Insurance Coverage for Partial Hospitalization Programs (PHPs)
What is a PHP?
A partial hospitalization program (PHP) is a type of intensive outpatient program (IOP) for addiction and/or psychiatric treatment.1 In a sense, a PHP is often the midway point between inpatient and outpatient treatment.2 As such, PHPs typically offer slightly less intense levels of care than residential and inpatient services but higher levels of care than general outpatient treatment.3 In fact, in terms of the four Levels of Care established by the American Society of Addiction Medicine (ASAM), PHPs rank as a Level 2 (or 2.1 or 2.5) on the continuum of care.4
PHPs typically treat people with substance use disorders and/or co-occurring disorders who don’t need medical detox or 24-hour supervision and are deemed safe to spend the night in their home environments as opposed to residential or inpatient settings.3,5 While treatment durations vary, those in PHPs usually receive structured treatment for roughly 4 to 8 hours a day for a set number of days per week at a facility, and they return to their own residences at night.6,7
PHP services typically include the same types of therapies as inpatient facilities, such as:5,8
- Individual and group therapy.
- Medication management.
- Family therapy.
- Educational groups.
- Occupational and recreational therapies.
- Cognitive and behavioral therapies.
Goals of PHP Treatment
PHPs help those in treatment to learn coping strategies and relapse management, and they provide psychosocial support and individual treatment.3 While PHPs vary, the Substance Abuse and Mental Health Services Administration (SAMHSA) indicates that the goals of Level 2 programs such as PHPs include:7
- Achieving abstinence.
- Fostering behavior changes that support a drug- and alcohol-free lifestyle.
- Facilitating participation in community-based support systems such as 12-step programs.
- Assisting patients in identifying and dealing with psychosocial issues (e.g., employment, housing, adherence to probation limitations)
- Aiding patients in developing a positive social network.
- Improving coping and problem-solving skills.
How Much Does a PHP Cost?
PHPs often provide an efficient and cost-effective option compared to inpatient or residential treatment.2 However, the exact cost varies widely depending on a patient’s personal needs and factors such as:5
- Length of treatment.
- Community versus hospital-based programs.
- Utilization of services.
- Insurance coverage.
If you have health insurance, the best way to estimate your costs is to verify your insurance.
However, there are several ways to pay for a PHP even if you don’t have insurance. Many treatment centers may be able to work with you to arrange a payment plan, use scholarships or block grants, employ a sliding-fee scale, or identify alternative funding.
Does Insurance Pay for a Partial Hospitalization Program (PHP)?
Under the Affordable Care Act (ACA), all rehab insurance coverage (except grandfathered plans) must offer mental health and substance use disorder services. Plus, any plan offered for purchase through the HealthCare.gov Marketplace can’t cap the amount of substance use or mental health treatment covered.9
And thanks to the Mental Health Parity and Addiction Equity Act (MHPAEA), most insurance plans must provide at least some coverage for partial hospitalization. Providing parity means that if insurance coverage offers medical and surgical benefits, the mental health and substance use disorder benefits may be no more restrictive than their medical/surgical counterparts.
For example, a co-pay for a medical specialist visit must be similar to a co-pay for a visit with a mental health specialist. That said, the Centers for Medicare and Medicaid Services indicates that there are a few types of plans that are exempt from stipulations of the MHPAEA (e.g., self-insured, non-federal government plans and self-insured small private employers with 50 or fewer employees).10
However, many treatment centers accept payment from government-sponsored insurance plans, such as Tricare, Medicare, and Medicaid. While each of these plans likely has unique stipulations regarding PHPs and coverage, they’re viable payment options for those that qualify.
Once again, the best way to determine costs and PHP insurance coverage is to verify your benefits with one of AAC’s admissions navigators at .
Is a PHP Right for Me?
Selecting the appropriate level of care for your needs is a critical step in your recovery journey. This vital decision is best made with the assistance of a mental health and/or addiction-recovery professional. So your first step in determining whether a PHP is right for you is to consult with a professional who can provide an assessment and diagnosis to ensure safe and appropriate care.
PHPs can be employed for a host of treatment situations, such as following inpatient/residential treatment, as a first step in recovery, and even prior to inpatient/residential treatment in some cases, allowing patients to step up to increased treatment as needs arise. Again, it’s critical to work with professionals to assess and recommend the level of care that’s appropriate for your unique situation and position along the path to recovery.
That said, given the fact that PHPs are inherently not residential nor inpatient facilities, PHP patients shouldn’t need detox or 24-hour supervision to ensure abstinence. While they likely need more care than traditional outpatient programs, patients should feel fairly secure maintaining abstinence during the evenings and potentially over the weekends without 24/7 assistance.3 Additionally, patients should have a relatively supportive environment to return to when not in PHP treatment. Lacking such an environment, a sober-living facility or Oxford-house-like care community may be a viable option in some instances.
Contact AAC’s 24/7 admission navigators at to help find treatment options that include PHPs. A simple conversation can not only answer your questions about PHPs but also help you discover potential payment options and take your first step toward recovery.
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