare providers in and out of their insurance company’s network. Typically, these plans provide more flexibility with the treatment options they will cover in the fact that their clients are able to see a doctor of their choice.
However, if the doctor is within the network of the PPO, the out-of-pocket price will be much lower. These plans normally have higher monthly premiums but lower copays. PPO plans normally have higher deductibles than HMO plans.
Overall, the most significant benefits of these plans are the fact that those who carry these plans can seek out more individualized treatment programs and see specialists of any type without referrals.
POS (Point of Sale)
Point of sale plans work very similar to HMO plans. However, it is possible to see providers outside of your network on certain occasions with POS plans. Every company is different in regard to the type of coverage they provide, so it is important to check the specifics of your plan.
Generally, a POS will cover a decent portion of the cost of recovering through an inpatient or outpatient program, making them a convenient payment option for those seeking addiction treatment.
How Can I Find Out the Coverage of My Policy?
If you are unsure about the specifics of your coverage, it is important to obtain this information to understand what services are covered. Finding out the level of coverage provided by your health insurance policy is actually fairly simple.
First, you need to obtain your insurance ID number. Once you have this, you can then contact your provider directly. They will be able to use this number to.look up your specific plan, and provide you with the drug and alcohol treatment options that are covered under your policy.
It is important to find out the coverage of your policy so you can be certain what percentage of the costs are covered when it comes to addiction treatment. This will also give you information on what alcohol and drug rehab facilities are in and out-of-network with your provider.
Typical Costs of Addiction Treatment
The cost of recovery at a drug or alcohol rehab center will be based on several important elements. Some of the factors that may influence the overall cost of addiction treatment include:
- The individual’s required level of drug or alcohol addiction treatment.
- The duration of the individual’s stay at their treatment facility.
- The individual’s specific insurance policy and coverage.
- Any additional rehab costs, such as from special amenities, services, or other features.
Because addiction treatment insurance coverage varies depending on the provider, personal expenses will vary based on specific plans. However, most insurance companies, even private providers, include the coverage of substance use disorder treatment as a mandatory service.
Insurance companies do not base coverage on the specific substance an individual is seeking drug and alcohol treatment for. When a client is seeking these services, coverage is mandatory regardless of the specific substance or driving forces behind their disorder.
Due to the regularity of co-occurring substance use and mental disorders, coverage for mental health care and treatment options is also offered by most insurance providers. This may include recovering at a dual diagnosis treatment center and various other mental health services.
What Mental Health Issues are Covered by Insurance?
When insurance providers cover certain types of treatment, the level of coverage provided must be uniform despite the specifics of treatment. For example, a plan that provides visits with a medical doctor for $30 must also provide mental health visits for the same price.
Additionally, no specific mental health issues are outlined in terms of what is covered and what is not. This is similar to insurance providers covering treatment regardless of the specific type of alcohol or drug addiction an individual is being treated for.
Are My Medications Covered During Treatment?
Medication maintenance programs are often integrated into various levels of drug and alcohol rehab, although these are primarily used as a part of aftercare treatment. These programs provide medications to individuals who cannot function without drugs.
Often, chemical changes that occur as a result of substance abuse are too strong for an individual to recover from. Medications are needed to correct these imbalances so individuals can live normal lives.
An example of one of these programs is an opioid maintenance treatment using medication like methadone and suboxone. These medications prevent relapse and make long-term recovery possible long after treatment is finished.
Most health insurance plans cover the cost of these treatment programs. However, plans like Medicare and Medicaid will only cover these aftercare programs if they are deemed necessary for an individual to function normally.
This determination is normally made based on information provided by a counselor or physician. When you are deciding whether treatment is the best option for you, it is important to weigh the cost of rehab vs. the cost of addiction.
Cost of Rehab vs. Cost of Addiction
The cost of rehab pales in comparison to the cost of addiction, even when it comes to your potential out-of-pocket expenses. Typically, the cost of rehab can be measured solely in terms of monetary value.
However, when you are discussing the cost of addiction, money is only the beginning. Addiction comes at the expense of yourself, your family, your job, and many other important elements in your life.
This is not downplaying the high cost of addiction on society. It is estimated that addiction costs our society $532 million per year. Included in this figure are the cost of housing people that are incarcerated, healthcare, and other funding sources that are allocated for addicted individuals.
Regardless of how you view the cost of addiction, getting treatment is well worth the investment. After all, some of the prices you pay as a result of addiction, monetary or otherwise, can never be recovered.
When you commit to attending treatment, it is important to decide whether an inpatient or outpatient program is more appropriate for your situation. It is important to consider several factors when making this decision.
Outpatient vs. Inpatient Treatment Programs
An inpatient treatment program requires a patient to reside at the rehab facility temporarily. Inpatient rehabs will provide multiple types of therapy and mental health services. Clients will also receive education regarding their substance abuse disorder.
This may include informing them of their triggers and providing them with the necessary tools to prevent relapse. New skills prepare each client for a better and independently sober life once treatment is complete.
The focus of inpatient rehab is providing a controlled environment that prevents the possibility of relapse and removes elements of temptation. This is conducive to successful recovery and education regarding substance abuse from both a medical and holistic standpoint..
Normally, outpatient treatment programs are more affordable. These programs allow clients to continue to work and live at home as normal. However, traveling to an outpatient rehab facility can be challenging, especially if there is not one within a reasonable distance.
There are several risks involved with outpatient treatment, including:
- Individuals may find it harder to focus on recovery because of the stresses of other dynamics such as their work or home responsibilities.
- The overall atmosphere may not be conducive to recovery because of triggers or other elements.
- There may be a significant risk of relapse because of temptations and the lack of a controlled environment.
Deciding between an inpatient and outpatient treatment program is a crucial choice to make. Choosing an outpatient treatment program requires several important elements, including:
- A strong support system and constant evaluation and assessment are necessary. It is important that those involved with an individual’s recovery hold them accountable.
- The recovering individual must have a significant amount of willpower and a heavy focus on recovery and abstinence.
- The recovering individual must also be able to separate themselves from individuals involved with substance abuse or any sources for obtaining narcotics.
Regardless of the specific choices made regarding treatment, having access to insurance benefits is important. These benefits will cover inpatient or outpatient rehab treatment, continued mental health services, and other types of aftercare.
Verifying Your Insurance Plan and Finding Other Payment Options for Drug and Alcohol Rehab
Having insurance is not mandatory for finding an addiction treatment provider, but it certainly increases the odds of making that important step and successfully recovering. Do not hesitate to reach out, with or without current insurance, to the Admission team at Icarus Behavioral Health.
We can review the resources available to you. From COBRA policies that can help in the case of job loss, to using a plan you find through the Health Insurance Marketplace, our dedicated staff can refer you to resources that may be able to help provide coverage for needed treatment.
So don’t wait; reach out to the Icarus team today, and start your journey to recovery through finding affordable drug and alcohol rehab programs that can serve all of your personal care needs!