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Reviewed by Millions of Americans do not have insurance coverage from well-known companies. Instead, they rely on coverage from small insurance providers. For individuals with these plans, understanding their insurance coverage for drug rehab can be difficult.
Learn About How Small Insurance Providers Cover Drug Rehab:
Small Insurance Providers: What Are They?
Everyone knows the big names in the health insurance game. While these companies hold the lion’s share of health insurance policies in the U.S., they are not all that is out there. Many smaller health insurance providers are relied on by millions across the country.
Small insurance providers tend to be state or local rather than offering coverage at the national level. However, they can be national companies that simply are not well known. They are usually independent and run as non-profit organizations. In many cases, their products are limited, sometimes specializing in specific types of policies or offering many types, but with little in the way of options for customization.
Some examples of small insurance coverage providers are:
- Rocky Mountain Health Plans in Colorado
- HCC Medical Insurance Services nationwide
- CCHP Health Plan in California
- Arise Health Plan in Wisconsin
Generally speaking, these smaller insurance providers offer more affordable policies than larger companies because they have better connections with the local community and lower overhead, making it easier to negotiate prices and keep their costs low. The easiest way for people to find policies through these companies is to work with an insurance broker in their state.
Do Small Providers Cover Drug Rehab?
Just as with larger providers, smaller insurance companies will offer drug rehab coverage in some circumstances and not in others. And when they do offer this coverage, there are restrictions.
As a rule, short-term, temporary, and fixed-benefit insurance plans will not cover substance abuse rehab. Major medical policies, however, will cover drug rehab in most cases. Any plan sold through the Affordable Care Act exchange must offer this coverage.
Deductibles, Premiums, And Out-Of-Pocket Costs For Drug Rehab
While health insurance plans from small providers are often more affordable than those offered by larger ones, there are still fees associated with them. There are specific terms that users should know so they can understand their health insurance for drug rehab. These are premium, deductible, and out-of-pocket expenses.
Premium
The premium for health insurance coverage can be thought of as the subscription cost. This is the money one pays to have access to the product—the insurance coverage for rehab, 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.
Deductible
A deductible is the amount of money a person must pay towards their healthcare costs each year before insurance coverage will kick in. So if someone needs drug rehab, 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 rehab. For example, there may be a copay to pay towards medications and rehab stays, as well as for therapy sessions. 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.
Drug Rehab Options Covered By Small Providers
In general, drug rehab will be covered by small provider insurance policies so long as the services are considered essential. However, there can be limits even on essential services.
For example, inpatient rehab is considered an essential service for substance abuse. As such, small provider policies cover it. Where the restrictions come in is in how long they will cover it and at what facilities. Many will not cover more than 30 days within a single calendar year and will require the facility to be within their network. They also will restrict their coverage to therapies like cognitive behavioral therapy and group talk, not paying for things that are seen as an alternative, such as massages and art therapy.
Other aspects of drug rehab that are likely to be covered by small providers are:
- Outpatient rehab
- Drug detox when withdrawals could be deadly
- Medication management
- Aftercare and maintenance
However, what is and is not covered is specific to a given policy, and users should take time to check their coverage before trying to enroll in a substance abuse rehab.
When Users Cannot Find Coverage During Open Enrollment
Most small insurance providers are part of the health insurance exchange created through the Affordable Care Act. This has been good in many ways, as it has increased competition in the industry and helped to lower the costs of many small provider policies. And given that all of these policies must cover addiction treatment, it is good news for anyone battling substance abuse.
However, the only time someone can start a policy is during the open enrollment periods. Outside of these periods, these plans are not available.
Given that the need for substance abuse treatment does not stick to the open enrollment schedule, someone may find themselves in need of a new insurance plan at another time of year. Luckily, there are still plans offered that are outside of the exchange. These plans can be entered into whenever the company allows, with many having rolling enrollment periods that essentially leave them open at all times. Users can seek out these policies through an insurance broker.
When Drug Rehab Insurance Is Critical
If someone has insurance coverage through a small provider, they may be able to get help paying for drug rehab. All they need to do to find out is to verify their coverage. It is better to get insurance which covers substance abuse treatment before an urge.
Page Sources
- Private plans outside the Marketplace outside Open Enrollment. HealthCare.gov. https://www.healthcare.gov/private-plan-exceptions-outside-open-enrollment/.
- Your total costs for health care: Premium, deductible & out-of-pocket costs. HealthCare.gov. https://www.healthcare.gov/choose-a-plan/your-total-costs/.