Does Health Insurance Cover Alcohol or Drug Addiction Rehab?
Health Insurance Glossary of Terms
Before you continue reading, here are some terms and definitions that may help you better understand your insurance policy and substance abuse treatment coverage.
- Deductible: The amount you pay for health care services before insurance coverage kicks in. If you have a $2,000 deductible, you pay the first $2,000, and then your insurance pays the rest. Sometimes you’ll have a copayment or will need to pay for coinsurance for covered services after the deductible is met.
- Copayment: The fixed amount you pay for health care services after the deductible is reached. For example, your copayment may be $20 per doctor visit.
- Coinsurance: The percentage of costs you pay for health care services received after you’ve met your deductible.
- Out-of-Network: A health care provider or organization that does not have an agreement with your health insurance provider.
- In-Network Provider. A healthcare provider or organization that has an agreement with your insurance provider to provide care at a discounted rate.
- Out-of-pocket and out-of-pocket limit: Out-of-pocket expenses are those you will be financially responsible for paying on your own. The out-of-pocket limit is the most you will have to pay for services in a year.
- Premium: The amount of money you must pay (monthly or annually) for your health insurance policy.
Does Your Health Insurance Cover Substance Abuse Treatment?
Yes, health insurance plans will generally cover the cost of treatment for substance use disorder (drug and alcohol addiction) and mental health conditions. The particular health insurance plan that you have will determine how much of your treatment is covered by your insurance plan, as well as how much you will be required to pay out-of-pocket. It’s best to check with your insurance provider before trying to enter a treatment program for substance abuse issues to understand the details of what is covered under your plan.
Find out instantly if your insurance may be able to cover all or part of the cost of addiction treatment. Or call us today at and an admissions navigator can help you through the verification process.
What Types of Rehab Does Insurance Cover?
There are various types of addiction treatment in the United States, most of which are often covered by health insurance policies. Nearly 90 percent of Americans have some form of health insurance in 2021.1 Depending on your insurance plan specifics, addiction treatment programs covered by insurance include:
- Inpatient rehabilitation.
- Outpatient care.
- Medical detoxification.
- Medication-assisted treatment.
- Dual Diagnosis & Co-occurring mental health treatments.
- Continuing care (e.g., counseling, therapy)
- Maintenance medication to support ongoing sobriety & other forms of MAT.
Insurance Providers & Rehab Coverage
Health insurance benefits are designed to make health care both affordable and accessible, and there’s no stigma attached to asking for help. People with addictions and insurance should use their coverage to the fullest in order to get the care they need to leave addictions behind for good. Talking to plan administrators is a great place to start, but remember that the staff of addiction treatment facilities can also be of vital help.
In some cases, they can smooth the path to payment, so families have one less thing to worry over as they recover. Explore more information about insurance providers and rehab coverage below. Call us at if you do not see your provider listed below. We may still be able to work with you or your insurance provider to find treatment.
Going to Rehab Without Insurance
If you don’t have private health insurance, don’t let this be a barrier to accessing treatment when you are ready. There are still various free rehab and state-funded rehab options available to you. States offer financial assistance for those who have no insurance and are in need free or low-cost addiction treatment. Google your state, county, or city to find low-cost substance use disorder programs and services. Many states offer free rehab or have state-funded rehab options, state insurance policies, and other ways to help those who need it.
Other options for paying for drug and alcohol addiction treatment include:
- Loans and/or payment plans. Many treatment centers provide financing options that allow you to pay back the cost of treatment in small increments after treatment.
- Scholarships. Some treatment facilities offer scholarships to those in need to cover all or part of the cost. Some states also offer scholarships and grants to those with addiction who need help paying for treatment.
- Financial support from family. Though asking for help can be difficult, you may be surprised by how many people may want to support you. Ask family and friends for financial support in your endeavor to get sober. It’s worth a try.
The Affordable Care Act (Obamacare) & Health Insurance Coverage
In March 2010, the Affordable Care Act was signed into law to make health insurance affordable and accessible to more people.2 The law also aimed to expand the Medicaid program and support innovative medical care delivery methods.
The Affordable Care Act also states that no one can be denied access to health insurance, even if they have a preexisting condition like substance use disorder. The ACA lists substance use disorder as one of the 10 elements of essential health benefits that all healthcare insurers must provide. This means that all health insurance providers are required to provide coverage for mental health care and treatment.3 Both rehab for substance use disorder/addiction and mental health care services fall under this mandate.
Can I Have Multiple Insurance Providers?
Yes, you can have multiple insurance providers. When two (or more) health insurance plan providers cover the healthcare costs of one person, this is called coordination of benefits. You may have dual insurance coverage if:
- You are married and covered under your insurance plan and your spouse’s.
- You are under 26 years old and covered by your parents’ insurance and your own.
- You are under 26 years old with divorced parents and are under both parents’ plan as a dependent.
- You are over 65 years old and have coverage through your employer and Medicare.
If you have two separate health insurance plans, one plan will be your primary coverage and the other is your secondary coverage. Your primary provider pays first – up to its coverage limits. Your secondary insurance will then step in and pay the remaining cost (partial or full) of the treatment(s). Even after secondary insurance pays, you may still have some out-of-pocket costs.
Common Types of Healthcare Plans & Benefits
The three most common healthcare plans are health maintenance organization (HMO) plans, preferred provider organization (PPO) plans, and point of sale (POS) plans.4 Substance abuse treatment and recovery may be covered by your insurance provider. Learn more about which plan, HMO or PPO, offers the best coverage:
- HMO (Health Maintenance Organization) plans allow patients to choose their primary care physician and see that doctor for most of their medical needs. This allows them to form a relationship with a doctor who knows their whole health history. When seeking a specialist or physician outside of the network with an HMO plan, a referral is needed by your primary care physician.5 HMOs have lower or no deductibles and overall coverage is usually a lower cost than PPO.6 Pros of HMO coverage are for those that are not seeking a specialist and healthcare providers out of their network and paying lower premiums.6 Health maintenance organizations cover healthcare costs for all in-network providers and services. You will be responsible for paying out-of-pocket if you seek care with a provider that is out-of-network with your insurance provider. HMOs generally offer lower monthly premiums and deductibles with set copays.
- PPO (Preferred Provider Organization) plans allow patients to see healthcare providers in and out of their network without referrals.7 Preferred provider organization plans offer a little more flexibility in that they allow members to visit any doctor of their choosing, both in and out of network, but you’ll pay less if you stay in-network. You don’t need a primary care physician, and referrals are not required to see a specialist. PPO plans have higher monthly premiums and lower copays for treatments and services received. PPOs can have higher deductibles than those with an HMO plan.6 One of the pros of PPO coverage is having the option see specialists and other healthcare providers outside of your network without a referral from your primary care physician.6
- POS (Point of Sale): Point of sale plans are similar to HMO plans. The primary difference is that you can sometimes see care providers outside of your network in certain cases. This is what “point of services” means. Each insurance company varies with its rules on POS plans, so be sure to check the details of your specific insurer if this is the type of plan you have.
Drug Addiction Coverage & Cost
Many healthcare insurance providers may be able to cover all or part of the cost of alcohol or drug rehab. The cost of rehab varies depending on the patient’s level of treatment, length of stay, insurance coverage, and other unique factors. The amount of coverage or insurance acceptance is based on the insurance policy that each patient is covered by. This means out-of-pocket expenses will vary.
HealthCare.gov reports that plans participating in the insurance marketplace must provide care in 10 essential health categories, one of those being addiction care. Many private health insurance plans follow these same rules, too, so they could be sold on the marketplace at a later point in time. Most insurance policies don’t separate drugs into “covered” and “non-covered” categories. If addiction treatments are considered a covered benefit, then care is provided to anyone who has an addiction, regardless of what that addiction is caused by. This is the same model health insurance programs use in order to treat other medical conditions.
For example, some people develop obesity through overeating, while others develop weight difficulties due to hormonal or gland abnormalities. Health insurance programs that provide a weight-loss benefit don’t cover one type of weight loss while eliminating the other. Doing so would make the plans much more expensive, as underwriters would need to delve deep into the medical history of each person needing care, and the plans would need to cover sophisticated tests in order to determine how the obesity came about. By just covering all obesity treatment, the plan can save money.
The same is true for addictions. Plan administrators don’t want to cover in-depth testing and interviews about what drugs were used, how the drugs were developed, where they came from, and what they’re mixed with. Plans can keep things simple by covering all drugs, if they provide an addiction care benefit.
Under the Affordable Care Act, insurance plans are required to provide a one-page summary of benefits and therapies, along with their fees, per the U.S. Department of Health and Human Services.
Covering addiction care can also help states to keep costs down. For example, a PBS report suggests that incarcerating an adult for one year can cost up to $37,000, while providing residential care for addiction costs just $14,600. State-run plans might very well provide robust addiction care for all drugs simply because doing so could keep other costs in line. Private plans might see benefits if addicted people don’t land in expensive emergency rooms due to addictions or overdoses. By providing care for addictions, they might also reduce the number of organ transplants they might need to cover. When it comes to savings, robust care for all drugs might be the best way to go, and many insurance plans do just that.
That means anyone with questions about what drugs are and aren’t covered by insurance can just look at this page and get clear answers in just minutes. That page is a good first stop for anyone with addiction treatment questions.
Verify Your Insurance
What Mental Health Issues Are Covered by Insurance?
The legislation passed as part of the Affordable Care Act didn’t stop with addiction care. Plans were also required, as part of the legislation, to provide the same level of care for mental health concerns that they do for physical health concerns. That means plans that provide doctor visits for a foot problem for $20 must also provide doctor visits for depression for $20. The care, and the cost, must be the same. The American Psychological Association says these parity laws apply to all sorts of programs, including those provided by employers, those coming through health care exchanges, and those coming through Medicaid and CHIP.
Parity laws don’t explicitly state what sorts of mental health conditions plans must provide care for, but the rules are similar to those seen in drug addiction. If plans provide care for mental illness, they typically don’t specify that some illnesses are covered while others are not. That would require a huge amount of paperwork and time, and most plan administrators don’t have much of either of those things to spare, so the plans simply cover all of it. Again, this is an issue that’s best discussed with a plan administrator. But in general, fears that mental health issues won’t be covered because they’re “bad” are typically groundless. Health insurance just doesn’t work that way.
Plans were also required, as part of the legislation, to provide the same level of care for mental health concerns that they do for physical health concerns.
Are Treatment Medications Covered?
Maintenance programs, part of aftercare treatment, are designed for people who can’t get to a normal level of functioning in the absence of drugs, even if they’ve been through a rehab program at a treatment center. Chemical alterations caused by drugs are just too severe in these people, and they need medications in order to correct those imbalances so they can live a life that’s free of the influence of drugs.
Maintenance treatment helps many people in recovery from certain substance use disorders, often long after the initial rehabilitation stay. For instance, opioid maintenance therapy on an opioid agonist medication like methadone or buprenorphine can help prevent withdrawal, minimize cravings and, over the longer-term, help to discourage relapse and allow that person to focus on sobriety and other day-to-day obligations.
Maintenance medications like Suboxone, buprenorphine, and Antabuse are made for people with these sorts of issues, but they can be expensive. Thankfully, most experts suggest that insurance plans typically do cover these drugs.
The National Alliance of Advocates for Buprenorphine Treatment says, for example, that most health insurance plans cover maintenance drugs for people in recovery from addictions to heroin and other similar drugs. The organization doesn’t specify how many plans offer this coverage or what typical copayments might be, but the group seems confident that most plans do provide this benefit.
The Substance Abuse and Mental Health Service Administration says, on the other hand, that Medicare and Medicaid plans will only cover these medications if their use is deemed vital for the ongoing health of the person in recovery. If the person is deemed somehow capable of healing without the medications, coverage wouldn’t be provided under these plans. These two opposing views make it clear that plans can handle addiction maintenance care very differently. That’s why it pays for families in need of this care to ask about coverage, copayments, and therapies before they start to get them. Some programs may have extensive coverage while others do not.
The Cost of Rehab vs. The Cost of Addiction
Addiction comes at a great cost: to the individual, family, friends, the community, and society at large. There is a great cost related to lost productivity, premature death, and crime.8 In fact, the societal cost of addiction is more than $532 billion a year.9 But more important than money is that treatment saves lives. If you or your loved one are ready to take the brave step to get treatment, the time is now.
Whether you have full insurance coverage for drug and alcohol addiction treatment or no insurance at all, getting treatment is worth it. With the right treatment plan, you can begin your path to recovery and long-term sobriety.
Frequently Asked Questions
- VA Benefits & Insurance for Rehab
- US. Department of Health & Human Services: Read exactly what is in the Affordable Care Act (ACA).
- HealthCare.Gov: The official site of the ACA. Find out if you can qualify, enroll or make changes to your insurance.
- Medicaid.Gov: See how the ACA works for those receiving Medicaid.
Internal Revenue Service: Learn about the ACA tax provisions and how they might affect the way you can file your
State Health Insurance Assistance Program: SHIP provides free insurance information, counseling and assistance to
Medicare beneficiaries and their family, friends or caregivers.
- Help Selecting a Plan: HealthCare.Gov also offers a concise online guide on understanding health insurance plans.
National Committee for Quality Assurance: NCQA Health Insurance Plan Ratings 2015-2016 – Summary Report (Private,
Medicare & Medicaid).
- Centers for Disease Control and Prevention. (2021). Health Insurance Coverage.
- Healthcare.gov. (2021). Affordable Care Act.
- Office of National Drug Control Policy. Substance Use and the Affordable Care Act.
- Blue Cross Blue Shield Blue Care Network of Michigan. (2021). HMO, PPO, POS: What do all these acronyms mean?
- Masterson, L. (2019, October 23). Insurance.com, What is the difference between HMO, PPO, HDHP, POS, EPO?
- (2018, March 23). HMO vs PPO for Individual Health Insurance.
- eHealth Medicare. (n.d.). What are the differences between Medicare HMOs and PPOs?
- Wickizer TM. State-level estimates of the economic costs of alcohol and drug abuse. J Health Care Finance. 2013;39(3):71-84.
- Georgetown University. Substance Abuse: Facing the Costs.