Does Insurance Cover Drug Rehab?

Although drug rehab is integral to lasting sobriety, it can be expensive. Sadly, many patients skip over rehab simply because they are worried about the financial costs, or because they aren’t sure whether their insurance will cover rehab.

You may find yourself among the many prospective patients asking themselves, “Does insurance cover rehab?” If so, find out more about the types of health insurance available, what kind of rehab might be covered and how to get treatment without paying out of pocket.

Types of Health Insurance Plans

The first thing to consider when determining whether health insurance can cover drug rehab costs is what kind of health insurance is available. There are three major categories of health insurance, and these are an HMO, a PPO and a POS.

An HMO is a Health Maintenance Organization plan, and it means that any rehab care will first need to be recommended by a primary care physician. HMOs are popular because they tend to come with lower premiums and lower deductibles, but they can have some drawbacks when it comes to addiction treatment. Patients with a HMO health insurance plan will nearly always need to attend a rehab facility within their HMO’s network. Coverage is likely, but options might seem limited.

A PPO is a Preferred Provider Organization plan, which means that insurance holders can visit in-network health providers without first getting an appointment and subsequent referral from a primary care physician. When addiction is self-evident, and waiting times to get an appointment can be long, having a PPO can be a major advantage. With a PPO, patients can contact rehab facilities directly and find out if total or partial coverage is possible. Keep in mind that for many PPO health insurance plans, there are both co-pays and deductibles that will need to be considered.

The third and final category of health insurance plans is the POS, or the Point of Service plan. These health insurance policies require patients to coordinate all rehab services through their primary care physician. Rehab, if patients want it to be covered, may need to be found within the plan’s network.

The ACA and Rehab Coverage

Prior to 2008, health insurance providers could opt not to provide care for patients with pre-existing conditions. For many individuals struggling with addiction, this meant that rehab would rarely be covered. Thankfully, that is no longer allowed among health insurance plans sold through federal or state marketplaces.

Under the ACA, or the Affordable Care Act, mental health and substance abuse disorders are regarded as key pillars of health care. This means that no health insurance plan is legally allowed to withhold rehab, counseling, therapy or prescription medication if it could be beneficial to the sobriety or mental health of patients. However, there can be limitations put on the coverage provided, which can range from available facilities to duration of treatment.

Addiction Treatment That Insurance Typically Covers

The kind of health insurance held by patients can play a significant role in how much coverage is available for addiction treatment. Patients with excellent health insurance, for instance, might have more options than a person who purchased a very affordable policy. Regardless, there are some key elements of treatment that are nearly universally assured among those with health insurance.

Virtually every health insurance policy will cover an initial assessment, whether that’s through a primary care physician or a specialist. This assessment will confirm a drug addiction, detail the severity of addiction and then recommend the best course of action for patients. The overwhelming majority of health insurance plans will also cover detox for those addicted to drugs, although there may be some restrictions on the type of facility or the duration of treatment.

Often, patients who want to have rehab that’s fully covered by health insurance may need to choose outpatient care. This includes all the treatment and therapy of inpatient rehab, but without the accommodation and 24/7 accountability. Some health insurance plans, of course, do cover inpatient rehab programs, or they may be partially covered. This allows patients to choose the best kind of care for their recovery, but it might also require supplemental payments.

Factors to Consider When Exploring Coverage

There are several individual factors to consider when determining the level of coverage for drug rehab that a health insurance policy might provide. The scope of the network is incredibly important, since it can determine where patients are able to seek treatment. The best option will be a large network, because it gives patients a variety of choices without the need for going out of network and paying higher costs.

Some policies will also outline specifics about the duration of rehab treatment, or these limitations might be suggested by a primary care physician, depending on the severity of the addiction. This means that a health insurance plan might cover 30 days of rehab, but not 60. Patients should also be aware that they may have to pay deductibles before coverage kicks in, co-pays for initial physician and specialist visits or any costs that exceed annual or lifetime limits on their policies.

Alternative Means of Payment

Some prospective patients may not have health insurance, or their plans may not provide for the level of care or rehab location they prefer. In these cases, it’s important to be aware of alternative means of payment.

Medicaid and Medicare are two options for low-income or older individuals who want to attend rehab but don’t have private insurance. Individuals might also ask rehab facilities about the availability of payment plans, which spreads the financial cost over months or years to make it easier to manage. Scholarships are also sometimes available, both through rehab facilities and through government or charitable organizations.

No one should ever feel that they can’t attend rehab for financial reasons. Health insurance will often cover the cost of rehab, although there are typically some restrictions with regard to network, facility and type of treatment.