Is Rehab Covered by Insurance?

rehab insuranceThe cost of treatment for an addiction can feel prohibitive to many families. Long term, the costs of not seeking help are tremendously more than the financial ones. Insurance policies vary widely but there are many options available to help make treatment affordable.

 

Ins and Outs of Rehab

The American Medical Association (AMA) recognizes alcoholism and substance abuse as diseases. For insurance purposes, this means health insurance companies must recognize them for treatment coverage. The Affordable Care Act (ACA) introduced comprehensive health insurance reforms which means health insurance is available to more people at lower costs. The ACA includes substance use disorders as one of the ten elements of essential health benefits. Essentially, all health insurance sold on the Health Insurance Exchanges or provided by Medicaid to certain newly eligible adults starting in 2015 must include services for substance use disorders.

 

Treatment Coverage

Insurance policies vary in what they generally cover, but most policies will cover one or more of the following:

Assessments – generally covered in full

Detoxification – mostly covered, rapid and ultra-rapid detox not usually covered

Outpatient Treatment – mostly covered (generally)

Inpatient (residential) treatment – partially covered (generally)

To determine coverage for substance abuse or drug rehab, call member services at the insurance company. Inquire as to the level of care provided (detox, assessment, inpatient or outpatient, full or partial hospitalization, etc). It is important to find out about in and out of network providers as well as co-pays or out-of-pocket expenses. This will help minimize any surprises on an insurance bill later following treatment.

 

Medicaid/Medicare

Medicare and Medicaid are insurance programs sponsored by the government which may cover some aspects of treatment but not necessarily all.

Medicare: coverage offered for persons aged 65 and older or with a severe disability no matter the income level. Coverage depends on what type of care is being sought. Inpatient coverage goes up to 190 days of inpatient services in a lifetime with a $1,260 deductible and variable co-payments. Outpatient coverage is offered for counseling and therapy, one screening per year, management of medication and a yearly “wellness” visit with the insured covering payments of up to 20% of treatment costs. Partial hospitalization may be covered as a percentage along with co-payments and deductibles.

Medicaid: Low income households can receive this insurance program. States are responsible for running their respective programs with Medicaid covering a number of mandatory services. Inpatient and outpatient care can be included as long as the facility accepts Medicaid.

 

Contact the insurance company responsible for coverage and look into all the treatment options available. Don’t let lack of insurance coverage be a barrier. There are sliding fee scales and opportunities to receive help for those whom insurance is not available.

If you’re looking for resources and treatment options for addiction recovery, contact Hired Power at 800-910-9299 today.