Does Insurance Cover the Cost of Rehab?

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Using Insurance for Rehab

If you have a substance abuse problem, you need to have access to the care and treatment program that best suits your specific situation and needs. Treatment programs can be expensive, with outpatient rehab starting at about $2,000 and inpatient rehab costing anywhere from $6,000 to $50,000.

Of course, there are several factors that come into play to determine the cost of a substance abuse rehab program. Where the facility is located, the kinds of programs offered, whether the program is inpatient or outpatient, what services and features are included in the program, who runs the program, and the length of the program.

Because of the cost involved, most patients and their families are concerned as to whether the cost of rehab is covered by insurance.

What Does Insurance Cover?

If your health insurance is through a group plan, then you are much more likely to have coverage that takes care of both inpatient and outpatient rehab. You would be responsible for any copays, coinsurance, and deductibles.

Depending on the insurance plan, the rehab might be covered at 100% after the annual deductible has been met.

However, if you have health insurance that you purchased privately, rehab might not be covered. You might have to purchase a special plan that includes substance abuse treatment coverage, or you might have to purchase a special insurance rider to get that coverage.

Check with your insurance company to make sure your policy includes substance abuse treatment coverage, such as inpatient rehab or outpatient rehab. Some plans might cover outpatient rehab, but not inpatient rehab. It is important to check your coverage before you start deciding on a rehab facility.

Care After Rehab

Sometimes the traditional stint in rehab is not enough, or additional treatment might be recommended. A stay at an inpatient rehab facility can be extended for an extra fee. Often, doctors recommend continuing care that includes therapeutic aftercare.

This kind of continuing care will involve an initial assessment then sessions at least once each week. Insurance will often cover the cost of the continuing care visits, but the number of visits that are covered might be limited.

After treatment is completed, some patients might move into a halfway house or sober living community until they are ready to live out on their own. This will give them the support they need to avoid drugs and alcohol. After they are ready, they can move out of the facility and return home.

How The Affordable Care Act Affects Rehab

When the Affordable Care Act (ACA) was passed, it included addiction treatment coverage. The ACA might be able to help you get treatment that you need. Using the ACA, addiction is not considered a pre-existing condition when you apply for insurance coverage.

Many ACA plans are less expensive thanks to need-based tax credits. Americans who are covered by Medicaid and Medicare are also offered treatment options and funding for medical treatment through the ACA. The requirements and costs for Medicaid and Medicare are different from the health insurance plans offered from the online Health Insurance Marketplace.

Under the ACA, complete coverage for addiction treatment must be offered just as it would be for any other medical condition or procedure. Some things available with ACA coverage includes:

  • Clinic visits
  • Addiction evaluation
  • Brief intervention
  • Addiction treatment medication
  • Testing for drugs and alcohol
  • Home healthcare visits
  • Anti-craving medication
  • Family counseling
  • Individual counseling and therapy

These insurance plans are required to help with different kinds of inpatient services, such as medical detox programs as well.

Determining How Much of the Costs of Treating Addiction is Covered by Insurance

ACA-sponsored health coverage is available through the Health Insurance Marketplace. There are five different kinds of plans available through the Health Insurance Marketplace. Those different options include:

  • Bronze plans – offering 60% expense coverage
  • Silver plans – offering 70% expense coverage
  • Gold plans – offering 80% expense coverage
  • Platinum plans – offering 90% expense coverage
  • Catastrophic – 60% total average cost

Those who have incomes that fall between the federal poverty level and four times the federal poverty level meet the eligibility criteria for ACA tax credits.

The federal poverty level is adjusted annually, and it changes based on the size of the family. As of 2018, for a three-member household the poverty limit is $20,780 per year in the 48 states and D.C. and $25,980 in Alaska.

There are multiple insurance options available to help those who are needing rehab for drug addiction and substance abuse.

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