You know you have a problem, and you know you need to fix it. But you also know that you can’t do it if you’re still running in the same circles while trying to heal.
That’s okay. For many, addiction recovery works best in residential treatment where you can focus solely on getting better.
This is when you start asking yourself, “Does insurance cover rehab?” We’re glad you asked. Here are answers to a few of your most pressing questions on rehab and insurance.
1. Does Insurance Cover Rehab?
The short answer? Yes.
Under the Mental Health Parity and Addiction Equity Act, insurance companies cannot legally discriminate against or refuse coverage to individuals suffering substance abuse disorders. In addition, they cannot impose less favorable limitations on those benefits than they would on, say, surgical coverage.
Furthermore, under the Affordable Care Act (ACA) of 2010, mental health and addiction services are counted as essential health benefits.
2. What’s Covered?
Under the ACA, coverage for addiction treatment services must be as complete as it would be for any other procedure or service.
Things that might be covered under these plans include:
- Addiction evaluation
- Family counseling
- A brief intervention
- Clinic visits
- Alcohol and drug testing
- Home health visits
- Inpatient treatment
Private insurance coverage, whether it’s obtained through the market or through your employer, typically offers coverage for many of the same services, though it is a good idea to check with your insurance provider to verify what’s covered.
You should also check the extent to which these services are covered based on the type of plan you have. For Obamacare, coverage generally breaks down as follows:
- Platinum: 90% expense coverage
- Gold: 80% expense coverage
- Silver: 70% expense coverage
- Bronze: 60% expense coverage
- Catastrophic: 60% total average cost coverage
Many private insurance plans will break down coverage similarly, but it’s still a good idea to check your coverage.
3. Who is Eligible for Coverage?
Under federal law, insurance companies cannot legally discriminate against you if you have a substance abuse disorder, nor can they refuse coverage for substance abuse treatment.
If you’re looking at coverage under the ACA, there are limits on who is eligible for ACA coverage (but not on who is eligible for substance abuse treatment coverage).
To qualify for coverage under the ACA, you must earn an income between the federal poverty level and four times the federal poverty level. There are also coverage changes based on the size of your family relative to your maximum annual income.
4. How Do You Find Out About Your Policy?
If you want to find out about coverage offered under your policy, your best bet is to call your insurance agent or your insurance company.
Make sure you have your insurance card on hand so that they can look up your policy.
Remember, all insurance providers are required to offer substance abuse and mental health treatment coverage, but the level of coverage you’re afforded will vary based on the type of plan you have.
5. What Should You Ask Your Provider?
Before you get on the phone (and spend an inordinate amount of time listening to hold music) it helps to know what to ask your provider.
Here are a few common ones to have on hand:
- Will my insurance cover inpatient, outpatient, detox, and/or aftercare?
- What percentage coverage do I have for these services?
- What will my monthly premiums be?
- What will my copay be?
- What will my out-of-pocket maximums be?
- What are the limits on my coverage?
- Will my prescriptions be covered? To what extent?
If you need any kind of specialized care or procedures, it’s a good idea to ask about those as well.
6. What’s the In- vs. Out-of-Network Difference?
One thing that will cause coverage prices to change significantly is whether your provider is in-network or not.
Some insurance carriers will offer coverage if you go to an out-of-network provider, while others (like Kaiser Permanente, for example) won’t offer coverage unless you go to an in-network provider.
So, while an insurance company may provide full coverage for services at an in-network provider, they may only offer partial coverage for an out-of-network provider. You would have to pay the difference on your own.
Keep in mind that accepting your insurance and being in-network aren’t necessarily the same thing. A physician or facility may accept your insurance without being in-network. The best way to check is to call the customer support number on your insurance card and verify your provider’s status.
7. What are You Expected to Pay?
Regardless of the type of insurance you have or how good it is, you will be expected to pay for some portion of your care out of pocket. How much depends on your plan.
Generally, you’ll be expected to pay for the following:
- Co-payment (a fixed amount you pay to receive treatment, usually small)
- Deductible (the amount you are expected to pay before your insurance takes over to pay the rest)
- Coinsurance (a fixed percentage of the total cost of your treatment that you are expected to pay before receiving treatment)
In addition, you are required to pay your monthly premium, which is more or less a service fee required to keep your insurance coverage active whenever you may need it throughout the year.
Looking for a Great Rehab Program?
Now that you know the answer to the question, “Does insurance cover rehab?” the next question is, “Are you looking for a great rehab program?”
If so, you’ve come to the right place.
We offer a wide array of alcohol and drug addiction treatment services, including residential treatment, intensive outpatient, aftercare treatment, and more.
Want to discuss your options? Use our contact page to get in touch.