Will My Insurance Cover Rehab?

The cost of a drug or alcohol addiction can easily outstrip the cost of treatment for substance use disorder when you factor in the expense of maintaining an addiction. Then, there’s the cost of consequent health problems and the hardships that result if you’ve lost a job and have no source of income. All in all, an addiction can easily cost you tens of thousands of dollars. Rehab, though often expensive, is a bargain when compared to the financial ruin that addiction can bring down on you. That’s what makes rehab insurance so important, and why you need to understand your coverage options.  

The majority of drug treatment facilities charge anywhere from $2,000 to $25,000 a month, which makes rehab a serious financial challenge. An insurance policy that covers at least part of inpatient or outpatient treatment can mean the difference between getting help and continuing to struggle with addiction — a chronic disease as serious as diabetes or heart trouble. In fact, according to the Substance Abuse and Mental Health Services Administration (SAMHSA), 89 percent of the more than 22 million people who need help for addiction never receive it.

Private insurance

Private insurance covers rehab, but how much it covers is the question that needs to be answered, because coverage varies from policy to policy. Private insurance is generally the most expensive form of coverage, though it provides the greatest number of treatment options. According to the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008, if you’re in a group plan with more than 50 enrollees, your insurance will cover rehab.

Ultimately, the best way to find out if your insurer covers rehab is to read your policy very carefully. Insurance plans “cover” addiction rehab, but that doesn’t always mean they’ll pay your bill in full. Check the fine print, which may include stipulations such as:

  • You can only use in-network doctors and facilities
  • You are not covered for detox
  • Your coverage can change based on the nature of your addiction and the length of your treatment

If you don’t have private insurance or if your policy doesn’t cover the treatment you need, it’s time to investigate other payment options.

Public insurance

The Affordable Care Act (ACA) — sometimes referred to as Obamacare — provides public funding for insurance plans through the Health Insurance Marketplace. In the marketplace, addiction treatment must be covered, because it’s considered an essential health benefit addressing a dangerous disease. However, the treatment you need may not be covered; for example, it may pay for detox, but not inpatient programs. The sheer number and complexity of choices available through the ACA can be a barrier to proper coverage, with each plan having different clinical networks and requirements.

If you’re a Medicare or Medicaid recipient, or have coverage through the Veterans Health Administration (VHA), your plan may help pay for rehab. In some cases, Medicare will cover inpatient and outpatient treatment for alcoholism and other substance abuse disorders.

Other options

Outpatient programs can be a viable option if you lack coverage, because they’re often more affordable. Outpatient treatment is also more manageable from a lifestyle standpoint, because it allows you to meet personal responsibilities and continue working while undergoing treatment. On the other hand, if your treatment facility is far away, then travel could be a problem, especially if you’re taking medication that impairs your ability to drive. Temptations at work and home can also complicate treatment.

Talk to your treatment facility

Many treatment facilities offer payment plans or charge based on ability to pay for those who don’t have insurance. This can be a big help if you’re out of work due to an addiction, so include this in your search criteria if you’re short on funds.

Meet with your employer

For those who are employed, your company may be willing to cover your addiction treatment, even if not required to do so. At the very least, it may be possible to work out an extended leave of absence so you’re not at risk of losing your job. That way, you can work out a payment plan without fear of lacking the resources to pay your treatment facility as agreed.

Alternative therapies

Many treatment facilities embrace the healing potential of alternative addiction treatments. Some, like acupuncture, massage therapy and chiropractic, are often covered by insurance, according to the National Institutes of Health (NIH). Many therapies, however, are viewed with skepticism by insurers, though that shouldn’t necessarily stop you from researching all of your options. The best therapy of all is the one that works for you, so don’t automatically dismiss homeopathy, naturopathy, kinesiology or herbal therapy just because they’re not typically covered by traditional insurance plans. Some insurers will discount alternative therapies if they’re provided in-network.

The simple answer to whether insurance covers addiction rehab is yes. However, that “yes” comes with conditions and lots of details, which means you need to read the fine print on your policy. Rehab insurance is a matter of patchwork — rather than blanket — coverage, so know your options before exercising them.