Does Insurance Cover Drug Rehab?

The answer is yes, in many cases! There are different types of addiction treatment that are covered by insurance - including Medicare, Medicaid, Blue Cross Blue Shield, Aetna, Tricare, and many more.

While struggling with a substance use disorder, you might get to a point where you feel that the time has come for you to get treatment for your condition before it continues getting out of hand. However, you might also be worried about how you are going to offset the cost of this treatment.

Insurance Coverage for Drug Rehab

The first step before reaching out to your insurance company is to have a list of very specific questions in place. When you have a definitive list of questions regarding your policy, you will be able to get the specific details that you are looking for when you get in touch with your insurance provider. It can also make it easier for you to focus your thoughts.

Some of the questions that could help you get the right answers from your insurer include:

  • Does my insurance policy require that I seek drug rehab treatment from the network of addiction rehabilitation centers approved by the company?
  • Does my insurance provide coverage for all phases of drug rehab, including detox, inpatient treatment, and aftercare services?
  • What types of drug rehab treatment programs will be covered under the policy I currently have?
  • What will my deductible or copay be in case I enroll for treatment for my substance use disorder?
  • Will my insurance policy cover all of the medications that might be prescribed to me when I enroll for addiction rehab and treatment?
  • Will my policy cover all the different types of therapy and counseling programs that might be in my addiction rehab treatment program?

Rehab Treatment Covered by Insurance

The types of treatment and rehabilitation services that will be covered by your plan will largely depend on the insurance company you are working with as well as on the coverage plan that you selected.

In general, most insurance providers will cover detoxification. This is especially if there is a high risk that you might face severe addiction withdrawal symptoms - some of which might also turn out to be fatal - if you do not undergo detox through a medically managed and supervised program.

The level of covered for inpatient and outpatient rehab will vary from one insurance plan to the next, as well as between different insurance coverage providers. However, as a policyholder you can expect your insurance provider to mitigate - at the very least - these costs with some coverage for your drug rehab.

Understanding HMO Plans

Health maintenance organizations, also known as HMOs, are companies that work with different insurance coverage providers to ensure that care is available for you. In many cases, they will liaise with different addiction treatment and drug rehab companies to provide these services.

As a patient, you will rely on primary care physicians who have been approved by the HMO network to take care of your general medical needs. However, if you find that you are going to need specialist medical care services, you will work with PCPs to get another health care provider - but who must also be in the same network.

Signing up with HMOs can save you money on your premiums. Additionally, it will allow you to enjoy the following extra benefits of insurance coverage for your drug rehab and addiction treatment:

  • Centralized health care services
  • Lower deductibles
  • Lower premiums
  • Streamlined care through a primary care physician

Understanding PPO Plans

Preferred provider organizations, or PPOs, are health insurance groups that will create a network of healthcare and medical treatment through local providers who participate in the same program.

The medical professionals participating in a PPO will always have a guarantee of receiving potential patients. As a member in such a group, on the other hand, you will enjoy discounts on deductibles and premiums.

Although HMO clients will enjoy secure plans, PPO policyholders will have greater flexibility in terms of the level and type of care that they can receive. In the same way, if you sign up for a HMO plan, you will guaranteed of coverage if you get treatment from within the network. However, this also means that you might have considerably fewer options in case you need to get medical assistance outside the network - such as during medical emergencies when you are far from home.

  • Freedom of choice on the providers that you can see
  • Partial coverage if you seek treatment out-of-network
  • There is no need for referrals to primary physicians
  • With PPOs, you will enjoy the following additional benefits:

However, there are cases in which a PPO plan might go wrong. This could be linked to your coverage options and cost savings. To this end, PPO might not always be the right fit for you because of the following additional disadvantages:

  • Fewer predictable costs
  • Risk that you might receive disorganized care
  • You need to fill in additional paperwork while making claims

Insurance Coverage Professionals for Drug Rehab

Navigating different insurance policies - most of which are complex - might be difficult to do on your own. This is especially if you are also struggling with a substance use disorder and co-occurring mental health disorders at the same time.

Additionally, speaking directly to insurance providers can also leave you with more questions that you started with. In such a case, you might be better off getting the extra support that you need instead of making a largely uninformed and confused decision.

To this end, you should consider seeking out insurance professionals who are well versed with the different insurance providers who can cover your drug rehab and treatment services until you fully overcome your addiction. They should also understand how the following popular insurance providers work:

  • Aetna Insurance
  • Anthem
  • Asuris Northwest Health
  • Beacon Health
  • Blue Cross Blue Shield (or BCBS)
  • Cigna
  • Healthnet
  • Humana
  • Kaiser Permanente
  • Molina Healthcare
  • Tricare
  • UMR
  • UnitedHealthcare
  • VelaPoint

If you need your insurance coverage to be subsidized or you find that you are no longer able to afford health insurance, you should also check if you are eligible for Medicare and Medicaid.

To become eligible to these federal insurance coverage options, you need to meet certain criteria that are specified on the specific Medicaid and Medicare websites. You should also check with different health insurance providers so that they can provide you with more information about your coverage, covered services, local healthcare plans, as well as any limitations and restrictions that might exist.

Covered Behavioral Health Services

According to the ACA - the Affordable Care Act - any and all behavioral health services that you receive will be covered under the health insurance plans that are available within the federal marketplace.

Addiction and mental health issues, in particular, are now considered essential health benefits. As such, they will be covered by both Medicare and Medicaid in the same way that all other surgical and medical procedures are covered. Under these programs, you may be able to enjoy the following drug rehab services:

  • Community-based programs
  • Counseling
  • Crisis services
  • Detox services
  • Inpatient treatment
  • Outpatient treatment
  • Prescription medications
  • Residential treatment
  • Therapy
  • Treatment for co-occurring disorders

You should keep in mind that you can only get your insurance provider to pay for your mental health care and addiction treatment after providing that it is a medical necessity, meaning that you might need to visit your primary care provider to get a referral so that you can enjoy the specialty services that you need.

Your Treatment May Be Covered By Your Health Insurance!

Many health insurance plans will help to cover the cost of addiction treatment.

Call now to speak with a treatment specialist to find out if your health insurance provides benefits for addiction rehabilitation.

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