If you have private insurance or insurance coverage from Medicare, Medicaid, or TRICARE, then most of your alcohol or drug addiction treatment costs should be covered. While you may still be obligated to pay a deductible or co-pays, all insurance providers in the United States now offer health benefits for mental, behavioral, and addiction treatment services.

If you have questions about your insurance benefits for you or a family member, Zinnia Health can help. Call our helpline 24/7 at (855) 430-9439 to learn more about your coverage options and the benefits available to you.

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Does Your Health Insurance Cover Substance Use Treatment?

Since the Affordable Care Act (also known as Obamacare) was established in 2010, all health insurance providers in the United States have been required to offer some coverage for mental health, behavioral health, and substance use disorder treatment services.

If you purchased your health insurance plan through the federal Marketplace, then your benefits have been standardized:

Bronze plans typically pay for 60% of your treatment costs
Silver plans typically pay for 70% of your treatment costs
Gold plans typically pay for 80% of your treatment costs
Platinum plans typically pay for 90% of your treatment costs

Terms such as “Bronze” are used by most health insurance companies to differentiate between levels of coverage, but it’s important to note that coverage varies widely depending on your insurance provider.

Medicare, Medicaid, and TRICARE also have different ways of determining coverage. You must also consider your plan’s co-pays and deductibles when determining the coverage available to you. The best way to learn about your health benefits is to call your insurance provider directly and ask.

List of Health Insurance Companies Rehab Coverage Policies We Reviewed

Cost of Addiction Treatment

The cost of addiction treatment varies between treatment programs and individuals. For instance, the length of stay will greatly impact treatment costs. Generally, inpatient rehab programs cost more than outpatient treatment.

Broken down by type of treatment, the national averages are:

$250-$800 per day for detox
$42,500/month for residential treatment
$1,400 to $10,000 over a 30 day period for outpatient treatment

Your out-of-pocket costs may be substantially less if you have insurance or qualify for a grant program. Keep in mind, these are averages. Private facilities typically charge more under self-pay options.

What Types of Rehab Does Insurance Cover?

There are many ways to get help with alcohol or drug abuse and no two treatment paths look the same. With that in mind, the type of coverage you have can impact the types of rehab centers and services available to you.

In general, insurance providers will cover the following:

Inpatient Hospitalization: Generally a short-term form of care, inpatient hospitalization for drugs or alcohol is typically covered, especially if it is deemed an emergency. Daily coverage limits on emergency room stays may apply.
Inpatient Residential Treatment: Residential programs can last for a month or more, and more insurance providers cover these programs, as long as the facility is employing evidence-based treatment methods.
Intensive Outpatient Treatment: Also known as partial hospitalization programs, intensive outpatient treatment can entail multiple appointments each day. Co-pays may apply, especially for specialist visits, and you may be required to get a referral from your general practitioner before seeing a specialist.
Regular Outpatient Treatment: Regular outpatient treatment programs generally involve fewer appointments than intensive programs. Co-pays and referrals may still be required. There may also be a cap on your covered outpatient visits in any given calendar year.

In addition to knowing the types of treatments that your insurance policy does cover, it’s just as important to read the fine print and understand what they do not. TRICARE and many other insurers explicitly state that aversion therapy and experimental treatments (such as wilderness programs and hypnosis) are not covered.

Would you like more information on the types of treatment covered by your insurance company? Reach out to Zinnia Health at (855) 430-9439 and our team can answer your questions.

Common Types of Healthcare Plans and Benefits

In addition to knowing the level of coverage you have (i.e., Bronze or Silver), you also need to know the type of plan you have. This will determine which treatment providers you can see, and whether you need referrals before visiting a specialist.

PPO

A Preferred Provider Organization (PPO) is a type of plan where you have coverage for any specialist, but you will have more coverage when visiting an in-network specialist. Most insurance companies have an online portal where you can find treatment providers in your area who are in the PPO network.

If you have a PPO plan, you do not need a referral to see someone outside of your network, but your copay will be higher.

HMO

A Health Maintenance Organization (HMO) is a type of plan where you are generally only covered if you visit an in-network provider. Emergency visits are often covered even if you see an out-of-network provider, but most other services are not. You may also be required to live or work within a certain service area to continue being eligible for coverage.

If you have an HMO plan, you will likely need to coordinate appointments through your primary care practitioner (PCP). You may need to get a referral from your PCP before visiting a specialist or other provider in your network. The goal of this system is to provide a single point of contact who can help coordinate your care, with a focus on preventative health services.

POS

A Point of Service (POS) plan encourages you to see providers in your network by offering better coverage, just like a PPO plan. However, unlike most PPO plans, a POS plan will require you to get a referral from your primary care practitioner before seeing a specialist.

If you have a POS plan, you will want to speak with your PCP about rehab treatment. They can give you information about specialists in your area who can help you take the next step in recovery.

Are Treatment Medications Covered by Insurance?

Yes, medications you are prescribed in treatment are typically covered by insurance. Certain treatment centers may offer treatment medications such as methadone or buprenorphine to reduce withdrawal symptoms during withdrawal and minimize cravings during rehab.

These “maintenance” medications are often covered by insurance, but the coverage limits depend on your plan. For instance, Medicaid and Medicare policies will cover the cost of your treatment medications if they are deemed “vital” to your ongoing health.

How to Cover Rehab Without Insurance

If you do not have insurance coverage for the cost of rehab, there are ways to reduce your treatment expenses.

Some rehab facilities offer payment plans that allow you to cover the cost of treatment over time.
Non-profit and state-run facilities also exist, which provide treatment free of charge, but sometimes have waiting lists.
Grants, such as those from the Substance Abuse and Mental Health Services Administration (SAMHSA) can cover some or all of your treatment services if you are eligible.

If you’re concerned about the cost of treatment, that should not be a deterrent to seeking help. Most healthcare providers, including all hospitals, are trained and obligated to assist with drug and alcohol addiction treatment regardless of your ability to pay.

Eligibility Requirements for Enrolling in a New Insurance Plan

You cannot simply enroll in a health insurance plan whenever you wish to add or change providers. Instead, you need to wait for the Open Enrollment period or see if you qualify for Special Enrollment.

Open Enrollment

Open Enrollment is a period in which you can enroll in health coverage which will begin as soon as January 1 of the following year. The Open Enrollment period begins on November 1. Starting on this day, you can renew your health plan, enroll in a new health plan, or change your health plan.

December 15 is the last day on which you can enroll or change plans if you want your coverage to begin on January 1. If you are okay with your coverage beginning on February 1, then you have until January 15 to enroll or change plans.

Those who enroll between November 1 and December 15 will be required to pay their first premium on January 1, which is when their coverage begins.
Those who enroll between December 16 and January 15 will be required to pay their first premium on February 1, which is when their coverage begins.

If you are trying to get health insurance outside of one of these windows, you will need to qualify for a Special Enrollment period.

Special Enrollment

Special Enrollment periods open to individuals when certain life events occur that leave them suddenly without insurance coverage or change the affordability of their existing insurance coverage.

You may qualify for a Special Enrollment period if one of these things has happened within the last 60 days:

You got married: If this happens, you can pick a plan by the last day of the month and your coverage can begin as soon as the first day of the following month.
You had a baby, adopted a child, or began fostering a child: If this happens, your coverage can start as soon as the day of the event.
You legally separated or got divorced and lost your insurance: If you were covered by your spouse/partner and you got divorced or legally separated, you are eligible for Special Enrollment.
Someone in your household died: You are eligible for Special Enrollment if someone in your household or on your Marketplace plan died, causing you to lose your existing plan.

Can I Have More Than One Insurance Provider?

Yes, you can have more than one insurance provider at the same time. In addition to intentionally enrolling in two health insurance plans, you may also have dual coverage if you have your own insurance policy and:

You have health insurance coverage through your employer
You are married and your spouse has an insurance plan that covers you
You are under 26 years old and your parents have an insurance plan that covers you
You are under 26 and your parents have separate insurance plans that list you as a dependent
You are over 65 years old and you are covered by Medicare

When you’re enrolled in multiple health insurance plans, there is a practice known as “coordination of benefits.” This means one insurance plan will be named as your primary coverage, and the other as your secondary coverage.

Your primary provider will pay up to your coverage limit, and then the secondary provider will pay the remaining costs up to your coverage limit. If any expenses remain, you will have to pay them out-of-pocket.

If you are thinking about getting a second insurance policy, be sure to read the fine print. Some insurance plans do not permit dual enrollment, in which case you will need to depend on coverage from your existing health plan or wait until you are eligible to end your coverage and enroll in a new policy.

What Resources Are Available for Substance Abuse Treatment?

There are multiple resources available for substance abuse treatment, including:

VA Benefits & Insurance for Rehab: Guidance on the eligibility requirements and benefits for those eligible for coverage from the Department of Veterans Affairs.
TRICARE Benefits: More information on the mental health and substance use disorder treatment programs covered by military insurance.
US. Department of Health & Human Services: More information on the Affordable Care Act and the requirements it sets for health insurance providers.
Internal Revenue Service: Information on the Affordable Care Act tax provisions and how they can change the affordability of insurance programs and treatment.
State Health Insurance Assistance Program: Free insurance information and assistance for those eligible for Medicaid.
HealthCare.Gov: Offers guidance on selecting the right plan for you or a loved one.

Finding an In-Network Treatment Facility

Finding a drug or alcohol rehab that is covered by your health insurance policy can be tough, but you don’t have to search alone. When looking for a rehab center, ask them the following:

Do they offer a type of treatment program covered by your insurance?
Are payment plans available to help you pay for out-of-pocket costs?
Do they have any grants or other financial assistance programs available to you?

Do you need help figuring out the benefits you’re entitled to? Call Zinnia Health at (855) 430-9439 to speak with our caring team about your treatment options.