Does Insurance Cover Drug Rehabilitation?
Substance use disorder (SUD) remains a significant health challenge in the United States, especially amid the escalating opioid crisis. Many individuals struggling with SUD do not receive the necessary treatment, often due to barriers such as limited access to care and financial constraints.
The journey to recovery from drug addiction can feel overwhelming, especially when faced with the uncertainty of how to pay for treatment, leaving many to wonder, does insurance cover drug rehabilitation?
Fortunately, the Affordable Care Act (ACA) has made strides in improving access to SUD treatment by expanding insurance coverage for addiction rehab, implementing regulatory changes that mandate SUD treatment in existing plans, and ensuring that SUD care is treated equally to medical and surgical services, as highlighted in an editorial in the American Journal of Public Health.
Generally, insurance plans that adhere to the ACA are required to cover a variety of services related to drug and alcohol addiction treatment. Moreover, these policies often include coverage for co-occurring mental health issues, such as depression and anxiety, ensuring access to a holistic approach to recovery.
However, it’s essential to recognize that insurance plans vary widely, meaning the extent of coverage and specific services included can differ based on your individual plan. There may also be out-of-pocket expenses to consider, including deductibles, copays, and services that might not be covered.
To understand your coverage and potential costs clearly, it’s advisable to review your plan’s specifics or consult directly with an insurance representative. Alternatively, you can reach out to your chosen drug rehab facility and ask them to verify your insurance coverage. They can provide insights into what is covered and any out-of-pocket expenses you might incur and suggest alternative payment options if your insurance falls short.
What Levels of Drug Rehab Does Insurance Typically Cover?
As previously mentioned, insurance plans vary, and the level of care covered, like covering medical detox treatment with insurance, will depend on your specific insurance policy.
Most health insurance plans rely on the concept of medical necessity, which refers to healthcare services or treatments considered essential for diagnosing, treating, or managing a medical condition in the most clinically appropriate and cost-effective way. This concept is vital in determining whether a specific service, medication, or treatment will be covered.
In the context of addiction treatment, medical necessity is assessed during your initial check-in and intake evaluation. A team of addiction specialists will analyze the severity of substance use, its impact on daily life, and any co-occurring disorders. This assessment helps them establish the appropriate level of care and treatment plan, which is then submitted to your insurance provider for review and approval.
Depending on the details of your insurance plan and what healthcare professionals identify as medically necessary, the following programs may be covered:
- Medical Detoxification – Often the first step in rehab, where the body safely rids itself of drugs or alcohol under medical supervision to alleviate withdrawal symptoms.
- Inpatient Rehabilitation – These are residential programs where individuals reside at the facility while receiving structured and intensive care.
- Partial Hospitalization Program (PHP) – This program offers a level of intensity similar to inpatient rehab but does not include 24/7 supervision. Patients participate in treatment during the day and return home at night.
- Intensive Outpatient Program (IOP) – A flexible rehabilitation option that provides intensive treatment several times a week, which is less intensive than PHP but still offers substantial support.
- Outpatient Care – This is a less intensive treatment option where individuals attend therapy, counseling, and support group sessions a few times a week.
- Aftercare Services – These services provide ongoing support following formal rehabilitation, including therapy, support groups, and regular check-ins to assist individuals in maintaining sobriety.
How Much of Drug Rehab Does Insurance Cover?
Drug rehabilitation will look different for each person, varying in levels of care and length of treatment depending on several factors, such as how long addiction has been present, the severity of addiction, and the presence of co-occurring disorders.
Nowadays, many insurance companies provide insurance coverage for addiction treatment, both short-term and long-term, tailored to the specific medical needs of the patient and the type of insurance plan they hold.
However, there may be restrictions on the number of days covered for rehab services. Detoxification services are frequently included in coverage, but again, this may be limited based on the severity of the addiction or the duration of treatment.
As stated by HealthCare.gov, all plans under the Affordable Care Act (ACA) must include behavioral health treatment, which encompasses psychotherapy, counseling, inpatient mental health services, and treatment for substance use disorders. Most insurance policies typically cover evidence-based therapies like cognitive behavioral therapy (CBT) and medication-assisted treatment (MAT).
However, alternative therapies offered at rehab facilities, such as acupuncture, massage, and chiropractic care, might not be included. Depending on your specific insurance policy, there may also be coverage for ongoing support after completing drug rehabilitation, including group therapy, individual counseling, and psychiatric medications.
What Are Typical Costs for the Levels of Addiction Rehabilitation?
The cost of drug addiction rehabilitation can vary significantly based on several factors, such as type of facility, treatment programs offered, location, and duration of treatment. More intensive treatment programs like inpatient rehab tend to cost more due to additional costs related to room and board.
The National Center for Drug Abuse Statistics mentions that the average price of drug rehabilitation is $13,475 per person. Here is a breakdown of typical expenses at different levels of care:
- Detox Programs: Range from $1,000 to $10,000 for a three to seven-day stay.
- Residential (Inpatient) Rehabilitation: Costs between $6,000 and $30,000 per month. Programs can last 30, 60, or even 90 days or longer and often include detoxification services.
- Outpatient Drug Rehabilitation: Typically costs between $1,000 and $10,000 per month.
- Intensive Outpatient Programs (IOP): Generally range from $3,000 to $10,000 monthly.
- Partial Hospitalization Programs (PHP): The average cost for a 30-day program is around $12,000, but it can reach up to $30,000.
What to Do If Your Insurance Doesn’t Fully Cover Drug Rehab: Payment Options and Resources
Insurance plans often do not cover all the necessary treatments for effective recovery in drug rehabilitation programs. The financial burden can be significant for those without insurance, requiring them to pay out of pocket.
While drug rehab can be expensive, the consequences of staying in addiction can be even more severe, impacting job stability, financial health, personal relationships, and overall quality of life.
The idea of affording high-quality drug rehabilitation can be overwhelming for many, but there are various options available to assist with these costs. Numerous treatment centers provide flexible payment plans tailored to your financial situation.
They can also create customized treatment strategies that align with your budget. Furthermore, several scholarship and grant opportunities are designed to help cover treatment expenses.
Contact WhiteSands Treatment if You Still Have Questions Related to Does Insurance Cover Drug Rehabilitation?
Understanding whether insurance covers drug rehabilitation can be crucial to your recovery journey. At WhiteSands Treatment, we believe everyone deserves access to high-quality care to overcome addiction.
We work with a wide range of insurance providers to make treatment as affordable as possible. Furthermore, we offer flexible payment plans and can assist you in finding scholarship or grant options, allowing you to concentrate on your recovery rather than financial concerns.
If you are still wondering does insurance cover drug rehabilitation and any other questions related to addiction treatment or if you would like to verify your insurance plan, don’t hesitate to contact us.
Call WhiteSands Treatment at 877-855-3470 today to connect with one of our experienced specialists and take the first step towards a healthier, drug-free life.
External Sources
- American Journal of Public Health – The Affordable Care Act Transformation of Substance Use Disorder Treatment
- HealthCare.gov – Mental health & substance abuse coverage
- National Center for Drug Abuse Statistics – Average Cost of Drug Rehab
If you or a loved one needs help with abuse and/or treatment, please call the WhiteSands Treatment at (877) 855-3470. Our addiction specialists can assess your recovery needs and help you get the addiction treatment that provides the best chance for your long-term recovery.
About the Author
Jackie has been involved in the substance abuse and addiction treatment sector for over five years and this is something that she is truly eager about. She has a passion for writing and continuously works to create informative pieces that not only educate and inform the public about the disease of addiction but also provide solutions for those who struggle with drug and alcohol abuse.
