Rehab Insurance Coverage for Drug and Alcohol Addiction Treatment
If you or a loved one is struggling with alcoholism or drug addiction, you may be wondering how to pay for rehab. The cost of addiction treatment can feel overwhelming, but there are numerous options to help cover the cost of alcohol and drug rehabilitation. If you have health insurance, it may be one of the best options. Continue reading to learn more about rehab insurance coverage, including how to pay for outpatient and inpatient rehab without insurance, Medicare and Medicaid.
Does Health Insurance Cover Alcohol or Drug Rehabilitation?
You may be wondering, ‘is drug or alcohol rehab covered by insurance?’ Most insurance plans provide some level of substance abuse treatment coverage, although this may differ depending on the provider, your specific plan, location and other factors. Drug and alcohol addiction is a concern in America and has been linked to long-term changes in the brain and behavior, increased risk of developing chronic physical and mental health disorders and social and occupational difficulties.1, 2, 3, 4 As such, many insurance providers recognize the need to offer coverage for substance use disorders (SUDs).
Additionally, since the passage of the Affordable Care Act (ACA) in 2010, many private insurance companies have opted to cover the same essential health benefits (EHBs) that Marketplace insurers offer as part of the ACA, which includes mental and behavioral health services.6,11 This may include treatment such as inpatient, outpatient, detox, counseling and other services, but it’s important to talk with your health insurance provider about plan details to make sure you have alcohol and drug rehab insurance.
Does My Health Insurance Cover Drug or Alcohol Rehabilitation?
Rehab insurance health plan benefits can vary depending on your location and plan, but coverage may include:1
- Medical detox, where medical staff is available 24/7 to monitor patients and provide medications to ease withdrawal symptoms.2, 3, 7 Detox focuses on clearing the system of substances rather than addressing the addiction itself.7, 8
- Medication-assisted treatment (MAT), where medication is used in conjunction with therapy to further treatment goals, manage cravings and treat underlying mental health disorders if needed.2, 3, 8
- Group therapy, individual therapy and family counseling to help people learn the skills needed to prevent relapse, communicate effectively, solve problems, manage triggers and develop healthy, recovery-oriented hobbies.3, 8
Most policies will cover one or more of the following:
- Assessment – Often fully covered.
- Detoxification – Is typically covered, but may depend on the type of detox program.
- Outpatient treatment – Is typically covered, but may depend on the facility and program you choose.
- Inpatient (residential) treatment – Is typically covered, but may depend on the facility and program you choose.
Health insurance policies will often cover addiction rehab to the same extent that they cover other medical conditions, but they will typically only cover what a professional determines to be “medically necessary”.
Rehabilitation insurance benefits may also cover inpatient and outpatient programs, which provide a longer period of treatment. Studies show that remaining in treatment for at least 90 days may lead to better sobriety outcomes.3 Treatment can occur in more than one setting, such as attending one type of program followed by another form.3
Insurance does not always cover a specific length of time in drug and alcohol treatment, but coverage depends on your plan and individual needs. A set amount of time in alcohol and drug rehab may be approved at first, but your provider may be able to request additional coverage at the end of your approved time.
Is Inpatient Rehab Covered By Insurance?
You may be wondering whether your insurance covers treatment at inpatient rehab centers for alcoholism and substance abuse. Inpatient rehab involves staying at a facility for the duration of treatment, which can last for varying lengths of time. Patients often choose to stay for 28 days or, if they want more long-term treatment, for 60-day or 90-day rehab stays, depending on the level of care needed.3 Programs can consist of intensive group and individual therapy sessions, medication-assisted treatment, detox and/or psychiatric care as needed.3, 8 Participation in self-help groups is strongly encouraged and facilities may host meetings on-site.3
Insurance for rehab often covers inpatient rehabilitation, especially in cases where professional help is viewed as medically necessary. Medicare, a federal program that provides healthcare coverage to individuals aged 65 or older or those with certain disabilities, covers inpatient care.9 10 Coverage limits may vary depending on your needs and your insurance plan.
Does Insurance Cover Outpatient Rehab?
Outpatient rehabilitation provides the opportunity to receive effective care in an office-based setting while living at home and having the freedom to work, go to school and participate in family life.8 Treatment is offered on a spectrum of intensity, allowing services to be tailored over the course of your program to meet your needs as you progress in recovery.3, 8
Rehab insurance coverage for outpatient treatment may last longer than that of inpatient treatment, depending on your plan and needs. Medicare also covers outpatient substance abuse rehab, provided that it is essential to the recovery process.9
How to Find Out if Rehab Is Covered By Insurance
Before starting treatment, you should check your healthcare benefits to confirm your drug and alcohol rehab coverage. You can do this by calling the member services number on the back of your insurance card or using the online portal on your insurance website.
You can also confirm that American Addiction Centers treatment facilities take your insurance quickly and easily by using the form below.
Steps for Determining Insurance Coverage for Rehabilitation
- Call Member Services at your insurance company. Have your membership identification number ready.
- Write down the name of the representative(s) you speak with, as well as any notes about the conversation.
- Ask what “levels of care” are covered for addiction rehab (assessment, detox, inpatient, outpatient, residential, hospital-based, partial hospitalization, intensive outpatient etc.)
- Ask about in-network and out-of-network providers and the percentage covered by insurance for each.
- Ask about copays and deductibles.
- Ask what your out-of-pocket maximum expense is.
- Ask what criteria your insurance company uses to determine medical necessity.
Another option is to reach out to the admissions department of the program you’re considering regardless of what insurance you have or what you’ve heard about your policy. Programs have many ways of flexing benefits to make policies work.
Recovery.org is a subsidiary of American Addiction Centers (AAC), a leading provider in drug and alcohol treatment and recovery. AAC is in-network with many of the top insurance providers. You can use our free and confidential online insurance checker to see if your insurance covers treatment and recovery, contact AAC for free at .
Do Medicaid & Medicare Cover Drug Rehabilitation?
You may be wondering, ‘does Medicare cover substance abuse treatment?’ or ‘what is my Medicaid coverage for rehab?’ Medicare and Medicaid are government-sponsored insurance plans that cover screening for substance abuse, but this coverage does not always include treatment.
Medicare is for anyone 65 or older or with a severe disability no matter what their income level is. Its coverage changes based on the type of care you’re seeking.
- Inpatient – Medicare covers up to 190 days of inpatient services during your lifetime, with a $1,260 deductible and variable copayments.
- Outpatient – Medicare covers counseling and therapy, one screening per year, medication management and one yearly “wellness” visit (you pay 20% of treatment costs).
- Partial hospitalization – You pay a percentage of each service, as well as daily copayments and a deductible.
Medicaid is a plan for low-income households. The plan is run on a state-by-state basis, with each state covering varying degrees of drug and alcohol treatment services. However, Medicaid does require a number of mandatory services to be covered. These services include both inpatient and outpatient care, as long as the rehab facility you choose accepts Medicaid.
Health Insurance MarketplaceAnother insurance option is the Health Insurance Marketplace, which offers state government-organized insurance plans. These plans cover rehab to varying degrees, depending on the state, but they typically include coverage for assessment, detox and some outpatient care.
The open enrollment period for the marketplace plans takes place once a year, from November 1 to January 31, for coverage in the new year. You may also qualify for special enrollment periods in the case of certain life events:
- Moving to a new state.
- Certain changes in income.
- Changes in family size.
- Gaining membership in a federally recognized tribe.
Losing your job can bring anxiety and stress regarding healthcare, but there are options for maintaining your health insurance coverage. If you lose your job-based coverage, your former employer may offer you COBRA (Consolidated Omnibus Budget Reconciliation Act) continuation. COBRA provides people who lose their jobs, and their families, with the choice to temporarily retain the group health coverage they had under their employer’s group health plan.
To be eligible for COBRA, you must have insurance that is covered by COBRA, have experienced a qualifying event (including job loss) and be a qualified beneficiary. Your former employer will inform you of your eligibility to maintain your insurance through COBRA and you will have at least 60 days to decide if you want to continue your coverage. Once you have decided to do so, you will sign up for COBRA, and you will be responsible for paying the entirety of your premium (what was previously covered by you and your employer).
Once you are enrolled in COBRA, you will have the same coverage you previously had when you were employed. That includes any mental health and substance abuse treatment that was covered through your insurance plan. If you are pursuing rehab while covered by COBRA, you will be responsible for paying your premium. Changing jobs doesn’t mean that you cannot receive the alcohol and drug treatment you need.
Paying For Alcohol and Drug Rehab Without Insurance
You may be wondering, ‘can I get drug addiction rehab without insurance?’ If you do not have insurance, you have a couple options to ease the burden of paying for treatment.
One option that many rehab facilities offer is spreading the cost out across a payment plan. The plan involves monthly payments over a predetermined amount of time that equal the cost of treatment. Payment plans are a great way to spread the cost out to make treatment much more affordable.
Another option to pay for treatment is to find a facility that uses a sliding scale payment method. Sliding scale is a fee structure based on your ability to pay. You will only be required to pay what you can reasonably afford. People with lower incomes will be expected to pay less than those with higher incomes.
If you are wondering, ‘where can I find alcohol or drug rehab near me?’, the Substance Abuse and Mental Health Services Administration (SAMHSA) has a free facility locator to search for treatment centers near you with payment assistance programs.
Rehab Financing Options
Other financing options for paying for drug and alcohol treatment include:
- Credit cards.
- Health care credit cards.
- Personal loans.
- Home equity loans.
- Specialized loan companies.
Many treatment centers also offer rehab scholarships, where the facility will cover part or all of the cost of recovery.
To find rehab facilities that offer these scholarships:
- Call the drug and alcohol rehab programs that you’re considering.
- Tell them your situation.
- Ask if they offer rehab scholarships and what you need to do to be considered for one.
Most treatment facilities have a specific amount of money they can use for rehab scholarships per year. So, if they cannot fund you, make sure to ask about other substance abuse treatment centers nearby that may offer financial help.
Another way to get help paying for rehab is to apply for a SAMHSA grant, which can cover part or all of your recovery costs. In some cases, your state substance abuse agency will even reimburse alcohol and drug treatment costs.
Regardless of whether or not you have insurance for rehab, addiction treatment is an important and vital step toward saving yourself from the downward spiral of alcohol and drug abuse.
Other Options for Substance Abuse and Addiction Treatment
12-Step Self-Help Programs
12-Step programs (for example, Alcoholics Anonymous and Narcotics Anonymous) are free recovery options that work best when practiced alongside other types of addiction treatment. These programs follow a spiritual route to recovery based on principles outlined in the Big Book of AA. They begin with the admission of being powerless over addiction, inspiring a new way of living and lifelong recovery development.
If a spiritual journey is not for you, try the science-based Self-Management and Recovery Training (SMART). This program is also a free support group that uses proven techniques from cognitive behavioral therapy. SMART recovery’s goal is to support and encourage participants to evaluate their own thoughts and behavior patterns in order to make positive changes in their lives.
Stabilization programs are another viable low-cost treatment option. These programs generally involve 2 to 6 weeks of stay following detoxification, and they focus on progress in recovery rather than slip-ups. Once you complete the substance abuse program, you have the option to move on to a sober living house or therapeutic community.
Holistic (or alternative) treatment programs, yet another potentially lower-cost recovery option, focus on the health of the mind, body and spirit. They incorporate traditional treatments (detox, therapy, medical care etc.) with holistic services such as yoga, acupuncture and meditation to heal and help a person on the road to recovery.
Free Rehab Programs
While rare, there are free and state-funded drug rehab options. Unlike private, luxury and executive rehabs, religious organizations offer drug and alcohol treatment as part of their ministry services at no cost. Non-profit rehab organizations also offer low-to-no-cost treatment. These free programs take an extra bit of effort to get into, but it is possible if you put in the time.
How to Find Substance Abuse Treatment Near Me
You may be thinking, ‘where can I find the best rehab centers near me?’ or ‘how can I find drug and alcohol rehab programs that are covered by insurance?’ American Addiction Centers is here to help. You can contact our admissions navigators 24/7 for free at to help you find the right addiction recovery program and learn about ways to cover the cost. You can also check your insurance coverage online now to determine whether your insurance provider will cover rehabilitation treatment.
Health insurance coverage can be a confusing maze to navigate, especially when it comes to treatment. Alcohol and drug rehab coverage can make the high cost of treatment manageable and affordable, allowing more people to access care for addictions. Federal laws ensure that insurance companies offer similar benefits for mental health care as they do for physical health conditions.
A range of treatment types is offered for substance use disorders and the majority of public and private health insurance plans provide some coverage for addiction treatment. However, checking your benefits before seeking care to ensure that your drug or alcohol rehab insurance is accepted at the facility you choose to attend is a good start on the road to recovery.
Insurance Providers With Rehab Coverage
- Ambetter Insurance
- Aetna Insurance Coverage
- UnitedHealthcare Insurance
- Humana Health Insurance
- Cigna Insurance
- Blue Cross Blue Shield
- Kaiser Permanente
- Veterans’ Insurance