Insurance Coverage for Drug Rehab: What to Know

One of the biggest concerns that people have is whether they will be able to afford the cost of rehab. Luckily, insurance coverage can dramatically reduce the amount that many treatment seekers will have to pay out of pocket.

Read more to discover the answers to questions like “Does insurance cover drug rehab?”, “How many times will insurance pay for rehab?”, and “How long does insurance pay for inpatient rehab?”

If you or someone you love needs help with addiction, call 888-534-2295 today to speak with a treatment specialist.

Does Insurance Cover Drug Rehab?

Yes. As a result of the Affordable Care Act (also known as Obamacare), health insurance plans in the United States must cover drug and alcohol rehab and mental health services.

Additionally, the Mental Health Parity and Addiction Equity Act of 2008 states that insurance companies cannot discriminate or deny rehab insurance coverage to individuals with substance abuse disorders.

While insurance must cover rehab services, providers are allowed to put limitations on what services are covered. Some of the most common limitations include:

• • A limit on the number of days of treatment that are covered
  • Limited coverage for detox services
  • Coverage exclusions for specialized programs
  • Pre-authorization for rehab services

• Periodic review of the ongoing necessity of treatment
• Geographic restrictions
• Restricting coverage to in-network providers
• Limitations on aftercare coverage

Despite these limitations, insurance is highly effective at paying for drug and alcohol rehab. In a study of 250 adults living in recovery, 44% had been able to use insurance to cover the costs of rehab.

How Many Times Will Insurance Pay for Rehab?

Some insurance companies may consider a relapse to be part of a “pre-existing condition” and deny coverage for additional treatment.

However, the limits placed on the care, treatment, and financial responsibility for mental and substance abuse disorders must be equal to those placed on any other physical health treatment.

Ultimately, it all comes down to the type of plan you have, the services you require, and how many days you’ve already been in rehab. It is important to remember that many insurance providers do not base their coverage on the number of times a patient has attended rehab, but rather the total number of days they have attended rehab.

For the most useful information, ask your insurance provider directly about how many times they will pay for rehab.

Can My Work Fire Me for Going to Rehab?

No. The Americans with Disabilities Act (ADA) considers substance use disorders to be disabilities and protects individuals who seek treatment for them. This means that employers are prohibited from firing employees based solely on their decision to go to rehab.

However, the ADA does NOT protect employees who are actively misusing substances, and employers can enforce their workplace policies regarding illegal drug and alcohol use.

Therefore, it is very important for employees to notify their employer about their intention to seek treatment, so they meet the ADA’s requirements for employers to reasonably accommodate employees with a disability.

Do Medicaid and Medicare Cover Rehab?

Yes, Medicaid and Medicare both cover rehab for eligible individuals. However, the services covered by Medicaid and Medicare can vary.

Medicaid is a joint federal and state program that provides healthcare to low-income individuals. Medicaid does cover substance abuse rehab, but the specific details vary from state to state. Examples of rehab services that Medicaid covers include, detox, inpatient rehab, outpatient rehab, counseling, and medication. Medicaid bases eligibility on factors such as income and household size.

Medicare is a federal program that primarily serves individuals aged 65 or older, and younger individuals with disabilities. It consists of different ‘Parts’, which offer coverage for different services. For example, Medicare Part A would cover inpatient rehab, Medicare Part B would cover outpatient rehab, and Medicare Part D would cover prescription medications used in addiction treatment.

Things to keep in mind about paying for rehab with Medicare and Medicaid include:

• Not all facilities or programs accept Medicaid and Medicare.
• Coverage specifics can vary between states and plans.
• Both Medicare and Medicaid may have associated out-of-pocket costs.
• Some individuals may be eligible for both Medicaid and Medicare, in which case both programs will work together to provide coverage.

What Addiction Rehab Services Does Insurance Typically Cover?

Most insurance policies will cover both inpatient and outpatient treatment at a rehab center.

Inpatient treatment is more costly because you receive care and monitoring, 24 hours a day. Outpatient care is designed for individuals who cannot leave their small children, school, or their job for an extended stay in a rehab facility.

Both inpatient and outpatient care can include supervised medical detox, plus therapy and counseling as needed.

Other examples of rehab services that may be covered by insurance include:

• Individual counseling
• Group therapy
• Medication-Assisted treatment (MAT)
• Dual diagnosis (co-occurring disorder) treatment
• Aftercare and continuing support
• Family counseling and education
• Holistic therapies

For the most specific and helpful information, ask your insurance provider to describe your coverage for inpatient rehab programs, partial hospitalization treatment programs, intensive outpatient programs, regular outpatient programs, and sober living communities.

How to Check What Your Insurance Covers

To check what drug and alcohol rehab services your health insurance covers, take the following steps:

1. Ask your insurance provider about what mental health and drug addiction treatment services are covered in your policy.
2. Ask your provider if there are any plan limitations when it comes to rehab coverage.
3. Ask your provider about co-payments, deductibles, and out-of-pocket maximums.
4. Verify your insurance coverage, by asking an admissions representative at rehab you are interested in for an estimate of the cost of the treatment, and how much your insurance will cover.

How to Find Rehabs in Your Insurance Provider’s Network

Finding rehabs in your insurance provider’s network is critical if you want to maximize your coverage and minimize your out-of-pocket expenses. Here are some different ways of searching for in-network rehabs:

• Visit your insurance provider’s website and use their online directory or search tool to find providers in your network.
• Call your insurance provider’s customer service hotline.
• Ask your primary care provider for referrals or recommendations.
• Contact rehab facilities and ask them to verify your insurance.
• Explore third-party online directories and databases.
• Use your insurance provider’s mobile app.

Paying for Rehab Without Insurance

Paying for rehab without insurance can seem like a challenge, but it is certainly not impossible.

Here are some alternative options available that can help you pay for rehab:

• Sliding Scales: Many rehabs offer sliding scale payment options, where the cost of rehab is partially determined by the patient’s ability to pay. Facilities may also offer discounts for upfront or lump-sum payments.
• Personal Savings and Assets: Many patients utilize personal savings, sell assets, and/or seek financial support from family and friends to pay for rehab.
• Payment Plans and Financing: Many rehabs offer flexible payment plans or work with third-party financing companies to help patients pay for rehab.
• Government-Sponsored Programs: These programs are usually free and designed to help eligible patients get the addiction treatment services they need.
• Local Community Resources: Community and religious organizations like churches and nonprofits may offer financial support for local rehab patients.
• Workplace Assistance: Employee Assistance Programs (EAPs) and other workplace benefits may help cover the cost of rehab.

Remember, the cost of addiction far outweighs the cost of rehab. Seeking out treatment will always be worth it.

Most rehab facilities will try to work with you to make treatment as affordable as possible, so make sure to ask the admissions staff about your payment options.

Start Your Journey to Recovery by Verifying Your Insurance Today

Drug and alcohol addiction can ruin the lives of the sufferer and their loved ones. Luckily, professional help is out there, and insurance can dramatically decrease the out-of-pocket expenses of attending rehab.

Legacy Healing is dedicated to making sure that you or your loved one get the treatment you deserve. We accept most major insurance providers and can also help if you do not have insurance.

Verify your insurance or call 888-534-2295 to speak with a treatment staff member about our services and payment options today.

Insurance for Addiction Rehab FAQs

Does health insurance cover drug rehab services?

Yes, health insurance is required by law to cover drug rehab services, including inpatient and outpatient rehab, detoxification, counseling, and medication-assisted treatment. However, insurance plans are allowed to place limitations on what is covered, such as limiting the number of days of treatment.

Contact your insurance provider for more information about the specific coverage offered by your plan.

What types of substance abuse treatment are typically covered by insurance?

A wide variety of substance abuse treatments are typically covered by insurance, including inpatient and outpatient rehab, individual and group therapy, detox, and medication-assisted treatment. Other services that may be covered by insurance include aftercare, holistic therapies, alternative therapies, and ongoing counseling. What specific services are covered will vary from plan to plan.

How do I find out if my insurance covers drug rehab?

If you are in America, your insurance is required to cover some drug rehab services. However, the amount of coverage can vary, and it is possible to exhaust your coverage. The easiest ways to find out what drug rehab services your insurance policy covers are to either contact your provider directly or contact a rehab you are considering and have them verify your insurance for you.

Are there any limitations or exclusions for insurance coverage of drug rehab?

Yes, insurance companies are allowed to put limitations on insurance coverage of drug rehab. Examples of common limitations include caps on the total number of days covered, requiring pre-authorization before services are provided, and restricting or excluding certain services. Contact your insurance provider to find out what your coverage limitations are.

What if I don’t have insurance? Are there other options for drug rehab?

If you don’t have insurance, or your insurance does not cover the full amount of treatment, there are several other ways to pay for drug or alcohol rehab, including:

• Personal savings
• Looking for facilities with sliding scale fees
• State-funded programs
• Financing or loans
• Religious, charitable, and community organizations
• Friends and family