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Health Insurance Plans For Drug Rehab

health insurance application for health insurance coverage

Article Contents

In the United States, more than 20 million people are estimated to live with a substance use disorder. Substance abuse and addiction are common struggles that can cause significant harm and pose life-threatening consequences without quality treatment.

When searching for drug addiction treatment, one common concern among individuals and families is cost. Many New England rehab centers accept some form of insurance. Without health insurance, addiction treatment services can become very costly. 

Recovering Champions is an accredited addiction treatment facility. Our treatment staff understand how intimidating the process of finding and paying for treatment can be. 

Here we provide:

  • information about common types of health insurance plans
  • what types of addiction treatment services your health insurance plan may cover
  • what to know about using insurance to pay for addiction treatment
  • finding rehab centers that accept your insurance

Types Of Health Insurance Plans

Health insurance can come in many forms. In the United States, there exists a wide range of health insurance plans for people of varying income levels and backgrounds.

Common types of health insurance in the U.S. include:

  • public insurance (e.g. Medicare and Medicaid)
  • private Insurance
  • military Insurance
  • state government health plans

Private health plans can also be categorized as health maintenance organization (HMO) plans and preferred provider organization (PPO) plans. These are the most common types of private insurance. 

Your amount of coverage, and the treatment providers you have access to through your coverage, will depend on the type of insurance plan you have. Health insurance plans and available mental health benefits can vary according to geographic location and other personal factors. 

New England Health Insurance For Addiction Treatment

Your health insurance options may vary according to where you live in the United States. Even government health plans like Medicaid and Medicare can be referred to by different names depending on your state or region of residence.

In New England, which spans multiple states in the northeast, there are several healthcare insurance options. 

Common New England health insurance providers include:

What Does Health Insurance Cover?

Under federal law, health insurance companies are required to treat medical, mental health, and substance abuse issues the same when determining coverage amounts. This is called parity.

In 2010, the Affordable Care Act (ACA) expanded mental health and substance use disorder coverage by including mental health benefits as Essential Health Benefits. The ACA also expanded access to quality healthcare coverage and strengthened mental health parity laws.

Not every insurance plan covers the same levels of care or types of addiction treatment services. The types of addiction treatment services that are covered by your health insurance will depend on a range of factors.

Factors that can determine your coverage include:

  • type of insurance
  • type of insurance plan
  • accepted insurance by the rehab center
  • level of care
  • type of treatment center (private, state-run, luxury rehab)

You can determine which types of addiction treatment services are covered by your insurance plan by consulting your insurance policy or contacting your insurance carrier directly. Some rehab centers and treatment providers can also verify your coverage for you.

Levels Of Care Covered By Health Insurance

Drug and alcohol addiction can be treated at multiple levels of care. This refers to the different types of treatment programs that exist to treat substance abuse and mental health conditions. 

Levels of care vary in their intensity, structure, programming, and cost. Your insurance policy should specify the amount of coverage you are eligible for—full or partial—and any additional requirements you must meet in order to use your plan’s health benefits for addiction treatment.

Drug And Alcohol Detoxification Programs

Drug and alcohol detox is highly recommended for people with severe or chronic substance abuse issues. Health insurance may cover detox services. The types of detox services that are covered by health insurance benefits may vary. 

There are different types of detox programs, including medical detox and social detox. Your plan may specify which types of detox treatment services are covered, if applicable.

Inpatient Treatment Programs

Inpatient treatment is the most effective treatment for substance use disorders. Many insurance plans offer financial assistance for covering inpatient treatment costs. The amount of cost coverage may depend on whether the rehab facility accepts your insurance, and other details pertaining to the treatment facility. 

If you’re planning to use insurance to pay for inpatient rehab, be sure to check with your insurer and administrative staff at the rehab center to confirm your coverage. Private rehab centers may only accept certain insurance plans. 

Residential Treatment Programs

Residential treatment programs are often conflated with inpatient treatment. Although the two are very similar, some insurance plans may differentiate between the two when determining cost coverage. Residential rehab centers may offer a more comfortable environment that is less clinical than an inpatient detox center or psychiatric hospital.

Residential rehab centers may offer an array of medical and behavioral health treatments. These treatment programs can vary in their length, intensity, programming, and treatment approach.

Day Treatment

Day treatment, also known as partial hospitalization, is the highest level of outpatient care for drug addiction. Partial hospitalization programs do not involve staying at a treatment facility overnight.  

Your eligibility for day treatment program coverage may depend on factors pertaining to physical health, mental health, and need for treatment. Day treatment providers can help you verify whether your insurance policy covers day treatment.

Outpatient Treatment

Intensive outpatient treatment and standard outpatient treatment services may be eligible for health insurance coverage. 

Outpatient treatment services that may be covered by insurance include:

  • drug counseling
  • behavioral therapy
  • family counseling
  • group therapy
  • support groups
  • psychiatric services
  • clinical care

Outpatient treatment settings provide an opportunity for residents to continue strengthening their commitment to recovery. Outpatient treatment providers can treat ongoing mental health concerns and address other underlying issues associated with substance abuse.

Medication-Assisted Treatment

Many New England treatment providers offer buprenorphine (Suboxone) therapy or methadone maintenance therapy to treat opioid and opiate addiction. This is known as medication-assisted treatment (MAT).

MAT is an evidence-based treatment for opioid use disorder. It can also be helpful for alcohol addiction and cocaine addiction. In the wake of the U.S. opioid epidemic, many states—including New England states—have moved to expand healthcare coverage for this life-saving treatment.

Using Your Health Insurance To Pay For Drug And Alcohol Rehab

Using your health insurance to pay for drug or alcohol rehab may require that you take certain steps first. This may include getting prior authorization for treatment, meeting your health plan’s deductible, and confirming your responsibility for any co-pays.

Getting Prior Authorization

Insurance providers may require that policyholders obtain documentation that verifies the medical necessity of treatment before providing coverage. This can be referred to as prior authorization or precertification.

Proof of medical or mental health necessity can be acquired from a clinician following a medical and mental health evaluation. Your insurance provider may require that you or your loved one undergo a full evaluation and get a physician referral no more than 72 hours before entering rehab.

Premium And Deductible Requirements

Policyholders are required to keep up with insurance premium payments in order to use health insurance benefits. If you’re behind on your payments, this may affect your coverage. 

You may also have to meet a deductible before insurance benefits for addiction treatment coverage can kick in. You can learn more about your plan’s deductible, and its relation to addiction treatment costs, by checking your plan’s policy or contacting your insurance carrier directly.

Co-Payment Requirements

Health insurance plans may require that you pay for some of your rehab costs out-of-pocket. This is your copayment. Your co-pay refers to the percentage of costs you are responsible for covering yourself. Co-payment amounts vary depending on your insurance policy and the types of treatment services you receive.

Finding New England Rehab Centers That Accept Your Insurance

Verifying your insurance coverage is an important step towards getting substance abuse treatment for yourself or a loved one. Doing this can help prevent unnecessary costs down the line, and can provide reassurance as it concerns your coverage.

If you’re looking for addiction treatment for yourself or a loved one in New England, our addiction treatment specialists can help. 

With your permission, our addiction treatment specialists can:

  • review your insurance plan to determine your coverage
  • explain your in-network and out-of-network treatment options
  • determine which type of rehab program may best suit your needs

Recovering Champions is an accredited rehab center in Cape Cod, Massachusetts that offers evidence-based care for substance abuse, addiction, and dual diagnosis. 

Contact us today to learn more about the types of insurance we accept, the types of treatment your insurance plan covers, and to learn more about our leading addiction treatment programs.

Written by Recovering Champions Editorial Team
This page does not provide medical advice.
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