Rehabilitation centers can be pricy, leading many addicts seeking recovery to question if they have rehab insurance coverage. Health insurance that covers substance abuse is common, but how much coverage it offers will vary. Anyone looking to get clean from addiction should check to see how their rehab insurance coverage works.
Learn About Insurance Coverage For Drug Rehab:
Does Insurance Cover Drug Rehab?
Nowadays, it is important coverage to have drug rehab insurance. Approximately 21.7 million Americans are either in recovery or are in need of addiction rehabilitation program. Even if someone does not foresee themselves suffering from addiction, few addicts pictured themselves suffering from their disease until it became a reality. However, this brings up the question of if rehab is covered by health insurance. As it so happens, there is no one answer to this question.
When the Affordable Care Act was put in place, it established ten elements of essential health benefits. Substance use disorders are among them. This means that any policy sold on the Health Insurance Exchanges or that is provided by Medicaid or Medicare must cover services for substance use disorders.
This might sound like all policies are required to be health insurance that covers substance abuse rehabilitation, but there is room within this policy for coverage to be still denied:
First, these requirements only govern policies offered by the government or that are sold on the Health Insurance Exchanges. Private providers that do not put a policy on the exchange do not need to follow this requirement.
Second, the policies that must follow this requirement can exploit the vague language used. Services for substance use disorders must be covered, yes, but it is not stated that this means all services that can possibly be related to the treatment of substance abuse. Based on this lack of clarity, drug rehab insurance could be restricted to only the elements that are outlined by the ACA:
- Clinic visits
- Inpatient detox
- Family counseling
- Brief interventions
- Home health visits
- Addiction evaluations
- Anti-craving medication
- Alcohol and drug testing
- Addiction treatment medication
Notable here is that rehabilitation itself is not explicitly mentioned. Clinic visits are, which could be interpreted as outpatient rehab. However, this certainly leaves a loophole.
With that said, most insurance companies follow the spirit of the law and do cover the required elements of substance abuse care plans, as well as multiple forms of rehabilitation, such as inpatient, outpatient, and partial hospitalization.
Does Health Insurance Cover Rehab For All Addictions?
According to the language of the Affordable Care Act, mental health and substance use disorder services must be covered. Substance use disorder covers all substances of abuse. This means that alcohol, street drugs, prescription drugs, and even things like huffing paint are covered. Substance abuse health insurance is easily accessible as a result. Since ACA also bars addiction from being considered a pre-existing condition, substance abuse insurance cannot be denied based on how long a person has been battling their disease.
However, it is possible to be addicted to many things, from gambling to pornography. As for other addictions, these are covered under the mental and behavioral health services umbrella. However, it is possible for each policy provider to interpret this requirement differently.
What Types Of Drug Rehab Does Health Insurance Cover?
The types of drug rehab that a policy covers will vary depending on the provider and even the tier of coverage the insured person has selected. Rehab insurance can be severely limited or comprehensive. In nearly all cases, health insurance that covers substance abuse will cover at least some form of rehabilitation.
Insurance providers can limit which rehab facilities they will cover. In many cases, they only extend drug rehab coverage to treatment at facilities that are classified as being within their network. Even when looking at in-network facilities, care could be restricted to certain types of rehab and duration of treatment.
This means that rehab covered by insurance could include all types of treatment a given facility offers, or it could be limited to exactly what is required by law and nothing more.
Types Of Care Covered
- Inpatient rehab
- Outpatient rehab
- Partial hospitalization rehab
- Detoxification and withdrawal management
- Ongoing one-on-one therapist sessions
- Group therapy
- Family counseling and support planning
- Alternative approaches, such as equine therapy
- Contingency management
- Various levels of intervention
- At-home visits
- Assessments and evaluations
- Medical management of cravings
- Medications that prevent getting high
- Medicines that address co-occurring disorders
- Testing for substance abuse
All providers will cover multiple types of care, as they are mandatory. Some may extend drug rehab insurance coverage to all of them. An insured individual must examine their policy to know what will and won’t be covered.
List Of Largest Private Insurance Companies Which Provide Drug Rehab Coverage
- Blue Cross Blue Shield
- Kaiser Permanente
- Kemper (former Unitrin)
- Providence Health Plan
- State Farm
- United Healthcare
Does Rehab Insurance Cover Medical Maintenance?
The Affordable Care Act does outline anti-craving and addiction medications as being among the elements that policies must cover. Most private health insurance providers do cover medical maintenance whether or not they have been put on the exchange. Logically, it makes more sense for a for-profit company to cover these medications than to exclude them. These medications are cheaper than extensive and repeated rehabilitation stays and are also more affordable than treating the health conditions substance abuse causes.
Rehab insurance coverage from state-funded programs tends to exclude medical maintenance or only cover it for a short period of time so that the user can get stable. These programs are governed by unique rules, which means they can exclude coverage others cannot. However, Medicaid is required to follow all ACA guidelines, and as a result, its substance abuse insurance coverage includes medical maintenance. To what degree it covers this can vary by state. Insurance for drug rehab by Medicare states that medical maintenance is only granted by the Part D monthly premium.
How To Use Rehab Insurance Coverage
If someone has health insurance coverage and is in need of help with a substance abuse disorder, they must look at how their policies work. Health insurance that covers substance abuse constitutes the majority of policies in the United States. As such, the majority of insured individuals will have some level of rehab insurance.
It is important to note that each insurance provider will set its own limitations on coverage and determine different conditions that the insured must meet for rehabilitation to be covered. In most cases, for rehab to be covered by insurance, there must be:
- prior authorization before the individual starts the program
- in some cases, a referral from a doctor stating that rehab is needed
There are some standard steps that insured individuals should take before using their drug rehab insurance. These are:
- Contact the insurance company and find out if a referral is needed and any other steps that must be taken to get the approval needed to enroll in a rehabilitation program.
- Ask them if coverage is restricted to in-network providers, and if it is, to get a list of all rehab facilities that are covered.
- Find out what forms of care are included. For example, detox, inpatient therapy, alternative therapies, aftercare, etc.
- Get information on how long rehab will be covered. Some plants only cover 28 days of rehab, while others do not place a limit.
- Inquire about any specific limits of coverage. Will they only cover rehab up to a certain dollar amount? Are certain therapies restricted?
- Learn about what prescription medications are covered and how much to expect to pay for them.
- Ask about the copay and deductible and begin planning ways to cover them.
Accessing Insurance For Drug Rehab
If someone is insured and battling addiction, there are two scenarios: treatment can be covered in part or in full. They should speak with their insurer prior to enrollment. If a person does not have coverage yet, it is above time to get one. There are numerous state-funded as well as private insurance options available on the market to fit any budget and needs.
- Substance Abuse and the Affordable Care Act. Office of National Drug Control Policy. https://obamawhitehouse.archives.gov/ondcp/healthcare.
- Abraham A. J., Andrews C. M., Grogan C. M., et al. The Affordable Care Act Transformation of Substance Use Disorder Treatment. American Journal of Public Health. 2017; 107(1): 31–32. doi:10.2105/AJPH.2016.303558. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5308192/.
- Self-Funded, Non-Federal Governmental Plans. The Center for Consumer Information & Insurance Oversight. https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Market-Reforms/nonfedgovplans.html.