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When discussing treatment options, many struggling with a substance use disorder and their loved ones have a common question, “does health insurance pay for rehab?” The short answer is yes, it does. Thanks to the passage of the Affordable Care Act, more Americans have access to addiction treatment.
Most insurance companies provide some level of coverage for drug rehab. While the specifics vary per policy, anyone looking to get treatment for a substance use disorder should be able to tap into their health insurance to cover some or all of the cost.
How The Affordable Health Care Act Changed Drug Rehab Coverage
Today, many people suffering from addiction cite their finances as a barrier to seeking treatment. Only one in ten people with a substance use disorder get the treatment they need. Payment issues and lack of knowledge about insurance coverage is part of this problem.
Years ago, many insurance companies did not cover substance abuse treatment at all. Companies denied coverage for addiction treatment. Sometimes, they’d even consider co-occurring mental health conditions “pre-existing conditions.”
After the Affordable Care Act (ACA) in 2010, insurance companies categorized mental health disorders and addiction changed. The ACA requires that all plans provide coverage for cognitive and behavioral health services, including substance abuse.
While the length of coverage depends on someone’s plan and treatment program, at least this was a step in the right direction.
In addition to addiction treatments, the ACA also mandated policies to cover the treatment of mental illness. An essential step for those with dual diagnosis struggles. Many people who struggle with addiction and substance abuse issues also struggle with a co-occurring mental health disorder, such as anxiety or depression.
What About Employee Assistance Programs?
According to the U.S. Office of Personnel Management (OPM), “EAP addresses a broad and complex body of issues affecting mental and emotional well-being, such as alcohol and other substance abuse, stress, grief, family problems, and psychological disorders.”
These voluntary programs are also free and confidential, so counseling and referrals are kept between you and the treatment organizations you’re paired with. It’s also possible for an employer to initiate the EAP process if a worker’s substance abuse issues become apparent and affect work. Either way, an EAP representative will eventually make the referral that puts the employee in touch with treatment options before finally returning to work.
The program also helps with addiction education, peer group programs, and family support. Many EAPs also offer adjusted work schedules so employees can seek treatment while working. In this case, many employees are referred to an outpatient program that gives them the flexibility to maintain a working schedule.
Understanding Health Insurance Policies
There are two main healthcare plans out there — HMO and PPO. Either of these plans modalities may cover substance abuse treatment. However, each one offers different coverage.
HMO (Health Maintenance Organization)
Usually, these are more affordable plans. They allow patients to choose a primary care physician and see them for most medical needs. HMOs have lower or no deductibles, and the overall coverage is lower than other plans.
PPO (Preferred Provider Organization)
These are more flexible plans that allow patients to see healthcare providers in- and out-of-network without a referral. PPOs have higher deductibles, and the coverage is often higher than other plans.
What Type of Addictions Are Covered?
Insurance plans that participate in the marketplace must provide care in ten essential health categories, including addiction care. Most insurance companies don’t specify which drug addictions are covered. If someone needs addiction treatment, then care is provided, regardless of what addiction is caused by. This is very similar to how health insurance programs treat other medical conditions.
What Types of Addiction Treatment is Covered by Health Insurance?
Here’s where each insurance company differs in terms of coverage. Overall most health insurance will cover whatever treatment is needed to help someone with an addiction. However, the coverage and length of coverage will vary depending on someone’s policy. Overall, most addiction treatments covered by health insurance companies include:
- Drug and alcohol medical detox
- Inpatient rehabilitation
- Outpatient care
- Dual diagnosis programs
- Aftercare recovery programs
- Medication-assisted treatments
Lighthouse Recovery Institute partners with many health insurance providers to offer the best alcohol and drug treatment at a low cost for our patients. Depending on your policy, you may be able to go to several facilities nationwide, including ours in sunny Florida. Find out if your insurance provider covers treatment, or use the tool below.
What Types of Rehab Facilities Are Covered?
No two rehab facilities are the same. Some addiction centers only focus on maintenance recovery, while others offer just detox services. The same differentiators can be seen in the type of treatments available or the accommodations.
For example, most insurance policies will provide coverage for these types of treatments:
- Cognitive-behavioral therapy (CBT)
- Dialectical-behavioral therapy (DBT)
- Group therapy
- Family therapy
- Vocational rehabilitation
Occasionally, some treatment centers will incorporate New Age treatments like acupuncture, yoga, or music therapy that are often not covered by insurances.
Some rehab facilities, like private treatment, executive treatment, and luxury rehabilitation facilities that offer spa-like accommodations might not be covered by insurance. Of course, this all depends on the type of policy each person has.
Some plans to provide coverage for every single treatment approach. For example, some programs offer care for inpatient detox, residential treatment services, and outpatient counseling. That’s the full spectrum of addiction care, all under one plan.
Are Treatment Medications Covered?
Many substance abuse programs integrate medication-assisted treatments during and after someone completes their treatment. These are meant to help those who can’t function normally in the absence of drugs, even after completing treatment.
As you might know, the chemical alterations caused by drug and alcohol abuse sometimes are too severe and cause permanent damage. In this case, people might need some medication to correct those imbalances and remain drug-free.
Maintenance programs can help people maintain their recovery long after leaving treatment. For example, opioid maintenance therapy with medications like methadone can prevent withdrawal symptoms, reduce cravings, and provide other long-term health benefits.
Other maintenance programs like Suboxone or buprenorphine can help others with similar difficulties. However, these treatments can mean thousands of dollars a year. Thankfully, most insurance companies do cover these drugs.
Some organizations say that most health insurance plans cover these drugs for people recovering from heroin and other similar drugs. However, the Substance Abuse and Mental Health Service Administration (SAMHSA) points out that Medicare and Medicaid plans will only cover these drugs if their use is considered “vital for the ongoing health of the person in recovery.”
This is why, as someone progresses through treatment, asking about coverage and alternative therapies is critical before they sign up for something they might not be able to afford.
Using Health Insurance to Pay for Rehab
Health insurance benefits are designed to give people access to mental health and substance abuse care at affordable prices. The idea is to eliminate the stigma associated with drug abuse and start asking for help.
It’s paramount that people with addiction and their loved ones learn about using their health insurance to its fullest potential. Talking to your insurance provider is a great place to start. However, speaking directly to the staff of addiction treatment facilities can also be helpful. Most admission specialists can answer your most common questions about insurance coverage for drug rehab. At Lighthouse Recovery Institute, our admission specialists can help you find out your policy’s coverage and help you start the path to recovery.
Even if your insurance policy doesn’t cover a portion of your treatment plan, ask about the different financing options available. Treatment centers like Lighthouse Recovery Institute count with rehab program scholarships, financing options with easy-to-follow payment plans, and other options to help you afford the treatment you need to leave addiction behind.
Learn More About Your Insurance Drug Rehab Coverage Options
Get Help Today
If you or someone you know is struggling with a substance use disorder, don’t wait. Seek treatment today. At Lighthouse Recovery Institute, our caring staff is always available to answer your questions. We know that seeing someone suffer from substance abuse disorder can be heartbreaking and overwhelming.
But, you don’t have to go through it alone. We’re here to help you learn more about addiction and how to make it a thing of your past. Reach out today, and let’s start walking towards a drug-free life in recovery.
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