Does Insurance Cover Rehab for Alcohol Misuse?
Does Insurance Cover Rehab for Alcohol Misuse?
Substance Use Disorders (SUD) continue to be a problem in the United States. In 2021, more than 46 million Americans aged 12 or older suffered from an SUD. Of those, 94% did not receive treatment for the disorder.1
For many, the cost of healthcare services for alcohol addiction treatment is a barrier to recovery. As a result, these people don’t seek help because they believe it is out of their financial reach. However, the truth is that health insurance typically covers alcohol rehab—either fully or partially—for individuals.
While various factors influence the amount and type of coverage each insurance plan provides for alcohol addiction treatment, insurance carriers are under legal obligation to cover some or all substance use disorder services. Plus, for rehab services not included in insurance coverage, private pay and personal loans can help cover gaps, making treatment more financially feasible for those in need of care.
Using Insurance to Cover Alcohol Rehab
In 2010, the Affordable Care Act passed. By 2014, it required all new small group and individual insurance plans to cover 10 essential health benefit categories, including mental health and substance use disorder services. Furthermore, it called for health plans and insurers that offer mental health and substance use disorder benefits to provide coverage that is comparable to that offered for general surgical and medical care.2
As a result, health insurance may cover inpatient rehab, outpatient rehab, and other services for the treatment of substance use disorders. But policies—and even individual plans—differ on the level of coverage they provide for rehab.
Therefore, it can be challenging to navigate the coverage, exclusions, and whether the specific treatment program being considered accepts payment through insurance. Luckily, most rehab centers employ insurance specialists to help prospective clients understand their policies.
In addition, those seeking addiction treatment can contact their insurance providers directly to ascertain coverage specifics.
How to Find Insurance for Alcohol Rehab
First, check your policy. Call the insurance company and ask about the types of addiction treatment the policy covers. While private insurance plans often have the most comprehensive coverage, they tend to cost more. In other words, if a particular plan has extensive rehab coverage, it is likely that those benefits include high premiums, paid for by the policyholder.
Common insurance companies that may be able to cover at least some of the cost of rehab include: Blue Cross Blue Shield, Aetna, Anthem (Elevance Health in California and Nevada), Cigna, Humana, United Healthcare, and more. For Veterans, TRICARE may also cover rehab depending on your plan as well.
Similarly, employer-provided group insurance plans can be expensive and may be subject to restrictions.
For self-employed individuals, people not insured through work, and those who don’t otherwise have insurance, the Affordable Care Act Marketplace and state exchange plans provide options for getting coverage for addiction treatment.
If the policyholder is seeking alcohol addiction treatment for the first time, for instance, the insurance plan may cover rehab.
However, if the person relapses and needs to return to treatment–which is often part of the recovery process–insurance plans may exclude additional treatments.
Types of Insurance Plans for Alcohol Rehab
While there are several types of insurance plans, each of which offer various levels of coverage for alcohol rehab, two of the most common are health maintenance organizations (HMOs) and preferred provider organizations (PPOs).
An HMO provides services at a fixed fee via a contracted network of healthcare providers. Members need to select providers within this network in order for care to be covered under the plan. Generally speaking, an HMO has fixed premiums at a slightly lower cost than PPOs. However, you usually need to select a primary care provider that then manages your health and from which you’ll typically need a referral before visiting a specialist. Most major carriers (e.g., Blue Cross Blue Shield, Cigna, etc.) offer some kind of HMO program.
A PPO also comprises a network of providers contracted to provide services as an agreed-upon rate to members of that plan. Often, PPO premiums are slightly higher than HMOs, but you’re free to see almost any provider of your choosing without obtaining a referral from a primary care provider first. Granted, you’ll typically pay less for in-network rather than out-of-network providers, but the choice is yours. Again, most large insurance companies (e.g., Aetna, Anthem (Elevance Health in California and Nevada), Blue Cross Blue Shield, United Healthcare, etc.) offer PPO options.
Finding Alcohol Rehab that Accepts Private Insurance
Most rehabs accept some form of insurance. Many of the rehab facilities under the American Addiction Centers umbrella are in-network with insurance providers, which can help with the cost of treatment. Explore our treatment centers near you to find the best treatment for your needs.
Is Addiction Considered a Pre-Existing Condition?
Under the Affordable Care Act, which went into effect for plans beginning on or after January 1, 2014, health insurance companies can’t refuse coverage or charge more for pre-existing conditions.3 In the past, insurance companies used pre-existing conditions (such as addiction) as reasons to deny people health insurance or charge fees that made getting insurance cost prohibitive.
Can I Go to Alcohol Rehab Without Insurance?
If you don’t have insurance, various state-funded health programs can help with the cost of rehab. These programs include Medicare and Medicaid. In addition, most treatment facilities accept payment options such as payment plans, loans, and public assistance. If the cost of rehab is deterring you or someone you love from finding treatment, call us today at .
Does Medicare Cover Alcohol Rehab?
Medicare parts A and B include coverage for addiction treatment. Part A helps pay for hospitalization for substance abuse treatment. Part B covers partial hospitalization or outpatient addiction treatment services.4
In addition, Medicare Part D provides coverage for medications that doctors consider medically necessary for the policyholder’s alcohol addiction treatment. However, some medications, such as methadone, are not eligible for coverage under Part D.
Does Medicaid Cover Alcohol Rehab?
Medicaid is the public health insurance program, funded jointly by states and the federal government, for low-income families. It covers the basics of alcohol dependency recovery—such as inpatient care, outpatient visits, and more. In most states, Medicaid recipients don’t pay a co-pay for addiction treatment services. However, not all facilities accept Medicaid as a form of payment.
What Does Health Insurance Cover for Alcohol Treatment?
Heath insurance coverage varies by policy. As a result, outpatient and inpatient rehab coverage differ by individual health plan and treatment provider. Generally, alcohol use disorder treatment coverage includes medically necessary therapies, medications, and services, which may include:
- Screening and alcohol intervention services.
- Detoxification from alcohol.
- Medication for detox or recovery maintenance.
- Inpatient services at a hospital or specialty care center.
- Outpatient rehab or treatment services.
- Individual or group counseling.
Additional services deemed not medically necessary are less likely to be covered. For example, some facilities feature amenities such as gourmet food, recreation programs, holistic care services, and other luxury accommodations, which may not be covered by insurance.
Furthermore, the out-of-pocket cost of Medication-Assisted Treatment (MAT) prescription programs vary by on provider. For instance, naltrexone’s cost with insurance may be different from plan to plan.
What Are Out-of-Pocket Expenses For Rehab Treatment?
While many insurance plans cover a healthy portion of treatment expenses, there are still costs for which the policyholder is responsible. These include:
- Premiums: The cost of having insurance.
- Coinsurance payments or co-pays: A lesser fee paid to access a doctor or service.
- Deductibles: A certain amount the policyholder is expected to pay before coverage begins.
- Lifetime limitations: Some insurance plans only pay for coverage up to a certain point; the policyholder is responsible for all costs beyond that.
How to Use Insurance to Pay for Alcohol Rehab
After verifying coverage levels for the specific policy, use insurance to help pay for rehab. Here’s how:
- Talk to a doctor to determine treatment needs. A doctor performs an assessment–which is generally covered–to determine the degree of misuse or addiction and the medically necessary treatment needs. This information meets the requirement for coverage, and consequently, helps inform the decision about the right facility for the individual.
- Find the appropriate rehab program. Ask the healthcare provider for rehab suggestions or consider one of American Addiction Centers’ facilities. Or check a state or municipality’s Behavioral Health or Health and Human Services department to find a convenient regional facility. In all cases, verify that the rehab program provides professional medical treatment to ensure that insurance will cover it.
- Determine the ability to use insurance. After finding the appropriate facility with the recommended level of treatment, verify that it not only accepts insurance but that it accepts the specific plan.
- Work with the rehab center to determine insurance coverage. A reputable rehab center employs specialists who can work with the insurance company to determine the level of coverage for the specific program. In some cases, these specialists can help individuals navigate payment options not covered by insurance, such as deductibles, co-pays, and other out-of-pocket costs. Some facilities also offer various financing options, so inquire about this prior to enrollment.
