Will Insurance Cover The Cost Of Addiction Treatment?

Most insurance plans are required to cover behavioral health services, including addiction treatment, under the Mental Health Parity and Addiction Equity Act of 2008. This means that for the majority of people with health insurance, at least some portion of the cost of inpatient drug rehab will be covered.

That said, coverage varies widely depending on your specific plan. Some insurance programs cover residential treatment in full, others provide only partial coverage, and some don’t cover residential stays at all. Knowing what your plan actually includes before you start treatment can save you from unexpected costs later.

What Types Of Insurance Cover Recovery Programs?

Most types of health insurance fall into two main categories: plans funded through the state and federal government and plans offered by private insurance carriers.

State And Federal Insurance For Drug Rehab

State and federally funded insurance programs, like Medicaid, provide healthcare coverage for people with financial barriers. Millions of people receive Medicaid insurance every year, and many use their health benefits for substance use treatment services.

Types of state and federally funded insurance programs include:

• Medicaid: each state has its own specifications for Medicaid plans, eligibility requirements, income level requirements, and health benefits.
• Medicare: similar to Medicaid, Medicare offers health coverage to people all over the U.S. who are ages 65 or older. This can include drug rehab coverage.
• Tricare: medical insurance for U.S. veterans, active duty military members, and their families.
• Indian Health Service, Tribes, and Urban Indian programs (ITU): Health service coverage available to Alaskan Natives and American Indians in the United States.

Private Insurance Carriers That Cover Rehab Programs

Private health insurance carriers provide health plans through your employer, group, or individually. Because of the wide variety of private insurance plans, one health plan can vary greatly from the next, from copays and premiums to covered services and approved providers.

However, private insurance carriers do cover rehab treatment.

Common insurance providers that cover rehab programs in the United States:

• Aetna
• Ambetter
• Amerigroup
• Anthem
• Assurant Health
• Beacon
• Blue Cross Blue Shield (BCBS)
• Cambia Health Solutions
• Carefirst
• Centene
• Cigna
• Connecticare
• COBRA
• Coventry Health Care
• Harvard Pilgrim Health Care
• Health New England
• Highmark
• Humana
• Kaiser Permanente
• Lifetime Healthcare
• Magellan
• Medical Mutual
• Molina Healthcare
• Optima Health
• Priority Health
• Tricare
• UnitedHealthcare
• WellPoint
• VA Health Insurance

What Private Insurance Covers For Drug Rehab Programs

Private insurance may cover a range of services during your stay at a rehab center. Again, what’s covered will depend on your individual insurance plan. Plans with a higher level of coverage (such as those commonly in “Gold” level insurance packages) often cover more rehab services, which may include residential treatment stays.

Substance abuse treatment services commonly covered by insurance:

• detoxification programs
• inpatient treatment programs
• outpatient programs
• partial hospitalization programs (PHP)
• intensive outpatient programs (IOP)
• day treatment
• medication-assisted treatment for opioid and alcohol addiction
• long-term recovery programs
• aftercare programs
• dual diagnosis care for co-occurring disorders
• mental health treatment
• counseling
• behavioral therapy

Those with a lower level of coverage may still cover treatment, with higher out-of-pocket costs to you. Because of this, rehab facilities often offer payment plans to clients. Evidence-based care is usually covered by insurance plans, so long as it is deemed “medically necessary.” This simply means you may have to undergo a drug and alcohol abuse assessment to show your need for care.

What Treatment Services Public Or State Insurance Covers

Medicaid coverage for drug rehab programs is regulated by the Medicaid program. This means Medicaid recipients can only get coverage for care that is approved for the program.

Addiction treatments which may be covered by state insurance programs:

• drug and alcohol detox
• counseling
• behavioral programs
• PHP
• IOP
• day treatment
• dual diagnosis programs
• mental health services
• aftercare
• continuing care
• relapse prevention programs

In some states, you may only be able to access a day treatment program (partial hospitalization or intensive outpatient treatment) with Medicaid. In these states, residential treatment will not be covered by Medicaid at all. Long-term rehab programs are not always covered by Medicaid. Some states also require that you try an outpatient program prior to entering an inpatient program.

How To Verify Your Insurance Coverage Before Starting Treatment

One of the most important steps you can take before entering a rehab program is confirming exactly what your insurance will and won’t cover. Start by calling the member services number on your insurance card and asking specifically about substance use disorder benefits, including inpatient, outpatient, detox, and medication-assisted treatment. Make sure to ask about copays, deductibles, out-of-pocket maximums, whether prior authorization is required, and whether your preferred facility is in-network. Out-of-network treatment is often covered at a reduced rate or not at all, and starting treatment without prior authorization can result in denied claims.

Most reputable rehab facilities also have admissions staff who handle insurance verification as part of the intake process and can often give you a clearer picture of your coverage than a general call to your insurer. Either way, try to get confirmation of your benefits in writing before committing to a program.

Rehab Insurance FAQs

If you would like to know more about insurance coverage for addiction treatment programs, learn answers to frequently asked questions below.

❓ What Are My Options For Rehab If I Don’t Have Insurance?

✔️ Even if you do not have an insurance plan, you can still access addiction treatment. You may qualify for a payment plan through a rehab facility based on your income.

You could also ask friends and family for help paying for a program, or use your savings account. Alternatively, you could take out a medical loan to fund your recovery.

Or, search our list of free rehab centers by state for facilities that offer free and low-cost recovery programs.

❓ Does Insurance Cover Detox?

✔️ Many insurance programs cover detox programs, since drug and alcohol detox is often a crucial first step to entering recovery.

❓ Does Insurance Cover Opioid Treatment Programs?

✔️ Opioid treatment programs (OTP) are generally covered by insurance, as opioids are one of the top forms of drug abuse in the nation.

Medication-assisted treatment is the most effective form of care for opioid use disorder and may involve use of medications like methadone or Suboxone.

❓ Does Insurance Cover Inpatient Treatment For Addiction?

✔️ Whether your plan will cover your inpatient stay at a rehab center depends on the plan, your coverage level, the rehab facility, and whether they accept your type of plan.

Speak to a treatment center specialist to learn about your rehab coverage and treatment center options.

❓ Does Insurance Cover Substance Abuse Outpatient Services?

✔️ Outpatient services for alcohol and drug use issues are often covered by Medicaid and other health plans. Which types of outpatient programs are covered will vary by plan.

Use Your Insurance To Get Started On Your Recovery Program

Looking for an affordable way to enter addiction recovery? Let us help you.

Contact our helpline today to learn about free, low-cost, or affordable treatment options for substance abuse for you or your loved one.

Written by the Affordable Rehabs Editorial Staff