It is not uncommon to wonder if health insurance does cover drug rehabilitation because these treatments are often expensive. The Affordable Care Act requires private insurance companies, or ACA, to provide their members coverage for substance abuse treatment.
The law considers substance abuse treatment an essential health care benefit for all U.S. citizens. For this reason, most insurance companies will not be able to refuse to provide this coverage altogether.
However, our specific coverage will depend on each state and our chosen plan of care. Many companies will ask you to choose from a small pool of approved providers for a lower cost and may even ask you to pay for some costs.
The Affordable Care Act and drug rehab
Often concerns about insurance coverage for drug rehab are a barrier to people not wanting to get treatment. For this reason, only one in ten people with such a disorder receive treatment when required.
This is especially due to payment problems and lack of insurance. However, addiction treatment has become less stigmatized recently, especially because of the ACA. But, some insurance companies may make it difficult for people suffering from addiction to get the help they need.
What should coverage look like under the ACA?
In the old days, insurers did not cover substance abuse-related treatment and used to deny treatment. Today, however, the law known as Obamacare requires all insurance plans to offer substance abuse treatment.
However, insurance coverage for detox and rehab programs will depend on each person’s plan. Sometimes, people will need a medical referral for insurance to pay for treatment.
Many people who struggle with these disorders also suffer from some mental health disorders. For this reason, medications necessary for treatment or time spent in an inpatient rehabilitation facility are often covered.
Medicaid and Medicare
People who have Medicaid are also covered through the ACA. This is federally covered insurance intended for low-income people, and nearly 12% of adults who are beneficiaries of this program have a substance disorder.
On the other hand, Medicare is health insurance provided by the federal government for people over 65 or under the age of 65 with disabilities. It provides coverage for the treatment of alcohol and substance use disorders under the following conditions:
- The services provided must be medically necessary.
- Services will be received in a Medicare-approved, in-network facility.
- The provider will establish the plan of care.
All mental health and substance abuse facilities do not accept this coverage. For this reason, we will always need to contact the facility in advance to understand the specific treatment options.
What coverages do drug rehab insurances offer?
Some insurance plans will cover up to 100% of treatment and detox expenses when members meet their deductibles. However, other providers will require co-payments to be paid for each of the services charged by the company, and if they are out-of-network facilities, the treatment could be much more expensive.
The detoxification process varies depending on the substances used, and the amount covered by insurance varies depending on the process chosen and the person’s plan. Non-medical detoxification may be less expensive in a hospital-based detox center.
While insurance companies are required by law to provide coverage for substance abuse treatment, they do not necessarily have to cover the entire inpatient treatment. For this reason, you should always check with your insurance company to know what coverage they will provide.
How long is rehabilitation covered?
Multiple criteria will be used to determine the coverage they will offer a patient. Most commonly, insurance companies will work with our physician or treatment provider to determine what treatment is needed, what they will cover, and how long.
There are multiple levels of care in addiction treatment, and some plans will only cover a detox stay. On the other hand, some may provide coverage for many levels as the patient progresses through the continuum of care.
It is common to go through a comprehensive assessment of the needs of someone with a substance use disorder. In this way, it can be determined if improvement has been experienced or where there are difficulties with treatment. Based on these assessments, companies will be able to decide what coverage they will offer for different treatments, so they are treated on an individual basis.
Is residential treatment the same as inpatient treatment?
Inpatient rehabilitation will have different levels of care, while residential treatment will be a subcategory of this type of treatment. Multiple programs are part of inpatient care ranging from detoxification to residential care.
Detoxification, or withdrawal management, is usually considered the first step in receiving inpatient treatment for a substance use disorder. Once the substance is eradicated from the patient’s body, residential care may be chosen. In these cases, effective behavioral therapies can treat substance use disorders.
Does insurance cover aftercare?
Many insurance policies impose different time limits for outpatient and inpatient care. Some companies offer policies that extend coverage for up to six months or a year, while others stop coverage after a few days or weeks.
For this reason, we should always look closely at coverage with the chosen treatment center and insurance provider before committing to a specific treatment plan.
Detoxification alone can rarely guarantee a lasting recovery, as ongoing care is required for the patient. Generally, mental health services will be covered by insurance. Still, we should verify the coverage details, including methods such as cognitive behavioral therapy, group therapy, family counseling, and vocational rehabilitation.