Will Insurance Cover Substance Addiction Treatment (Rehab)?

Health insurance covers substance addiction treatment and rehab programs, but the amount of coverage and restrictions vary from policy to policy. The Affordable Care Act (ACA) requires health insurance providers to cover addiction treatment. According to the ACA, providers must cover:

  • Inpatient behavioral health treatment services
  • Addiction treatment
  • Behavioral health, including psychotherapy and counseling

Any treatment deemed “medically necessary” is likely covered under your policy. Regarding addiction, this could include:

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Rehab Costs with Insurance vs. Without Insurance

Rehab is an option regardless of whether you have insurance coverage, but it tends to be more expensive without coverage. 

Keep in mind, having insurance coverage doesn’t mean the cost of medical care is free for you. Most policies require you to pay a percentage of the cost of rehab. In most cases, the higher your premium the higher the percentage of care covered by the insurance provider. This means that some addiction treatment options might still cost you several hundred or thousand dollars. 

It’s important to get an estimate in advance before committing to care or make payment arrangements in advance so you aren’t surprised by a large bill. However, you should also keep in mind that regardless of the cost of care, it’s important to seek the care you need when dealing with addiction.

If you don’t have insurance coverage and you aren’t able to pay for your rehab expenses in full out-of-pocket there are still options. Rehab is expensive. Intensive outpatient programs range from $200 to $400 per day. Partial hospitalization programs are more expensive and range from $350 to $500 a day. Residential and inpatient programs tend to run about $600 or $700 or more per day.

If you are unable to pay for treatment upfront, ask about payment plans offered by the treatment facility or look for other ways to cover the cost of your care. Friends and family might be willing to chip in or you might be eligible for a medical care line of credit that will extend your payments and make them affordable.

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Does Blue Cross Blue Shield Cover Rehab?

Blue Cross Blue Shield (BCBS) is one of the most popular insurance providers in the United States. BCBS does offer coverage for addiction treatment. This insurance company offers various plans, so your specific policy determines your level of coverage. 

The majority of insurance plans offer coverage for detox if it is medically necessary. If possible, check your coverage or have a trusted loved one review your policy and help you determine what facilities and types of treatment are covered by your specific policy. 

Your doctor can also offer guidance on how to move forward with treatment if Blue Cross Blue Shield is your insurance provider.

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Types of Insurance Coverage for Rehab

Many types of insurance coverage are available for rehab, including:

Medicare

Medicare Part A, also known as Hospital Insurance, covers medically necessary inpatient alcohol rehab or drug rehab. It requires proof of necessity from a doctor. 

Your out-of-pocket costs with Medicare vary based on the number of days you receive care. The rules regarding your payment obligations under Medicare are consistent, but your personal situation has a strong bearing on those obligations. It’s important to review your situation with your doctor or a rehab facility, so you know where you stand.

Also note, you must be 65 or older to qualify for Medicare and that it does not cover the cost of:

  • Private nursing
  • Some personal items, TVs, or phones needed while in care
  • Private accommodations unless they are medically necessary

Medicaid

Medicaid is a state and federal health insurance program that uses income and other factors to determine eligibility. The majority of people using Medicaid are low-income families, pregnant women, disabled people, seniors, children, and parents. 

Exact eligibility rules vary from state to state. Some states expanded Medicaid coverage under the Affordable Care Act, so it’s important to check your eligibility even if you were denied in the past.

The ACA also made coverage for substance abuse treatment under Medicaid mandatory. Insurance benefits must meet the requirements as directed in the Mental Health Parity and Addiction Equity Act (MHPAEA), which a federal law preventing discrimination in coverage based on medical need.

Despite the expansion in the last decade, you should not assume the cost of your care is automatically covered by Medicaid. Make sure you review your coverage and your payment obligations with a chosen care facility before beginning a treatment program.

Private Insurance

Many people have private insurance coverage. This means they pay their premium out-of-pocket and have a great deal of flexibility regarding their coverage. Access to and coverage for drug or alcohol addiction treatment varies a great deal. 

You should contact your provider for information about your specific overage. In many cases, private insurance pays a significant portion of addiction treatment expenses.

Military Insurance

TRICARE is the insurance provider for military families. It offers varying levels of addiction treatment that range from withdrawal, detox, medication-assisted therapy, and other continuing care options. 

State-Financed Health Insurance

In addition to Medicaid, some states offer state-financed health insurance coverage. These programs are funded from a variety of sources, including SAMHSA grants, reimbursement through Medicaid, and direct from state budgets. 

State-financed support is offered on a limited basis and there is often a waiting list for coverage. Some applicants might be given priorities over others depending on their specific situations.

Most programs increase access to addiction treatment options and long-term rehab facilities. The majority of alcohol and drug treatment facilities accept this coverage. 

Resources

“Inpatient Rehabilitation Care Coverage.” Www.Medicare.Gov, www.medicare.gov/coverage/inpatient-rehabilitation-care.  

“Rehabilitation | TRICARE.” Tricare.Mil, www.tricare.mil/CoveredServices/IsItCovered/Rehabilitation.   

Boninger, Joseph W., et al. “Patient Protection and Affordable Care Act: Potential Effects on Physical Medicine and Rehabilitation.” Archives of Physical Medicine and Rehabilitation, vol. 93, no. 6, June 2012, pp. 929–934, www.ncbi.nlm.nih.gov/pmc/articles/PMC3508768/, 10.1016/j.apmr.2012.03.014.

Updated on: September 22, 2020
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Alcohol Rehab Help Writing Staff
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Medically Reviewed
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Annamarie Coy,
BA, CADACII/ICADC, ICPR, MATS
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