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Does Insurance Cover Rehab?

Last Updated: February 14, 2022

Authored by Isaak Stotts, LP

Reviewed by Michael Espelin APRN

Addiction treatment centers can be pricy, leading many addicts seeking recovery to question if they have rehab insurance coverage. The introduction of the Affordable Care Act in 2010 compelled all insurance providers to cover mental health and substance abuse treatment. However, how much coverage it offers will vary. Anyone looking to get clean from drug or alcohol addiction should check to see how their alcohol rehab insurance coverage works.

Does Health Insurance Cover Rehab?

Nowadays, approximately 21.7 million Americans are either in recovery or require addiction treatment services. Even if someone does not foresee themselves suffering from addiction, few addicts picture themselves suffering from their disease until it becomes a reality. However, this raises the question: “does insurance cover rehab?”.

When the Affordable Care Act was put in place, it established ten elements of essential health benefits. Mental health and substance use disorders are among them. It means that any policy sold on the Health Insurance Exchanges or provided by Medicaid or Medicare must cover services for mental health and substance use disorders.

Mental health therapy, therapist talking to a patient.

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. Alcohol rehab insurance can be severely limited or comprehensive. However, in nearly all cases, health insurance covering addiction will pay for at least some form of rehabilitation services.

Providers can limit which rehab centers they will cover. In many cases, they only extend drug rehab insurance coverage to treatment at facilities classified as being within their network. Even when looking at in-network treatment centers, care could be restricted to certain types of rehab and duration of treatment.

It means that rehabilitation covered by insurance could include all types of treatment a given treatment center offers, or it could be limited to exactly what is required by law and nothing more.

Types Of Care Covered:

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.

Does 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. It means that alcohol, street drugs, prescription drugs, and even things like huffing paint are covered. Addiction health insurances are easily accessible as a result. Since ACA also bars addiction from being considered a pre-existing condition, providers cannot deny substance abuse insurance 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, each policy provider can interpret this requirement differently.

List Of Largest Private Companies Which Provide Drug Rehab Coverage:

Deductibles, Premiums, And Out-Of-Pocket Costs

To understand the policies of different health insurance providers regarding addiction treatment services, one needs to learn specific terms. These terms are widely used in plan descriptions, and they describe the conditions and requirements for drug and alcohol rehab insurance coverage. These are premium, deductible, and out-of-pocket expenses.

Premium

The premium for health insurance coverage can be considered the subscription cost. This is the money one pays to have access to the product—the coverage for rehabilitation, in this case. It is paid every month, every quarter, twice a year, or once a year, depending on what works best for the individual.

A couple discussing insurance premium and deductibles.

Deductible

A deductible is the amount of money a person must pay towards their health care costs each year before the coverage kicks in. So if someone needs drug rehabilitation, they may need to pay everything on their own up to a certain amount, at which point the company begins paying. As a rule, the lower the deductible, the higher the premium, and the higher the premium, the lower the deductible.

Out-Of-Pocket Expenses

In addition to the deductible, there are other out-of-pocket expenses that are part of drug rehabilitation. For example, there may be a copay to pay for medications and addiction rehab stays, as well as for therapy sessions. In addition, there could be coinsurance, which works similarly to copays. When copays and coinsurance percentages are low, the premium tends to be higher. Most plans will have a maximum out-of-pocket set for a given policy, and once that is reached, the company pays in full.

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 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 more affordable than treating the mental and physical health conditions addiction causes.

Coverage from state-funded programs tends to exclude medical maintenance or only cover it for a short 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 drug and alcohol rehab insurance coverage includes medical maintenance. To what degree it covers it can vary by state. Medicare states that medical maintenance is only granted by the Part D monthly premium.

How To Use Drug Rehab Insurance Coverage

If someone has health insurance coverage and needs help with a substance abuse disorder, they must look at how their policies work. The majority of policies in the United States cover substance abuse. As such, most insured individuals will get help with some level of rehab insurance.

Insurance agent explaining coverage to the client.

It is important to note that each policy provider will set its own limitations on coverage and determine different conditions that the insured must meet for rehab treatment to be covered. In most cases, for rehabilitation to be covered by insurance, there must be a prior authorization before the individual starts the program and, in some cases, a referral from a doctor stating that rehabilitation is needed as part of addiction treatment.

Insured individuals should take some standard steps before using their drug rehab insurance.

These Are:

  • Contact the health insurance company and find out if a referral is needed and any other steps that must be taken to get the necessary approval 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 covered rehabilitation centers.
  • Find out what forms of care are included. For example, detox, inpatient therapy, alternative therapy, aftercare, recovery coaching, etc.
  • Get information on how long treatment in rehab will be covered. A plan may only cover 28 days of rehabilitation, while others do not place a limit.
  • Inquire about any specific limits of coverage. Will they only cover addiction recovery up to a certain dollar amount? Are certain therapies restricted?
  • Learn 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.

Enrolling in Drug Rehabilitation Center

If someone is insured and battling drug or alcohol addiction, there are two scenarios: treatment can be covered in part or in full. They should speak with their insurer before enrollment. If a person does not have coverage yet, it is time to get one. There are numerous state-funded and private options available on the market to fit any budget and needs. There are also some free rehabilitation centers that don’t require having an insurance plan.

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Page Sources

  1. HealthCare.gov, Affordable Care Act (ACA). https://www.healthcare.gov/glossary/affordable-care-act/
  2. Abraham, A. J., Andrews, C. M., Grogan, C. M., D’Aunno, T., Humphreys, K. N., Pollack, H. A., & Friedmann, P. D. (2017). The Affordable Care Act transformation of substance use disorder treatment. American journal of public health, 107(1), 31-32. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5308192/
  3. HealthCare.gov, Your total costs for health care: Premium, deductible & out-of-pocket costs. https://www.healthcare.gov/choose-a-plan/your-total-costs/
  4. Centers for Medicare & Medicaid Services, Self-Funded, Non-Federal Governmental Plans. https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Market-Reforms/nonfedgovplans

Published on: October 2nd, 2019

Updated on: February 14th, 2022

About Author

Isaak Stotts, LP

Isaak Stotts is an in-house medical writer in AddictionResource. Isaak learned addiction psychology at Aspen University and got a Master's Degree in Arts in Psychology and Addiction Counseling. After graduation, he became a substance abuse counselor, providing individual, group, and family counseling for those who strive to achieve and maintain sobriety and recovery goals.

Medically Reviewed by

Michael Espelin APRN

8 years of nursing experience in wide variety of behavioral and addition settings that include adult inpatient and outpatient mental health services with substance use disorders, and geriatric long-term care and hospice care.  He has a particular interest in psychopharmacology, nutritional psychiatry, and alternative treatment options involving particular vitamins, dietary supplements, and administering auricular acupuncture.