Finding Insurance Covered Drug Rehabs

Exclusive Hawaii Rehab Drug Rehab September 21, 2022

Justified or not, one of the biggest obstacles with helping people suffering from drug addiction is their lack of insurance and financial help in covering a rehabilitation center’s cost. When finding insurance covered drug rehabs, it doesn’t take long to realize not all drug rehabs are created equal. With some of the best programs and options offered at private drug rehabs, as they are not solely funded and governed by their residing state. However, insurance may be able to help cover some or all of the cost of addiction treatment from both private and public drug rehabs. In fact, the ACA (Affordable Care Act) requires long-term private and public insurance plans to cover 10 essential health benefits including treatment for mental and behavioral health disorders. Most importantly which includes treatment for substance use and abuse disorder, or in other words drug rehab. Whether for yourself or for a loved one, researching insurance options and the facilities covered is a great start before choosing a potential drug rehab.  

The Debate Of Whether Drug Abuse Is A Mental And/Or Medical Disorder

Insurance companies may provide a debate of whether drug abuse or addiction is a covered medical condition under a policy. An addiction to alcohol, nicotine, or any other substance is not considered a disability depending. However, an individual might be considered disabled thier addiction caused an impairment. For example if you have liver disease or depression caused by alcohol dependency, that would be an impairment. A substance use disorder (SUD) is a mental disorder that affects a person’s brain and behavior, leading to a person’s inability to control their use of substances such as legal or illegal drugs, alcohol, or medications. Legal definitions, agreed upon understanding of medical and mental disorders should be discussed and broken down before any signing on a dotted line. Especially when finding insurance covered drug rehabs and programs that could potentially be a great fit for anyone seeking recovery. 

Insurance That Can Potentially Cover Drug Rehabs And Their Cost

While each drug rehabilitation facility will be unique in its own offerings, programs, and cost- it is always a wise choice to ask about insurance coverage. There are two main types of insurance, just as there are two types of drug rehab facilities- Public and Private. Public health insurance is often Medicaid, which is state-based coverage for lower-income Americans that qualify. With the other common type of public insurance being Medicare, a federal plan for older and disabled Americans. Private insurance is mostly provided through group plans by an employer with coverage paid for/bought by the insured person(s) or known as non-group plans. With private insurance the exact amount of coverage of course will depend on the specific insurance plan. Each insurance plan will have its own definitions and fine print for what the policy covers for the insured, so always be sure to read the fine print when purchasing. As with most insurance policies, the insured person(s) are responsible for costs outlined such as a deductible, co-payment, or co-insurance. Outweighing costs and what will be most suitable for someone’s financial situation is key in finding insurance covered drug rehabs. 

When insured, an important factor in choosing a drug rehab facility is whether the programs offered are within your insurance provider’s network. Unfortunately, many health insurance plans do not offer any coverage for non-emergency care outside of the network. And most often when coverage is provided- it may or will be much more expensive even so. However, both private and public insurance are bound by the provisions of the ACA, meaning both can help provide coverage for medically-necessary substance use disorder treatment. 

Insurance Providers Known When Finding Insurance Covered Drug Rehabs

Thankfully, there are a wide variety of insurance companies that offer coverage plans for substance and/or drug rehabilitation. There are different types of health insurance plans available, and each one will have its own different coverage and options. This can impact things such as how much you would pay out-of-pocket and how your rehab provider can work with you based upon your rehab insurance coverage. Important to note is SAMHSA’s National Helpline- a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families finding insurance covered drug rehabs. When purchasing insurance, the exact amount of coverage and how much you pay out of pocket depends on your individual plan. Therefore it is essential to compare plans before making your final decision on insurance coverage with a potential drug rehab in mind.  

Two of the most common Insurance Providers are Health Maintenance Organization (HMO) Plans and Preferred Provider Organization (PPO) Plans. HMO Plans limit your coverage to providers within the insurance plan’s network. You might be able to get emergency care outside the network, but regular care (and substance use rehab) will need to be from doctors and providers in the network. PPO Plans have more flexibility but may have a higher monthly premium. You pay less if you use in-network providers, but may be able to use other providers at a higher cost. Again, knowing the type of insurance plan you have will help you find the right rehab center for your needs or for those of someone you love.

Some Examples Of Programs Covered By Insurance In Drug Rehab 

When insured, it’s comforting to know that there are a variety of treatment options and programs for drug abuse and rehab. They can vary greatly, as some are more intensive than others. For example, some programs will allow the individual seeking recovery to live at home while others will not and require treatment solely at a covered facility. The right program or form of treatment should be determined by working with a professional including a medical doctor. Once the type of care needed is determined, the next step is seeing if and what your drug rehab insurance will cover and allow. When finding insurance covered drug rehabs, such examples of allowed programs and treatment can include:

Medical Detox: Most drug rehabs will offer at the very least detoxification programs in aiding with recovery. Detoxing is a process during which your body is deprived of the craved substances and rids itself of those substances. Detoxification can cause extreme discomfort, and those engaged may experience potentially life-threatening withdrawal symptoms. As a result, many may find detox programs that are managed 24/7 by a team of licensed medical professionals a safer option. This process can help you stabilize before moving onto a more intensive type of treatment, and can be covered depending on insurance and facility. 

Inpatient Rehab – When finding insurance covered drug rehabs, you will often see there are Inpatient and Outpatient Programs offered. An Inpatient Program enables the client to live at the facility so that you can receive 24/7 assistance while working towards recovery. Inpatient Programs generally offer a variety of group and individual therapies, one-on-one counseling, and specialty programs to provide excellent support toward recovery. Inpatient programs can take place both in a hospital setting, or at a private facility. These types of programs can also last for a few weeks or months or up to a year with Residential Programs. Each drug rehab facility can and will provide information about insurance coverage, so always ask.

Outpatient Rehab – Outpatient programs on the other hand can assist individuals who need to reside at home during treatment. Outpatient programs allow you to receive treatment at a facility while still living at home and participating in work, school, and daily life. Again, when finding insurance covered drug rehabs ask if insurance plans can cover such a program for recovery. 

Aftercare: Aftercare is a program that helps individuals maintain recovery after completing a comprehensive Inpatient Program or Outpatient Program. Aftercare plans usually connect you with sober individuals, groups, and support networks such as the commonly known Alcoholics Anonymous (AA) to help clients maintain life long lasting recovery. Each insurance plan will provide coverage options differently, such as Aftercare options. 

Finding insurance covered drug rehabs that work with your policy do not need to be a difficult process. An excellent first step would be contacting your doctor or a trusted medical professional to determine the care and programs needed for full recovery. Besides establishing the treatments and care needed, they can also connect patients to in-network drug rehabs. And again, the SAMHSA treatment locator is another way of finding insurance covered drug rehabs that are near you or someone you love in need of care.