There’s a lot to think about once you decide to get professional treatment for a drug or alcohol substance abuse problem or addiction. Perhaps at the top of the list is the concern of how it’s going to get paid and who’s going to pay it. “Can I afford it?” “How will I pay for this?” “What about my insurance?” “What if I don’t have insurance?” There are many questions like this, and they are all valid.
Addiction treatment is not cheap. However, no matter how costly treatment is, one can’t really afford passing up an opportunity to get addiction help. There’s too much at stake: your health, your money, and your personal relationships.
An estimated 19.3 million people ages 12 and older who were classified as needing substance use treatment did not receive it at a specialty facility in 2015, reports the 2015 National Survey on Drug Use and Health (NSDUH).
You don’t have to be among the nearly 20 million people who needed services for a substance addiction but chose to pass them up. There’s no doubt that for many of them the cost was a barrier to treatment. But you can make a different choice. There is help for drug rehab financing, and there are various ways to ensure the bills are covered.
Before you commit to treatment, it’s a good idea to take some time to look at your financial options. First, know that addiction recovery treatment won’t look the same for everyone. Many different factors are reviewed before determining the best course of treatment for the individual. There are multiple ways to address substance abuse and addiction, so keep flexibility in mind, which could make treatment more customized and affordable.
What To Know About Substance Abuse Insurance Coverage
Insurance providers generally understand that addiction is a treatable medical condition under the Affordable Care Act (ACA). As of 2014, under this measure, insurance plans are required to cover 10 health services known as Essential Health Benefits, regardless of the kind of insurance one has. These benefits include help with mental health issues, drug or alcohol abuse, and counseling and therapy. However, what’s covered varies, and whatever services are not covered by your insurer must be paid by you or another payment source. While most insurance companies cover addiction treatment, they might not cover every type of therapy or every kind of addiction treatment facility.AFFORDING ADDICTION TREATMENT
Some insurance providers have established relationships with treatment centers, so in those instances, it likely will be easier to get treatment at that center rather than a facility that is unknown to your insurance provider. That doesn’t necessarily mean out-of-network facilities are not an option for people needing treatment. You or your loved one still may be able to receive coverage for another treatment center if it appears to be a better fit for you. But expect the insurance company to want to evaluate that facility first to see if it meets their criteria. Insurance providers typically evaluate these factors of a center it reviews:
- The type of treatments it provides
- Whether the facility is in state or out of state
- Whether it is privately or publicly funded
- And other factors
Addiction treatment is delivered in diverse settings with a variety of behavioral and pharmacological approaches, says the National Institute on Drug Abuse. People in need of substance abuse treatment have thousands of facilities to choose from. There are nearly 15,000 specialized substance abuse treatment facilities across the U.S., so there’s definitely no shortage. Health plans typically provide substance abuse treatment coverage. It’s important to know, however, that not every facility or treatment type will be covered by a particular health plan. Much will depend on whether you have public insurance, private insurance, or group insurance.
Treatment facilities that are partially or completely subsidized by the government accept state or federal health insurance plans for full or partial payment of services. These plans generally have specific income guidelines, which applies to only certain people and situations. Public insurance includes Medicare, for people age 65 and older, and Medicaid, which is for low-income households.
Private insurance costs more, but it also offers more health care options. It also is more comprehensive than government-subsidized insurance plans. These options can include inpatient or residential rehab, holistic therapy treatment, luxury rehab, and other treatment options that are not covered by public insurance.
When it comes to drug rehab financing, an individual or employer picks up the cost of private insurance. Neither federal government or its agencies pay for it. In addition to having more options, private insurance plans pay a large portion of treatment costs. Your deductible, the amount you are required to pay before your insurer covers its portion, also factors into how much you’ll spend, but the amount you pay likely will be less than what you would pay if you had no insurance.
In private insurance, the three main managed care plans are:
HEALTH MAINTENANCE ORGANIZATIONS (HMOS)
Insurers of this kind cover care costs from in-network providers, which makes them more affordable. If the drug or alcohol rehab center you are considering is listed as “in-network,” it means it has established an agreement with your insurance company and some services are billed at a lower or discounted rate. If the rehab is “out of network,” which means it does not have an agreement with your insurer, then your out-of-pocket costs may cost more.
PREFERRED PROVIDER ORGANIZATIONS (PPOS)
PPOs work with in-network providers but may cover some costs from out-of-network providers. However, going outside of the network may cost you more. You also may have to pay costs upfront and work with your insurance company to get a reimbursement.
POINT OF SERVICE (POS)
A POS is the most flexible of the three plans. People with a POS can seek care from HMO and PPO providers when they need care.
GROUP HEALTH INSURANCE
Under this plan, an employer provides health care coverage to a select group of people. These plans cost less for participants than individual plans because there are more people involved, and they offer the same benefits as individual insurance plans.
People in these plans who want to use their benefits to cover addiction treatment may be concerned about losing their jobs. However, under the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008, health insurance companies are required to provide the same level of benefits for mental and/or substance use treatment and services that they do for medical or surgical care.
The Affordable Care Act expands the Act’s requirements by ensuring that the plans the Health Insurance Marketplace offer cover the many behavioral health treatments and services available, SAMHSA writes.
Check with your group plan to see what services are covered.
Give Maryland House Detox a call at 1-855-928-0596, and let one of our representatives discuss full and partial private payment options and help work with you to create a practical plan for drug rehab financing.
A concern that often arises among potential clients is whether treatment for their specific substance dependency will be covered by their insurance plan. As long as your plan lists addiction treatment as a covered benefit, then care will be provided, regardless of the source of the addiction.
What Does My Substance Abuse Treatment Insurance Cover?
It’s important to know what kinds of substance abuse treatment your plan covers. While many insurers are generally likely to provide full coverage for outpatient care over inpatient or residential care, which are longer in duration, what matters most is that you choose the treatment program and services that are most effective for a successful recovery.
Depending On The Specific Terms Of Your Health Plan, You May Be Eligible For Coverage For:
- Medical detox, which may include maintenance medications
- Inpatient care at an approved, in-network facility
- Long-term residential care at an approved, in-network facility
- Outpatient care with an approved, in-network provider
- Co-occurring disorders or mental health issues
- Aftercare counseling, therapy, services
Some health plans cover all substances, including alcohol, to make things easier for the person seeking recovery. However, that doesn’t mean insurers will cover all treatment or therapies. They also may not cover certain medications. Aftercare services, which are essential to the addiction recovery process, may not be covered by a particular insurance company.
If you’re unsure about which services or programs your insurance plan covers, call your insurance provider or job’s benefits department for guidance or to get questions you have answered. When you make the call, ask the insurance representative if your primary care physician will have to issue a referral before expenses are covered. Also, ask about any required copayment ready and whether the substance abuse treatment expenses will apply to a deductible.
How Long Will My Insurer Pay For My Addiction Treatment?
The length of your substance addiction coverage depends on what your health plan covers. Your insurer insurance may cover the full duration of the time you are in addiction recovery while others may set coverage limits to a certain number of days. People who need a medical detox may find this to be a challenge if the process goes over the three- to ten-day period or if one is required to stay in residential treatment more than 30 days.
The duration of your stay in rehab treatment may also be determined by whether you are at a private or public treatment facility. Private facilities can cost more, which means you can reach the maximum treatment limits that are covered faster than you would at a public treatment center.
Can I Get Substance Abuse Treatment Without Insurance?
If you do not have health insurance to cover the costs of substance abuse treatment services, you should still give us a call at 1-855-928-0596. All is not lost because you don’t have insurance or another way to pay for your addiction treatment. It will take some research, but you or your loved one could be eligible to receive scholarships or grants to cover your treatment costs.