Is Alcohol Rehab Treatment Covered by Insurance?
Does Health Insurance Cover Alcohol Rehab Treatment?
Health insurance typically covers alcohol rehab—either fully or partially—for individuals. That’s because addiction is a disease and requires medical treatment in the same way that heart disease or cancer requires treatment. However, various factors influence the amount and type of coverage each insurance plan provides for alcohol addiction treatment. Learn more about your specific coverage and options here.
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.
Substance Use Disorder (SUD) continues to be a problem in the United States. In 2019, more than 20 million Americans aged 12 or older suffered from a SUD.
For many, the cost of health care services for alcohol addiction treatment becomes a barrier to recovery. As a result, these people don’t seek help because they believe it is out of their financial reach. But many who deal with alcohol abuse are unemployed or struggling financially. Similarly, even individuals with steady incomes may find the cost of rehab prohibitive when compared to other financial responsibilities.
Luckily, health insurance often covers at least some of the cost of addiction treatment.
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 abuse 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 coverage 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 the specifics of their policies.
In addition, those seeking addiction treatment can contact their insurance provider directly to ascertain coverage specifics.
How to Find Insurance Plans Accepted by Rehabs
First, check the policy. Call the insurance company and ask about the types of addiction treatment the policy covers. While these private insurance plans often have the most comprehensive coverage, the plans 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, 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 or 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 process1–insurance plans may exclude additional treatments.
Find Rehabs That Accept Insurance
Most rehabs accept some form of insurance. Many of our rehab facilities 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.
- All Treatment Centers
- California Rehab Center
- Miami, Florida Rehab Center
- Tampa, Florida Rehab Center
- Las Vegas Rehab Center
- Massachusetts Rehab Center
- Mississippi Rehab Center
- New Jersey Rehab Center
- Rhode Island Rehab Center
- Texas Rehab Center
- Locations Nationwide: Resolutions Recovery Residences
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 (like addiction) as reason to deny people health insurance or charge fees that made getting insurance cost prohibitive.
Can I Go to 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
Medicare for Alcoholism: Is It Covered?
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.
More Topics About Insurance Coverage for Alcohol Treatment
- Insurance Coverage
- Insurance for Detox
- Cost of Detox
- Expense for Alcohol Rehab
- Price for Outpatient
- Personal Finances in Recovery
- Public Assistance Help
- State Funded Options
Medicaid for Alcoholism: Is It Covered?
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, alcoholism treatment coverage includes medically necessary therapies, medications, and services, which may include:
- Screening and 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, certain 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 alcoholism 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:
- First, talk to a doctor to determine treatment needs. A doctor performs an assessment–which is generally covered–to determine the degree of abuse 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.
- Second, find the appropriate rehab program. Ask the doctor for rehab suggestions or search area facilities through the Find Treatment Near You tool. Another option? 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.
- Third, determine the ability to use insurance. After finding the appropriate facility with the recommended level of treatment, verify that they not only accept insurance but that they accept the specific plan.
- Lastly, 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.
Ready for Rehab? Take Our Alcohol Addiction Assessment
Take our free, 5-minute “Am I an Alcoholic?” self-assessment below if you think you or someone you love might be struggling with an alcohol use disorder (AUD). The evaluation consists of 11 yes or no questions that are intended to be used as an informational tool to assess the severity and probability of an AUD. The test is free, confidential, and no personal information is needed to receive the result.
- Substance Abuse and Mental Health Services Administration. (2019). Key Substance Abuse and Mental Health Indicators in the United States: Results from the 2019 National Survey on Drug Use and Health.
- Office of the Assistant Secretary for Planning and Evaluation. (2013) Affordable Care Act Expands Mental Health and Substance Use Disorder Benefits and Federal Parity Protections for 62 Million Americans.
- U.S. Department of Health and Human Services. Affordable Care Act: Pre-Existing Conditions.
- Medicare.gov. Mental Health & Substance Use Disorder Services.