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Treatment cost is often one of the main deterrents for people considering drug or alcohol rehab, and understandably so. But don't let the fear of the cost keep you from getting sobriety to help you need-health insurance typically provides partial or even full coverage for addiction treatment. However, drug and alcohol rehab insurance coverage varies considerably depending on your particular plan and the type of treatment program you choose, so it's important to check your plan details before committing to a rehab facility. If you don't have insurance, there are plenty of other ways to finance your treatment, including payment plans, sliding scale options, and more.

How Do I Check My Rehab Insurance Coverage?

To begin, create an account with your health insurance provider's website. Because every insurance company has multiple plan types with varying coverage, it's important that you log in before advancing to any of the following steps. Once you log in, you will be able to view the breakdown of your specific plan.

Insurance can be confusing, but just remember the big two: benefits and network. You must always check these two elements before moving forward with any type of medical care substance use disorder.

Insurance Benefits

For benefits, navigate to the benefits portion of your insurance portal. (Sometimes, it will be called "Summary of Benefits" or "SOB.") Often the website organizes this section into readable charts. Let's review a few insurance terms that will be helpful as you try to determine your coverage for treatment programs. It might be beneficial to leave this article up as you search your insurance website so you can refer to the terms as needed.

Premium: A premium is a monthly payment you make to your insurance company. Medicare and Medicaid insurance plans typically have low or no premiums. If you have insurance through an employer, they typically take the premium out of your paycheck and pay the insurance company for you.

Deductible: A deductible is what you must pay out of pocket before your insurance kicks in, and it resets at the beginning of each year. If a benefit is "subject to deductible," it means your insurance will not cover that benefit until you meet your deductible. A benefit "not subject to deductible" means they will cover some or all of the expenses whether you have met your deductible or not.

For example, let's say outpatient therapy is covered at 80%, subject to a $1,000 deductible. That means you must pay 100% of your therapy costs until you have spent $1,000. After that, your insurance will cover alcohol rehab at 80% until the year is over. Then, you'll go through this same process again for the new year.

If your outpatient therapy is covered at 80%, not subject to the deductible, then insurance will cover your therapy at 80% even before you reach your deductible (this is always good news!)

Copay: This is the fixed rate you pay for a medical service, and the insurance covers the rest.

For example, if you had a $50 copay for outpatient rehab, you would pay only $50 for each visit. You will pay your copay each time you go for your treatment, or you will get a bill later (this is often up to the facility's preference).

Coinsurance: You will either have a copay or coinsurance, but never both. Coinsurance, instead of a fixed rate, is the percentage you owe on a medical service.

For example, "20% coinsurance" is another way of saying that your insurance plan covers 80% of your costs for that particular service.

With coinsurance, you may want to ask the facility for an estimate on expenses so you can calculate exactly how much your cost will be.

Out of pocket maximum: If your insurance has an out-of-pocket maximum (OOPM), this means that once you hit a certain amount in medical expenses, they will cover you at 100%.

For example, let's say you have met your deductible, and the insurance is paying 80% of your inpatient treatment at a rehab center. If your insurance lists an out-of-pocket max of $50,000, then once your medical expenses meet that amount, you will no longer have to pay for your treatment. Keep in mind: This does not mean that you personally have to pay $50,000 in rehab costs, but you and your insurance together have paid $50,000.

Referral: Some insurance policies require a referral acceptance before seeing a specialist, or they will not cover alcohol addiction treatment. Just look for "referral required" under the benefit listing. If it says nothing about a referral, you probably do not need one.

Prior authorization: This term is often short-handed "PA." If your insurance refuses to cover a service that your physician deems medically necessary, you can ask your doctor to fill out a prior authorization form. The treatment centers doctor will send the form to the insurance company. Your insurance will then re-determine whether or not they will pay for the service and either approve or deny your prior authorization request. Sometimes in the benefits section, an insurance company will list that prior authorization is required for a particular service.

Be sure to check the difference in coverage between detox, outpatient treatment, mental health conditions, and inpatient treatment options. If detox is not listed as a benefit, you may have to call your insurance company and ask a representative.

Insurance Providers Network

We have looked at the benefits. Now let's turn to the second of the big two: network. Unfortunately, just because your drug or alcohol rehab insurance covers treatment does not mean you can go to any treatment facility; you will need to go to an in-network rehab. Again, make sure you are logged in to your insurance portal so you can view your specific plan details.

First, find the section where you can search for doctors and clinics, and try to find the facility you are interested in. If it is not listed, your insurance will not cover any expenses to go to that facility. You can also search "inpatient rehab" and see which rehab centers are covered. Alternatively, you can find or ask for the "provider directory," which is an A-Z listing of all the physicians and rehabs your plan covers.

If for whatever reason, you have only one option for treatment and it is not covered under your insurance, you can ask your physician to submit a prior authorization request to be covered at that facility.

Even if the rehab you are interested in tells you they take your insurance, you will still want to double-check the coverage disclaimer with your rehab insurance. Just because a treatment provider takes Blue Cross Blue Shield insurance, for example, does not mean your specific plan will cover the cost of that particular alcohol or drug rehab. Unfortunately, the facility does not have all of the information the insurance company does, and they may think your plan is covered until the insurance company rejects the bill.

When in doubt, call or chat with an insurance representative. They are trained in your plan and can tell you exactly where and what is covered. You can also give us a call at Better Addiction Care to speak to a rehab specialist who can verify your insurance and match you with the best treatment program for you or your loved one. Give us a call at 800-429-7690 and take your first step toward recovery.

What Types of Insurance Cover Substance Abuse Treatment?

The Affordable Care Act (ACT), also known as "Obamacare," was implemented in 2010. This legislation requires insurance companies to cover some form of substance abuse treatment, but which American addiction centers are covered and the level of coverage depends on the plan.1 This means that employer insurance, Medicare, Medicaid, and health insurance through the Health Insurance Marketplace all provide some sort of coverage for rehab.

The four main types of insurance that cover rehab include:

Medicare: Generally, for people over 65 or who are disabled

Medicaid: Usually for individuals at or below a certain income

Employer: An insurance plan provided by your place of employment in which the monthly premiums come out of your paycheck

If you have this type of insurance, consider having a conversation with HR about your plan's coverage and ask about job-protected time off using FMLA.

Health Insurance Marketplace: You choose your own individual insurance through the Health Insurance Marketplace, which operates under the Affordable Care Act.

If you do not qualify for Medicaid but still have a lower income, you may qualify for a premium tax credit, which lowers your monthly premiums obligation.

How to Pay for Drug Rehab Without Insurance

If you do not have drug or alcohol rehab insurance, you can still get treatment. Several options are available to you, such as:

Payment plan: Some treatment facilities offer the ability to break up the full cost of rehab into smaller, more manageable monthly payments.

Sliding scale: Some rehab programs offer sliding scale options, which means they only require you to pay the part that you can reasonably afford.

Savings or retirement fund: While this option may not be ideal, remember how much money you are saving in the long run by getting help.

Substance abuse treatment loans: You can apply for a loan specifically designated for drug rehab. These loans may have lower interest rates than traditional loans.

Health care credit card: Like the loans above, certain credit cards are designed to pay off medical bills.

Fundraising: Reach out to friends, family, and church members, or start a campaign on GoFundMe.

Financial assistance: See if you qualify for a grant.

When you consider how much substance use costs-buying drugs or alcohol, medical visits, medication, hospital costs, legal costs, lost work time, etc.-investing in insurance and rehab will actually save you money in the long term. More importantly, though, your health and relationships are priceless.

We know this process can be overwhelming, which is why we have provided an overview of your financial options. There is hope for you, so please do not wait any longer to take action in favor of you. You deserve it.

Alcohol Rehab Insurance Resources

Office of National Drug Control Policy. (n.d.). Substance Abuse and the Affordable Care Act.

if you are struggling with substance addiction, call (800) 429-7690 to find an addiction treatment that's right for you.

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Do You Have Drug and Alcohol Rehab Insurance?

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Treatment cost is often one of the main deterrents for people considering drug or alcohol rehab, and understandably so. But don't let the fear of the cost keep you from getting sobriety to help you need-health insurance typically provides partial or even full coverage for addiction treatment.