Does Insurance Cover Rehab?

Drug and alcohol addiction, also known as substance use disorder and alcohol use disorder, are currently recognized as chronic mental health issues. As complex diseases that impact both how the brain functions and its overall chemistry, these ailments require professional treatment.

Under the Affordable Care Act, private pay health insurance companies are required to pay for a portion of this treatment. Many subsidized health care plans provide coverage for addiction treatment as well. More importantly, health insurance companies are no longer legally able to penalize existing policyholders or new applicants for having either substance use disorder or alcohol use disorder as a pre-existing condition.

Thus, although cost is seen as one of the biggest barriers to addiction treatment, it really doesn’t have to be. If you currently have private pay health insurance, you’ll need to find out which rehab services your plan will cover, and which services must be paid for as out-of-pocket expenses. If you do not have health insurance but need treatment for an existing condition, you can apply for a private pay health insurance plan that will cover most or all of your rehab costs. Navigating the health insurance landscape is never easy.

However, it can be even more challenging and confusing when addiction is involved. Fortunately, all rehab facilities have admissions counselors and other team members on hand who can help with this process. You can also call health insurance companies directly to get answers to your plan-related questions.

Important Factors to Consider When Using Your Health Insurance for Rehab

There are two primary types of health insurance plans that consumers can bind. These are preferred provider organization (PPO) plans and health maintenance organization (HMO) plans. With an HMO plan, you’ll only get your full range of coverage benefits when enrolling in a treatment facility that’s part of your insurance company’s defined network of approved providers.

Choosing to receive care outside of this network will invariably result in more out-of-pocket spending and may leave you with absolutely no applicable coverage benefits at all. To find in-network work providers for an HMO plan, you should contact your health insurance company. PPO plans are more flexible in terms of where policyholders can receive treatment.

A PPO plan comes with a defined network of approved providers, but policyholders can also work with facilities and licensed medical professionals outside of this network. Using in-network providers with a PPO plan is often cheaper than using out-of-network providers, however, your coverage benefits will remain accessible regardless of the route you choose.

Which Costs Will You Have to Pay Out-of-Pocket

Health insurance plans with low premiums and high deductibles are generally best-suited to consumers who are relatively young in age and have absolutely no pre-existing conditions.

With alcohol use disorder or substance use disorder as a pre-existing condition, it is generally best to buy or upgrade to a top-tier health insurance plan that has higher monthly or annual premiums but offers a greater range of coverage benefits.

Although you’ll pay more each month for a top-tier plan, your out-of-pocket rehab costs will be limited. Irrespective of your plan type, you’ll likely have to pay all:

  • Co-payments
  • Plan deductibles
  • Prescription fees

Fortunately, these charges are relatively nominal in comparison to the rehab charges that most plans will cover. Moreover, many rehab facilities are willing to accept reasonable payment plans.

There Are Several Ways to Pay Uncovered Rehab Costs

Working with a health insurance broker or a financial adviser is a great way to discover secondary policies that will cover any expenses that your primary plan does not. Many consumers bind and maintain secondary health insurance plans that take care of all of their prescription fees, co-payments, and plan deductibles.

These secondary policies can be especially helpful if you intend on staying in an inpatient rehab facility for six months or longer, or plan to engage in other forms of structured addiction treatment after a one to three-month program has ended. Most rehab facilities will accept a variety of payment types for uncovered expenses. For instance, you may be able to pay:

  • In cash
  • Using a credit or debit card
  • With a personal check

There’s also a limited range of needs-based scholarship opportunities that patients can take advantage of. These are funding opportunities that are provided by charitable organizations.

You can find out more about them by speaking with admissions counselors, calling local social service agencies, or contacting charitable organizations directly. Many people also take care of their uncovered rehab costs by crowdsourcing or by fundraising in other ways. If you’re ready to start addiction treatment but need help planning for the related costs, we’ve got you covered. Call us now at 844-639-8371.

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