Does Insurance Cover Residential Inpatient Drug and Alcohol Rehab

The cost of addiction treatment is often intimidating. So much so, in fact, that many people delay in seeking the help they need. Although cost is commonly seen and cited as the biggest barrier to recovery, it really doesn’t have to be. Whether you have health insurance now or you’re poised to buy it, some or all of your rehab costs may be covered. This remains true even if you want to enroll in residential inpatient drug and alcohol rehab.

In 2017 the Affordable Care Act made it unlawful for private pay health insurance companies to discriminate against applicants with pre-existing conditions. It also classified both drug and alcohol addiction as chronic mental health disorders. Under the Affordable Care Act, private pay health insurance companies are required to cover a portion of the necessary care for these ailments.

While this is certainly good news, there are still a number of important caveats to consider. The type and amount of insurance that you currently have or choose to bind can limit the amount of assistance received. Moreover, even with the most comprehensive health insurance plans, there are always a few treatment-related expenses that patients are responsible for paying out-of-pocket.

What to Expect When Choosing and Using Insurance for Inpatient Rehab

Every health insurance company and health insurance plan has clearly outlined provisions that it will make for the treatment of substance use disorder. You can find out more about these by:

  • Reading your policy documents
  • Speaking directly to your insurer
  • Consulting with an admissions counselor at your chosen rehab

Every rehab facility also has a list of insurance types that it’s willing and able to accept. Often labeled as partners by the health insurance companies they work with, rehab facilities have an in-depth understanding of individual plans and their benefits. If you have your eye on a specific inpatient rehab program, you can talk with this facility directly to get answers to your questions, receive an estimate of your out-of-pocket treatment costs, and learn more about your options for secondary funding. Many drug and alcohol rehabs receive limited donations from local charitable organizations. These funds are disbursed as needs-based scholarships on a first-come, first-served basis. Although they won’t cover your entire treatment costs, if available, they can help make up the difference.

Out-of-Pocket Costs and Plan Tiers

When you purchase health insurance, it’s important to pay attention to more than just monthly or annual plan premiums. Although there are a number of plans that have extremely low premiums, these options usually have high deductibles, excessive prescription fees, and considerable co-payments. All of these things will entail out-of-pocket spending whenever and wherever you receive treatment. Most plans with low premiums and high deductibles often have limited benefits.

They’re designed specifically to provide feasible, affordable options in coverage for those who require limited medical care. For instance, they’re ideal for young adults who are in good general health and who do not have any pre-existing medical conditions. Health insurance plans are typically divided into tiers with high-deductible, low-premium plans being at the very bottom. For instance, you might find plans listed as “bronze”, “silver”, “gold” and “platinum” with bronze being the most affordable but ultimately, the least worthwhile for those in need of addiction treatment.

On the other end of the spectrum are plans with high premiums, limited or no deductibles, and modest co-payments and prescription fees. These plans will provide the greatest amount of coverage for inpatient treatment and thus, they’ll leave you with a lot less out-of-pocket spending.

Limitations on Where You Can Receive Treatment

There are also two primary types of health insurance plans available: health maintenance organization (HMO) plans and preferred provider organization (PPO) plans. HMO plans require policyholders to choose rehab facilities and doctors that are part of their own tightly defined networks of approved providers.

If you have an HMO plan, the best way to ensure that your inpatient rehab costs are covered is by contacting your health insurance company and asking for a list of in-network facilities. Rehab centers can also tell you whether or not they’re a recognized part of your plan’s network. PPO plans have in-network providers as well.

However, these plans also allow policyholders to work with out-of-network doctors and facilities of their choosing. Choosing to receive care outside of your PPO plan’s network may increase your out-of-pocket costs depending upon how your plan is structured. PPO plans work best for people who want to receive inpatient rehab services for alcohol or drug addiction out-of-state. Navigating the world of health insurance isn’t easy.

Fortunately, you don’t have to do it alone. If you need help finding an inpatient rehab that accepts your coverage, we’re here to provide it. Call us today at 844-639-8371.

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