Insurance Coverage for Addiction Treatment
Addiction is a treatable disease.1 However, cost is often a significant barrier for people seeking help. Health insurance can help people afford the care they need.
This page will provide a general overview of how insurance benefits apply to addiction treatment.
Does Insurance Cover Rehab?
The passage of the Affordable Care Act (ACA) extended insurance coverage to millions of Americans. It also included many reforms that prohibited companies from barring coverage for certain conditions, including substance use disorders (SUDs). These reforms apply to employer-based private insurance plans, ACA marketplace plans, and government policies.2
While almost all insurance policies now provide at least some coverage for addiction treatment, the details of this coverage vary greatly depending on the specific plan. The treatment types and facilities that are covered will also vary depending on the company and insurance plan.
Which Insurance Providers Cover Alcohol & Drug Rehab at AdCare?
AdCare facilities, located in Massachusetts and Rhode Island, provide various levels of care, with some facilities offering medical detox and inpatient rehab and others providing outpatient therapy. Your insurance plan may cover one or more of these levels of care, depending on your plan.
AdCare also accepts many other insurance plans on an out-of-network basis.
Does AdCare Accept Medicare/Medicaid?
Yes. Some AdCare facilities in Massachusetts accept state-run and federal insurance plans. This includes:3,4
- Medicare, which provides coverage for individuals 65 years old or older, qualifying individuals with disabilities, and those with end-stage renal disease. See if you qualify for Medicare.
- Medicaid, which provides coverage for low-income individuals/families, pregnant women, and those with disabilities. See if you qualify for Medicaid.
How Do I Use Insurance for Rehab?
While the ACA expanded coverage for mental health and substance abuse, different plans provide varying levels of coverage, and certain treatment options or facilities may or may not be covered. Different plans are also likely to vary in what types of treatment they will cover (e.g., detox, residential rehab, outpatient therapy, etc.)
You’ll want to consider cost as well as what an addiction specialist recommends for your unique situation. Often, people without a stable living environment, severe co-occurring disorders, or a high probability of relapse fare better in an inpatient or residential program. Others may respond just as well to less intensive options like outpatient care or day treatment.5
The first step to using your insurance to pay for rehabilitation treatment is to find a facility you believe can treat you effectively and accepts your insurance coverage. You will pay less if you choose a provider in your insurance network.
However, you can also go out of network if you prefer and are willing to shoulder the extra cost. If the facility offers more than one level of care, the staff can help you understand which levels your insurance will cover and for how long.
When you call AdCare at , we can discuss your insurance with you and let you know if you are covered for treatment with us and, if so, the details of what may be covered.
If you don’t already have a treatment provider in mind, you can search for providers in your insurance plan’s network. Most insurance providers will have a way to search online for in-network treatment providers. If you’re not sure where to look, you can call the number on the back of your insurance card.
Can I Use My VA Benefits for Addiction Treatment?
Veterans that have VA benefits may have to seek treatment through a VA treatment provider. If this care is unavailable or unsatisfactory, however, VA community care enables veterans to get treatment through a treatment facility that is within the VA network.6
How Much Does Rehab Cost with Insurance?
Insurance policies vary greatly in how and when coverage applies. When looking at the summary of benefits and coverage for your insurance plan, there are several important terms to understand:7-10
- The deductible is the amount you will have to pay on healthcare costs before insurance coverage kicks in. This excludes monthly premiums.
- Copay. Copayment is a fixed amount you will have to pay for certain services after you’ve met your deductible. For example, this may be a $40 charge to see your primary care doctor.
- Co-insurance rate. This is the percentage of the cost covered by the insurance company after the deductible has been met until the out-of-pocket limit is reached. For example, your insurance may pay 80% of a hospital stay and require you to pay 20% until you’ve reached the out-of-pocket maximum.
- Out-of-pocket maximum. This is the maximum amount you would be required to pay for insurance costs within a year (with some exclusions such as monthly premiums and out-of-network services). Once this limit has been met, the insurance company will pay 100% of the remaining costs.
Different plans will cover your rehabilitation in different ways. Plans that have lower monthly premiums may have higher deductibles, for example. Sometimes, the deductible will not apply to addiction treatment.
Also, plans may differ in the ways they charge you for care. One plan may cover a co-insurance percentage for outpatient treatment, whereas another will charge a fixed co-payment for each visit to an outpatient clinic.
It is important to understand how your plan will cover your treatment prior to beginning your care so you aren’t surprised by the costs in the end. You’ll also want to make sure you that your provider is actually in your plan’s network if you cannot afford out-of-network care.
Many programs will “accept” most insurances; however, this does not necessarily mean they are in-network—only that they will bill your insurance.
How Long Will Insurance Cover Treatment?
How long your plan will cover your care will, again, depend on your plan. Many providers will cover a brief period of detox if it is deemed necessary and may cover several weeks to months of inpatient or outpatient rehab. You’ll need to speak to your insurance company or to a prospective treatment center for help determining how long your care will be covered.
There is sometimes a limit of how many days of treatment within a year will be covered by insurance. For example, your plan may cover rehab once per year for a duration of 90 days. Under this plan, if you were to relapse that same year and require additional treatment, costs would have to be paid out-of-pocket.
How Do I Check My Insurance Coverage?
You can find information about your specific insurance coverage by checking the summary of benefits and coverage for your specific plan. This will contain information as it applies to different treatment settings in or out of your insurance network, such as your:
- Annual deductible.
- Co-insurance rate.
- Out-of-pocket limit.
- Co-payment amount.
Often in the summary of benefits, substance use and behavioral treatment will be grouped together.
Your insurance card or the company website will usually include the phone number for customer service. After providing your membership number, representatives should be able to answer specific questions and detailed answers.
Admissions navigators for AdCare can also answer your coverage questions, as well as provide information about all the treatment options offered by AdCare. Call to speak to an admissions navigator. Addiction treatment is a highly individualized process, so pricing and costs may vary according to your customized treatment plan.1 Flexible payment options may also be available depending on your situation.
You can also use the benefits verification form below to check your insurance coverage.