Blue Cross Blue Shield Insurance Coverage for Drug and Alcohol Addiction Rehab

Last updated on May 21, 2021

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Deciding to seek rehabilitation treatment for drug or alcohol addiction can be a step in the right direction, but you may have some concerns about treatment. Paying for treatment, rehab services and navigating rehab insurance coverage levels can be confusing. The majority of insurance plans, however, do offer some addiction treatment coverage for substance abuse. This article discusses:

Basic information about Blue Cross Blue Shield.
Healthcare coverage levels and plans.
How to check your healthcare benefits.
Does Blue Cross Blue Shield cover drug rehab services?

Blue Cross started in 1929 as a plan to make healthcare affordable for Baylor University hospital patients.¹ Blue Shield had a similar start, offering health services to workers in exchange for a monthly payment.¹ These two plans spread rapidly and merged in the 1940s.¹ Blue Cross Blue Shield (BCBS) Health Plans provide coverage to one-third of Americans. Coverage is available in all 50 states and is widely accepted nationwide.²

Blue Cross Blue Shield Rehab Coverage Levels and Plans

While BCBS plans can vary based on which state you are in, most plans are broken into 3 levels:³

Bronze plans have the lowest premiums, but out-of-pocket costs are higher. BCBS pays about 60% of the costs of your medical care once your deductible is met.
Silver plans have higher premiums, but you pay less out of pocket than with a bronze plan. BCBS pays about 70% of your medical care after your deductible is met.
Gold plans have the highest premiums and lowest out-of-pocket costs. BCBS pays about 80% of your medical care once your deductible is met.

BCBS participates in Medicaid, which is a health insurance program for people with low incomes who often have severe health conditions.⁴ Medicare, a federal insurance program for people aged 65 and older, is also administered through BCBS.⁵

The advantage of a large, nationwide insurance company like BCBS means that you can easily access treatment in other states.⁶The BlueCard program allows you to benefit from local BCBS plan rates even if you decide to seek treatment outside your home state.⁶

How to Check Your Blue Cross Blue Shield Rehab Coverage

If you want to check your insurance benefits or find out if your insurance covers drug rehab, you can call the phone number on the back of your insurance card to connect with a customer service representative. You can also access your benefits through the BCBS website, which will connect you to your local BCBS provider.

BCBS offers coverage plans for current and former federal employees across the United States.⁷ As the leading insurance plan in the United States for federal workers, the BCBS Federal Employee Plan insures about 5.3 million current and former federal workers and their families.^7,8 There are 3 plans available:⁷

The standard plan offers access to in-network and out-of-network providers, with higher premiums, low deductible, lowest out-of-pocket maximum, and lower copays than the basic plan.
The basic plan offers access to in-network providers, with a lower premium, no deductible, higher out-of-pocket maximum than the standard plan, and highest copays.
The FEP Blue Focus plan offers access to in-network providers, with lowest premiums, higher deductible and out-of-pocket maximum, and lowest copays.

Does Blue Cross Blue Shield Cover Drug & Alcohol Rehab?

The Affordable Care Act (ACA) requires all insurance plans to cover specific services, known as essential health benefits.⁹ Mental health services are included as an essential health benefit, although specific plans cover varying levels of services.⁹ In general, Blue Cross Blue Shield mental health coverage includes drug and alcohol addiction treatment services that are in-network and considered to be medically necessary.³ There may be limits on what type of treatment will be covered, or for how long, and you may need authorization before you start treatment.

If you have questions about the specific Blue Cross Blue Shield addiction therapy coverage included in your plan, calling the number on your card is the best way to learn more about the services that would be covered and what your financial responsibility would be. You can also check to see if your insurance is accepted at American Addiction Centers facilities.

BCBS is a well-established insurance company that offers health insurance to many people across the country. A variety of coverage plans is available. They offer different levels of benefits, although each provides coverage for substance use disorder treatment regardless of where you decide to seek care. Since the coverage can vary depending on the plan and your location, it is important to check your coverage before seeking treatment.

Additional Resources on Health Insurance Providers and Coverage Levels

Visit the links below to find out more about your health insurance coverage levels, how to get your insurance company to pay for drug and alcohol rehab and also how to pay if you don’t have insurance.

Additional Resources on Drug and Alcohol Rehab

Whether you’re looking for a specific type of rehab treatment, substance related info or additional guides, below are some our popular and recommended.

Please note: American Addiction Centers (AAC) aims to provide the most accurate information on insurance coverage for addiction treatment, but policy changes and errors do occur. Always be sure to confirm your coverage directly with your insurance carrier. AAC is not affiliated with or endorsed by Blue Cross and Blue Shield (BCBS) or any of its licensees.