Does Health Insurance Cover Rehab?

The shocking reality is that 48.7 million Americans deal with substance abuse disorders, yet 94% of them never receive the critical treatment they need.

If 51% of working-age Americans have difficulty affording healthcare, you might be asking yourself, “How can I afford drug rehab?” Addiction is already a difficult journey, and thinking about the costs only makes it more challenging. The good news is that several options exist to help cover the cost of rehab, including health insurance.

Discover how insurance can help you access the treatment you need for a drug-free life.

Table Of Contents:

• Does Insurance Cover Rehab?
• Is Rehab Covered Under Insurance?
• What Types Of Rehab Does Insurance Cover?
• How Much Does Insurance Cover Drug Rehab?
• How Many Times Will Insurance Pay For Rehab?
• How to Use Insurance Coverage for Drug Rehab?
• Does Rehab Take Insurance? – Bottom Line
• People Also Ask

Does Insurance Cover Rehab?

Before we get into the details of the subject, it’s important to cover the terminology linked to health insurance. To assist you, we have simplified some of the key terms so you can get a hold of your policy and make educated choices regarding your healthcare:

• Premium: The amount paid for an insurance policy.
• Deductible: The amount you pay out-of-pocket before insurance coverage kicks in.
• Co-pay: A fixed amount you pay for a specific medical service.
• Coinsurance: A percentage of the cost you share with the insurer after the deductible is met.
• Policy: The contract between you and the insurance company.
• Claim: A request for payment for a covered loss.
• Coverage: The scope of protection provided by an insurance policy.
• Exclusions: Specific items or situations not covered by the policy.
• Limitations: Restrictions on coverage, such as maximum payouts or time limits.
• Exclusive Provider Organization (EPO): A plan that restricts coverage to a specific network of providers.
• Health Maintenance Organization (HMO): A plan for healthcare services through a provider’s network.
• Preferred Provider Organization (PPO): A plan allowing out-of-network providers but at a higher cost.
• In-network: Providers who participate in your insurance plan’s network.
• Out-of-network: Providers who are not in your insurance plan’s network.
• High Deductible Health Plan (HDHP): A plan with a high deductible but a lower premium.
• Health Savings Account (HSA): A tax-advantaged account used to pay for qualified medical expenses.
• Flexible Spending Account (FSA): A tax-advantaged account for eligible medical expenses.

Is Rehab Covered Under Insurance?

The short answer is yes. Many insurance plans cover rehab, but the extent to which rehab is covered by insurance can vary significantly depending on the type of insurance and the specifics of the plan.

The types of drug rehab covered by an insurance policy can change based on the provider and selected coverage tier. Rehab insurance may range from limited to comprehensive, but most plans will cover at least some rehabilitation services. Insurers often limit coverage to specific rehab centers within their network. Yet, even within these in-network facilities, coverage may be limited to certain types of rehab and specific drug rehab lengths.

This means that rehab insurance coverage could encompass all treatments offered by a facility or be limited to the minimum required by law. A list of the largest private companies that provide rehab insurance coverage is provided below:

• Aetna
• Amerigroup Insurance
• Anthem
• Blue Cross Blue Shield
• Humana
• Kaiser Permanente
• Kemper Direct (former Unitrin)
• Providence Health Plan
• State Farm Medical Insurance
• United Healthcare

What Types Of Rehab Does Insurance Cover?

Although insurance coverage is generally assumed to facilitate access to health care services, the relationship between insurance and access to addiction treatment can be complex.

Fortunately, the Affordable Care Act (ACA), also known as “Obamacare,” signed into law by President Obama in March 2010, includes substance use disorders as one of the ten elements of essential health benefits. The act requires that health insurance plans sold on Health Insurance Exchanges or provided by Medicaid include addiction treatment services.

The specifics can vary widely by provider and policy. Insured individuals must review their policies to understand what is covered and how long. Overall, you can expect your insurance to cover:

• Inpatient Rehabilitation: This involves residential treatment in a controlled environment.
• Outpatient Rehabilitation: This offers therapy and support services without requiring full-time residence.
• Intensive Outpatient Programs (IOPs): A step-down from inpatient, offering more flexibility.
• Medical Detoxification: This addresses the physical symptoms of withdrawal.
• Interventions: Various levels of professional intervention.
• At-Home Visits: In-home care and support.
• Therapy: Different forms of therapy and counseling (family, group, one-on-one).
• Medication-Assisted Treatment (MAT): Combines medication with therapy for addiction treatment.
• Dual Diagnosis Treatment: Addresses co-occurring mental health and substance abuse disorders.
• Aftercare and Continuing Care: Ongoing support to prevent relapse.
• Medications for Co-Occurring Disorders: Treatments for dual diagnoses.
• Substance Abuse Testing: Regular testing to monitor sobriety.

Does Medical Insurance Cover Alcohol Rehab?

Yes, Obamacare requires health insurance plans to cover alcohol rehab as one of the essential health benefits.

This coverage must be as comprehensive as other medical procedures, but most plans cover treatment as part of a cost-sharing plan, so the insured may still need to pay some of the costs.

To qualify for insurance reimbursements, you must submit your treatment plan to your insurance carrier for pre-approval before starting rehab. It’s important to note that the ACA also prevents health insurers from discriminating against patients with preexisting substance use disorders (SUDs) during the coverage process.

Does Insurance Cover Rehab For Depression?

One of the ACA’s most significant contributions to the health insurance industry is the establishment of health insurance marketplaces, where individuals can compare and purchase insurance plans.

Thanks to the ACA and mental health parity laws, health insurance marketplaces require plans to cover mental health conditions. They mandate that insurance companies offer equivalent coverage for mental health and physical health services.

This means you can get treatment for depression, but also for behavioral addictions such as gambling and pornography. Options such as therapy, medication, and inpatient rehab can be covered.

How Much Does Insurance Cover Drug Rehab?

The amount your insurance covers for drug rehab varies widely. Factors like your insurance plan (HMO, PPO, etc.), specific policy details (deductibles, copays), the level of care needed (inpatient, outpatient), and state regulations all play a role.

While many plans offer some coverage, checking your policy and the rehab facility’s insurance verification process is essential. Even if your insurance doesn’t cover 100% of the rehab costs, financial assistance such as:

• Many rehab centers offer sliding scale fees based on your income and ability to pay.
• Some facilities provide flexible payment plans to the burden of a large upfront payment.
• Many states offer publicly funded programs that provide free or low-cost treatment.
• Numerous non-profit organizations provide financial assistance for addiction treatment.
• Employers offer EAPs that can provide financial assistance for addiction treatment.
• Some financial institutions offer medical loans that can be used to pay for rehab.
• If you qualify, Medicaid and Medicare can provide substantial assistance for addiction treatment.

How Many Times Will Insurance Pay For Rehab?

Individuals recovering from various forms of addiction frequently encounter relapses, which have gained acceptance as an almost inevitable part of the recovery process.

The high rate of relapses, especially within a short period after even the most intensive treatment, is a primary concern in addiction treatment Many studies have shown relapse rates of approximately 50% within the first 12 weeks after completion of intensive inpatient programs that often last 4 to 12 weeks or more and can cost tens of thousands of dollars.

Given these high relapse rates, will health insurance cover rehab multiple times? The coverage for rehab by insurance for addiction relapse is not one-size-fits-all and is influenced by multiple factors:

• Specific policy limits (such as the number of admissions or maximum dollar coverage).
• The medical necessity of rehab and the patient’s treatment progress.
• Type of rehab required (inpatient vs. outpatient) and state and federal mandates.
• Patient’s compliance with aftercare and the effectiveness of prior treatments.
• Time between treatments and any instances of leaving treatment against medical advice (AMA).

These considerations collectively determine the frequency and extent of insurance covered rehab in cases of addiction relapse.

How to Use Insurance Coverage for Drug Rehab?

If you don’t know where to start when it comes to using your insurance for drug rehab, follow these steps to make the process smoother and ensure your treatment is covered:

• Confirm if a referral from a doctor is needed and check the steps required for pre-authorization.
• Determine if coverage is limited to in-network providers and request a list of covered rehab centers.
• Clarify what types of treatment are covered (i.e., drug detox, inpatient therapy, aftercare).
• Ask how long the insurance will cover rehab (some plans may cover only 28 days)
• Find out if there are any caps on the amount covered or restrictions on certain therapies.
• Learn which prescription medications are covered and the associated costs.
• Ask about copay and deductible amounts and plan for these expenses.

Does Rehab Take Insurance? – Bottom Line

Rehab centers typically accept insurance. However, coverage can greatly vary depending on the state’s regulations and the specific details of your insurance plan.

Remember that many factors—ranging from the type of rehab required to the individual’s past treatment history—can influence the scope of your coverage. Always review the benefits provided by plans in the marketplace to understand what specific treatments and services are covered.

The journey to recovery can be challenging, but rehab costs should not deter you from seeking the treatment necessary for a healthier life. If you’re considering rehab, don’t let financial concerns stand in your way. Explore your insurance options and reach out to a local rehab center.

People Also Ask

Is inpatient rehab covered by insurance?

Yes, many insurance policies cover inpatient rehab. The details of your specific policy, including any pre-authorization requirements and network restrictions, will depend on your specific policy.

Does my insurance cover rehab?

Most insurance policies include coverage for rehab, but specifics vary. Review your policy or contact your provider to understand the extent of your coverage, including types of treatment and providers.

How long does insurance pay for rehab?

The duration of coverage varies by policy. Some plans cover 28 days, while others offer more extended treatment based on medical necessity and prior authorization. Check your policy for specific limits.

Page Sources

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2. SAMHSA announces National Survey on Drug Use and Health (NSDUH) results detailing mental illness and substance use levels in 2021. (2023, January 4). SAMHSA. https://www.samhsa.gov/newsroom/press-announcements/20230104/samhsa-announces-nsduh-results-detailing-mental-illness-substance-use-levels-2021
3. Paying for it: How health care costs and medical debt are making Americans sicker and poorer. (2023). www.commonwealthfund.org. https://doi.org/10.26099/bf08-3735
4. Substance Abuse and the Affordable Care Act. The White House. https://obamawhitehouse.archives.gov/ondcp/healthcare
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