If you or a loved one are struggling with an addiction to drugs and/or alcohol, it can feel overwhelming. Getting help through an addiction treatment program is a way to start the road to recovery, but the cost may seem out of reach.
While you may be unsure of how to pay for addiction treatment programs, there are a number of ways to get assistance with paying for treatment. Many insurance companies offer healthcare benefits that cover mental health and substance use treatment to get people the help they need to recover. Treatment facilities may also offer payment options to help you get the support you need.
If you’re wondering how to pay for addiction treatment, this page will provide information about types of addiction treatment coverage offered by insurance companies, the types of treatment programs available, and how to find out if your insurance covers addiction treatment.
What Types of Addiction Treatment are Covered by Insurance?
Treatment for addiction used to be seen as a luxury expense reserved for those who can afford it. However, with the passage of the Affordable Care Act (ACA), more people have access to health insurance. The ACA includes Essential Health Benefits (EHBs), which offers coverage for mental health and substance use disorder services, such as addiction treatment.4, 5 Many private insurance companies are held to the same standards noted in the ACA, meaning they cover addiction treatment.
Types of addiction treatment coverage offered by many insurance plans often includes:
- Medical detox (inpatient and outpatient). This is the process of ridding the body of toxins prior to starting a treatment program. For example, an individual with an alcohol use disorder (AUD) or opioid use disorder (OUD) may go through detox to be stabilized before starting further treatment.
- Outpatient care. Outpatient treatment allows people to engage in various treatment programs and services without living in the facility. This is a good option for a person who wants to continue working or going to school while receiving support in their recovery.
- Inpatient or residential care. People receive treatment while remaining in a hospital or residential-type treatment facility. Treatment may include detox, therapy, support groups, and other amenities.
- Co-occurring mental health conditions. This refers to mental health conditions that a person may have in addition to their addiction to a substance. For example, an individual may be struggling with depression or an anxiety disorder along with an AUD.
- Follow-up counseling. People have the opportunity to speak with a counselor after treatment to help them continue their journey of recovery and sobriety.
- Maintenance and treatment medication. Some medications help those with certain substance use disorders, such as OUD, which are used to ease drug cravings and are often effective at preventing relapse. This can support people throughout their recovery while working, going to school, and/or continuing other types of treatment.6
Under many insurance plans, addiction treatment is covered for a number of substances, such as:7
After people choose a treatment facility and receive an assessment to address the level of care needed, a treatment plan is created to fit their individual needs.
Please keep in mind that you should check with your specific insurance company and plan to find out what treatments are covered. Coverage can vary based on geographic location, partnerships between insurer and the treatment facility, in-network vs. out-of-network facilities, and whether you have an HMO or PPO.
What’s the Difference Between an HMO and PPO?
An HMO is a health maintenance organization. HMO plans typically limit coverage to specific providers who are contracted with that HMO.1 Due to this type of coverage, some HMOs may require that a person live or work within their service area to be eligible for healthcare coverage, or that you get a referral from a primary care provider.1 If you have an HMO and are considering treatment for substance use, check with your insurance provider to see what’s covered in your area.
Some potential benefits of HMO plans include:2
- Lower or no deductibles.
- Overall coverage costs are typically lower than a PPO.
- Paying lower premiums for healthcare providers and specialists out of network.
A preferred provider organization is known as a PPO. This typically includes a network of providers that you can choose from, which will cost less than those out of your network. You also have the ability to go to a doctor, hospital, or other type of provider without having to get a referral.1 If you have a PPO and are considering treatment for substance use, check with your insurance provider to see what addiction treatment coverage you have.
Some potential benefits of PPO plans include:2
- Fewer restrictions on out-of-network providers.
- Members are not required to choose a primary care physician.
Insurance Coverage for Drug and Alcohol Addiction Treatment Programs
Small group and most individual health insurance plans are required to cover both substance use disorder services as well as mental health. Medicaid Alternative Benefit Plan is also required to cover substance abuse services and mental health services. Coverage for these services cannot be more restrictive than the coverage provided for surgical or medical. In other words, addiction and mental health need to be treated the same as other health conditions.4
The amount of coverage and cost will vary from one insurance company to another and may depend on the duration of treatment and/or length of stay at a facility. Additionally, coverage and costs may be contingent on the level of care a person receives. The level of care will be assessed by a clinical professional before entering treatment to ensure they receive the proper care for their substance use and/or mental health disorder(s). These levels of care based are based on the ASAM Continuum of care which includes:8
- Outpatient treatment.
- Intensive outpatient treatment.
- Residential/inpatient treatment.
- Medically managed intensive inpatient treatment.
Does My Insurance Cover Addiction Treatment?
Finding out whether or not you have addiction treatment coverage through your insurance can be done by contacting your insurance company or you can quickly verify insurance through American Addiction Center’s confidential form.
There are several health insurance providers that cover mental health and addiction treatment. This includes, but is not limited to:
The type of coverage may vary between each insurer and each individual’s plan. Be sure to check with your insurance provider to see if you have alcohol or drug rehab coverage, and what levels of care are covered.
American Addiction Centers is a nationwide leader in providing alcohol and drug treatment and is in-network with many leading insurance providers in the United States. Reach out to speak to one of our caring admissions navigators at (877) 336-0584 to help you start on the road to recovery.