One of the most frequently cited reasons for an addict to turn away from even the thought of treatment is because they believe that the cost of drug or alcohol rehab is simply out of reach for them to afford. Without tons of savings, great insurance, and an array of financing options, many simply feel defeated when it comes to their search for help in overcoming addiction. But does insurance cover rehab and if so, what does it cover?

If you have insurance, you may be wondering what your next steps are in determining whether you or your loved one’s treatment for addiction may actually be covered by your policy. Don’t let your addiction go untreated just because you don’t know whether you can afford help or not—call our helpline at 1-800-552-0697 to find out about the different types of health insurance coverage and how rehab insurance could help you get the treatment you need, at a price you can afford.

What is Drug & Alcohol Rehab?

Before you decide on a treatment plan, you must have an understanding of what drug and alcohol rehab IS. Much like you go to a doctor for a broken bone or a respiratory infection, you go to drug or alcohol rehab if you are struggling with addiction to these substances. You don’t delay getting help when you’re inflicted by pain or injury but yet most delay getting help when they are addicted to drugs or alcohol. This delay often comes as a result of many different reasons such as:

  • Fear that others will find out about your substance abuse.
  • Fear that the process will be painful.
  • Fear that you will “fail” in treatment.
  • Fear that you won’t be able to afford treatment.
  • Fear that you won’t get the adequate help that you need.

Did you notice a common denominator here? “FEAR” is the number one reason people do NOT get help for addiction to drugs or alcohol. Whether you are in fear about your finances, or in fear about losing your job when you go away from treatment, or you’re in fear about the “what ifs” that come along with entering an inpatient rehab center—FEAR is the factor that has some 23 Million Americans afflicted by addiction and a mere 2% getting treatment.

To reduce some of that fear, here’s what you can expect in drug or alcohol rehab:

  • Support and loving care from counselors, therapists, and other staff.
  • A clean, supportive environment where drugs and alcohol are strictly prohibited.
  • Around-the-clock care IF you are in an inpatient rehab center.
  • Structure and schedules that help to prepare you for life outside of treatment.
  • Detox, medical care and whatever you need to remain as comfortable as possible.
  • Visits from friends and family as you rebuild your support network for optimal, long-term healing.

Since the changes made to how health insurance is provided to individuals through Obamacare or the Affordable Care Act, all marketplace insurance plans are required to provide at least some coverage for drug or alcohol addiction as part of the “essential coverage” list. What this means is that inpatient or outpatient drug rehab, inpatient or outpatient alcohol rehab, counseling and therapy services for substance abuse and drug or alcohol detox services are often covered either partially or fully by your health insurance carrier.

Types of Insurance and Coverage Options

Various types of health insurance are provided to individuals through their place of employment, privately, and through the Healthcare.gov Marketplace. There are also state-funded insurance options such as Medicaid and Medicare for those who do not qualify for Marketplace plans, are not provided insurance as part of their employment or cannot otherwise afford health insurance coverage.

Under the Affordable Care Act, ALL insurance options listed above are required to cover essential treatment for substance abuse or addiction. Some provide detox and general counseling, other plans may provide live-in rehab, other insurance plans may provide long-term rehab up to 120 days or more. The bottom line is, these insurance programs are now required to offer help for addiction much like they previously did, and still do, for various medical conditions such as diabetes or a broken bone.

Coverage options vary based on your plan, your needs, and various other factors. If you’re not sure what will be covered by your health insurance policy, call our helpline at 1-800-552-0697 and we’ll review your policy with you to help you understand what IS and IS NOT covered by your specific policy and for your unique situation. Each case is different so a phone call is the best way to find out what’s going to be most beneficial for you.

The most commonly covered services that you can receive through your healthcare benefits include:

  • Drug or alcohol detox – a safe, medically monitored environment to stabilize physically from the effects of withdrawal.
  • Outpatient drug or alcohol rehab – a safe environment to receive counseling and therapy on a scheduled basis while you remain active at work, home or school when you’re not in treatment.
  • Inpatient drug or alcohol rehab – a fully-encompassing rehabilitation process in which you live in a rehab center, receive around-the-clock care and focus 100% of your time on recovery and healing.
  • Psychotherapy and other therapy options – individual and group therapy or counseling sessions, generally on an outpatient, as scheduled basis to help you develop coping skills necessary for long-term sobriety and healing.

Is Luxury Drug and Alcohol Rehab Covered?

Not all luxury inpatient rehab centers are covered by healthcare insurance. Often times what you will find is certain facilities are covered as part of an in-network service or that you can choose from one of these upscale facilities but it will be considered an out-of-network choice which means higher copays and coinsurance or no coverage at all for the patient.

It’s important to refer to your specific rehab insurance policy to find out what is covered and to learn whether luxury rehab programs may be offered as part of this healthcare option to you. Luxury programs are not generally considered an essential element to recovering from addiction—as much as you may “WISH” or “LIKE” to have gourmet meals, private rooms and a swimming pool during recovery, these amenities are not NECESSARY – as such, in deciding what portion of care you have to pay for outside of what your rehab insurance covers, many luxury amenities are NOT covered.

Private insurance, that you did NOT purchase through the Healthcare Marketplace and that is not through your employer may be more open to allowing payment for all or some of the benefits offered by a luxury rehab program. Again, a simple check of your insurance policy can help us to determine what rehab options are available to you and within your budget—just give our helpline a call at 1-800-552-0697 to find out.

What is NOT Covered?

In general, healthcare insurance plans will NOT cover treatments that are not deemed medically necessary to your recovery from addiction to drugs or alcohol or to heal physically or psychologically from other, dual-diagnosis conditions such as anxiety, depression, PTSD or other issues.

It can be frustrating working with the insurance companies—most insured individuals find quickly that insurance companies are in it for their own monetary gains and not for YOUR health. As such, you may find that it takes a lot of push and pull, back and forth, in order to get an insurance company to approve certain services or to deem some treatments medically necessary. It’s important you remain focused, and in control of YOUR health—don’t get discouraged.

We’ll help you every step of the way! Often times an insurer is more apt to accept a request for treatment when it comes from a doctor or other healthcare professional. As such, many patients have better luck first seeking the help of a professional to call their insurance company and work through the benefits program with them versus trying to “do-it-yourself.” Don’t be afraid to ask for help—this can be a long, ongoing process of back-and-forth approval requests and denials, let a professional help you make progress toward your treatment goals as quickly, and efficiently, as possible.

How Much Does Insurance Cover?

The amount of rehab covered by insurance varies by individual, policy, and unique situation. This makes placing an exact figure on how much insurance DOES cover nearly impossible without us knowing the facts. Some policies cover 100% after your deductible is paid—and some policies have a very low deductible making treatment VERY affordable. Other policies have higher deductibles and may only cover certain types of treatment such as X number of days in medical detox and X days in residential rehab.

We can help you figure out just what your insurance policy will cover by running a free, no-obligation insurance benefits check to determine what coverage options are currently available to you and where you should begin in terms of getting the addiction treatment that you need.  You may find that your insurance will cover 80% or more of your treatment, or that you just have a co-pay of a certain amount daily up to a maximum annual amount of XX Number of days in rehab.

Again, all plans are different so calling 1-800-552-0697 is very important so that we can explain your policy to you and help you find a rehab that accepts your coverage.

How Else Can I Pay for Addiction Treatment?

What if you don’t have insurance, or your coverage for rehab care is much less than what you anticipated? You STILL need treatment for addiction—you STILL need to go to rehab, but now you’re worried about HOW you can afford it…

Here are some other ways that you can pay for drug or alcohol rehab that your health insurance coverage does not provide for:

  • Set up a payment plan – most rehab centers will allow you to do this allowing you to make affordable monthly payments towards your treatment.
  • Take out a personal loan – if your credit isn’t ruined, you may be able to take a personal financial loan to help you pay for upfront costs associated with drug or alcohol rehab and to place additional funds in an account for out-of-pocket expenses later on.
  • Ask friends, family and loved ones for help – they may have turned you away previously because they do not want to further contribute to your addiction, but many family members are willing to step back into your life when you make the RIGHT choice to seek help for yourself—you might be surprised.
  • Healthcare credit cards and standard credit cards – you can often get healthcare credit cards with lower interest rates than a standard credit card allowing you to pay for treatment longer term with lower interest. Likewise you can pay for your treatment using your own credit cards.

These are just some of the options that are available to help you offset the out-of-pocket costs associated with getting addiction treatment even after insurance has covered a portion of the bill.

Get Help Finding a Rehab Center that Accepts YOUR Health Insurance

Need help finding a rehab center that accepts your health insurance? Whether you have Aetna, Humana, Cigna or one of the many other insurance plans available both in the Marketplace and through private health insurance vendors, we can assist you. Our helpline is available 24 hours a day, 7 days a week to help you make sense of the different types of insurance available to pay for drug or alcohol rehab, and what you need to do to get the help you need for long-term sobriety.

If you or someone you love is addicted, call 1-800-552-0697 for help finding a rehab center that accepts your health insurance and will provide you the best possible treatment for your situation.