Does Health Insurance Cover Drug or Alcohol Rehab?
- Public and private insurance policies cover substance abuse treatment to varying degrees.
- If you don’t have insurance, look at payment plans, sliding scale programs, SAMHSA grants, or financing options.
- Other options include 12-Step programs, SMART Recovery, or stabilization programs.
- Free rehab programs can be hard to find and get into but are possible.
- There is an increasing recognition that addiction is a disease and should receive the same treatment coverage as a medical condition.
- The cost of addiction treatment can make it difficult for people to access treatment, but most insurance plans offer addiction treatment coverage.
Is Rehab Insurance Coverage Including with health Insurance?
The American Medical Association recognizes alcoholism (alcohol use disorder) and substance addiction (substance use disorder) as diseases, forcing health insurance companies to recognize the need for rehab treatment coverage.
Drug and alcohol addiction is a major issue in America that has been linked to long-term changes in the brain and behavior, increased risk of developing chronic physical and mental health disorders, and social and occupational difficulties. 1, 2, 3, 4
Federal laws have been passed to provide expanded insurance mental health coverage at levels that are equivalent to those provided for physical health conditions.1, 4, 5 These laws ensure that a majority of private health insurance plans and all Medicaid plans offer coverage for mental health and addiction treatment.1, 6 This means insurance policies— both public and private—must cover substance abuse treatment to the same extent that they cover other medical conditions.
The Affordable Care Act further ensures that insurance agencies can no longer deny coverage to anyone based on a pre-existing condition, including substance addiction. If you do not have insurance, you can apply for coverage at any time. This may help to drastically reduce your out-of-pocket costs for treatment.
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Alcohol & Drug Rehab Insurance Coverage
Insurance health plan benefits can vary depending on your location and plan, but coverage may include:1
- Medical detox, where medical staff is available 24/7 to monitor patients and provide medications to ease withdrawal symptoms.2, 3, 7 Detox focuses on clearing the system of substances rather than addressing the addiction itself.7, 8
- Medication-assisted treatment, where medication is used in conjunction with therapy to further treatment goals, manage cravings, and treat underlying mental health disorders if needed.2, 3, 8
- Group, individual, and family counseling sessions to help people learn the skills needed to prevent relapse; communicate effectively; solve problems; manage triggers; and develop healthy, recovery-oriented hobbies.3, 8
Most policies will cover one or more of the following:
- Assessment – generally fully covered.
- Detoxification – generally mostly covered, but rapid detox and ultra-rapid detox tend to not be covered.
- Outpatient treatment – generally mostly covered.
- Inpatient (residential) treatment – generally partially covered.
Insurance policies will cover addiction treatment to the same extent that they cover other medical conditions. But they will only cover what a professional determines to be “medically necessary.”
Rehabilitation insurance benefits may also cover inpatient and outpatient programs, which provide a longer period of treatment. Studies show that remaining in treatment for at least 90 days leads to better sobriety outcomes.3 Treatment can occur in more than one setting, such as attending one type of treatment followed by another form.3
Insurance does not always cover a specific length of time in treatment, but coverage depends on your plan and individual needs. A set amount of time in treatment may be approved at first, but your provider may be able to request additional coverage at the end of your approved time.
Does Insurance Cover Inpatient Rehab?
Inpatient treatment involves staying at a facility for the duration of treatment, which generally lasts between 3 and 6 weeks.3 Treatment consists of intensive group and individual therapy sessions, medication-assisted treatment, and psychiatric care as needed.3, 8 Participation in self-help groups is strongly encouraged and facilities may host meetings on-site.3
Treatment insurance often covers inpatient rehab, especially in cases where treatment is viewed as medically necessary. Medicare, a federal program that provides healthcare coverage to individuals aged 65 or older or those with certain disabilities, covers inpatient care.9 10 Coverage limits may vary depending on your needs and your insurance plan.
Does Insurance Cover Outpatient Rehab?
Outpatient treatment provides the opportunity to receive effective care in an office-based setting while living at home and having the freedom to work, go to school, and participate in family life.8 Treatment is offered on a spectrum of intensity, allowing services to be tailored over the course of treatment to meet your needs as you progress in recovery.3, 8
Rehab insurance coverage for outpatient treatment may last longer than inpatient treatment, depending on your plan and needs. Medicare also covers outpatient treatment, provided that it is essential to the recovery process.9
Does My Insurance Cover Rehab?
Who Answers? if you have questions about using insurance to cover the cost of substance abuse treatment.
Or you can check your insurance coverage here.
Before starting treatment, you should check your healthcare benefits to confirm addiction treatment coverage. You can do this by calling the member services number on the back of your insurance card or using the online portal on your insurance website. You can also confirm that your insurance plan is accepted at American Addiction Centers treatment facilities using a link that can be found . For more information about specific major health insurance providers, use the following links:
Determining Insurance Coverage for Rehab
- Call Member Services at your insurance company. Have your membership identification number ready.
- Write down the name of the representative(s) you speak with, as well as any notes about the conversation.
- Ask what “levels of care” are covered for addiction treatment (assessment, detox, inpatient, outpatient, residential, hospital-based, partial hospitalization, etc.).
- Ask about in-network and out-of-network providers and the percentage covered by insurance for each.
- Ask about co-pays and deductibles.
- Ask what your out-of-pocket maximum expense is.
- Ask what criteria your insurance company uses to determine medical necessity.
Another option is to reach out to the admissions department of the program you’re considering regardless of what insurance you have or what you’ve heard about your policy. Programs have many ways of flexing benefits to make policies work.
Recovery.org is a subsidiary of American Addiction Centers (AAC), a leading provider in addiction treatment and recovery. AAC is in network with many of the top insurance providers. You can use our free and confidential online insurance checker to see if your insurance covers treatment and recovery.
Does Medicaid & Medicare Cover Drug Rehab?
Medicare and Medicaid are government-sponsored insurance plans that cover screening for substance abuse. But this coverage does not always include treatment.
Medicare is for anyone 65 or older or with a severe disability no matter what their income level is. Its coverage changes based on the type of care you’re seeking.
- Inpatient – Medicare covers up to 190 days of inpatient services during your lifetime, with a $1,260 deductible and variable co-payments.
- Outpatient – Medicare covers counseling and therapy, one screening per year, medication management and one yearly “wellness” visit (you pay 20% of treatment costs).
- Partial hospitalization – You pay a percentage of each service, as well as daily co-payments and a deductible.
Medicaid is a plan for low-income households. The plan is run on a state-by-state basis, with each state covering varying degrees of treatment. However, Medicaid does require a number of mandatory services to be covered. These services include both inpatient and outpatient care, as long as the facility you choose accepts Medicaid.
Health Insurance Marketplace
Health Insurance Marketplace plans cover substance abuse treatment to varying degrees, depending on the state.
The open enrollment period for the marketplace plans takes place once a year, from November 1 to January 31 for coverage in the new year. You may also qualify for special enrollment periods in the case of certain life events:
- Moving to a new state.
- Certain changes in income.
- Changes in family size.
- Gaining membership in a federally recognized tribe.
Losing your job can bring anxiety and stress regarding healthcare, but there are options for maintaining your health insurance coverage. If you lose your job-based coverage, your former employer may offer you COBRA (Consolidated Omnibus Budget Reconciliation Act) continuation. COBRA provides people who lose their jobs, and their families, with the choice to temporarily retain the group health coverage they had under their employer’s group health plan.
To be eligible for COBRA, you must have insurance that is covered by COBRA, a qualifying event (including job loss), and be a qualified beneficiary. Your former employer will inform you of your eligibility to maintain your insurance through COBRA, and you will have at least 60 days to decide if you want to continue your coverage. Once you have decided to continue your coverage, you will sign up for COBRA, and you will be responsible for paying the entirety of your premium (what was previously covered by you and your employer).
Once you are enrolled in COBRA, you will have the same coverage you previously had when you were employed. That includes any mental health and substance misuse treatment that was covered through your insurance plan. If you are pursuing treatment while covered by COBRA, you will be responsible for paying your premium. Although it might be slightly more complicated than it was when you were employed, losing your job does not have to mean that you cannot receive the substance abuse treatment that you need.
Paying for Rehab Without Insurance
Contact the Substance Abuse and Mental Health Services Administration (SAMHSA) to speak to a specialist about treatment program options based on your insurance or ability to pay.
If you do not have insurance, you have a couple options to ease the burden of paying for treatment.
One option that many facilities offer is spreading the cost out across a payment plan. The plan involves monthly payments over a predetermined amount of time that equal the cost of treatment. Payment plans are a great way to spread the cost out to make treatment much more affordable.
Another option to pay for treatment is to find a facility that uses a sliding scale payment method. Sliding scale is a fee structure based on your ability to pay. You will only be required to pay what you can reasonably afford. People with lower incomes will be expected to pay less than those with higher incomes.
The Substance Abuse and Mental Health Services Administration (SAMHSA) has a free facility locator to search for treatment centers near you with payment assistance programs.
Rehab Financing Options
Other financing options for paying for substance abuse treatment include:
- Credit cards.
- Health care credit cards.
- Personal loans.
- Home equity loans.
- Specialized loan companies.
Many treatment facilities also offer rehab scholarships, where the facility will cover part or all of the cost of recovery.
To find facilities that offer these scholarships:
- Call the programs that you’re considering.
- Tell them your situation.
- Ask if they offer rehab scholarships and what you need to do to be considered for one.
Most treatment facilities have a specific amount of money they can use for rehab scholarships per year. So if they cannot fund you, make sure to ask about other facilities nearby that may offer financial help.
Another way to get help paying for rehab is to apply for a SAMHSA grant, which can cover part or all of your recovery costs. In some cases, your state substance abuse agency will even reimburse treatment costs.
Regardless of whether or not you have insurance, substance abuse treatment is an important and vital step toward saving yourself from the downward spiral of addiction.
Other Treatment Options for Substance Abuse
12-Step self-help programs
12-Step programs (for example, Alcoholics Anonymous and Narcotics Anonymous) are free recovery options that work best when practiced along with other treatment options. These programs follow a spiritual route to recovery. They begin with the admission of being powerless over addiction, inspiring a new way of living and lifelong recovery development.
If a spiritual journey is not for you, try the science-based Self-Management and Recovery Training (SMART). This program is also a free support group that uses proven techniques from cognitive behavioral therapy. SMART recovery’s goal is to support and encourage participants to evaluate their own thoughts and behavior patterns in order to make positive changes in their lives.
Stabilization programs are another viable low-cost treatment option. These programs generally involve 2 to 6 weeks of stay following detoxification, and they focus on progress in recovery rather than slip-ups. Once you complete the program, you have the option to move on to a sober house or therapeutic community.
Holistic (or alternative) treatment programs, yet another potentially lower-cost recovery option, focus on the health of the mind, body and spirit. They incorporate traditional treatments (detox, therapy, medical care, etc.) with holistic services such as yoga, acupuncture and meditation to heal and help a person on the road to recovery.
While rare, there are free drug rehab options. Many religious organizations offer treatment as part of their ministry services at no cost. Non-profit rehab organizations also offer low-to-no cost treatment. These free programs take an extra bit of effort to get into, but it is possible if you put in the time.
Need Help Finding a Rehab Program?
Health insurance coverage can be a confusing maze to navigate, especially when it comes to addiction treatment. Drug rehab coverage can make the high cost of treatment manageable and affordable, allowing more people to access care for addictions. Federal laws ensure that insurance companies offer similar benefits for mental health care as they do for physical health conditions.
A range of treatment types are offered for substance use disorders and the majority of public and private health insurance plans provide some coverage for addiction treatment. However, checking your benefits before seeking care is a good start on the road to recovery, to ensure that your alcohol rehab insurance or drug rehab insurance is accepted at the facility you choose to attend.
Paying for Rehab Treatment
Additional Resources on Drug and Alcohol Treatment
- Abraham, A.J., Andrews, C.M., Grogan, C.M, D’Aunno, T., Humphreys, K., Pollack, H.A., Friedmann, P.D. (2017). The Affordable Care Act transformation of substance use disorder treatment. American Journal of Public Health, 107(1), 31-32.
- National Institute on Drug Abuse. (2018). The science of drug use and addiction: The basics.
- National Institute on Drug Abuse. (2018). Principles of drug addiction treatment: A research-based guide (3rd edition).
- Substance Abuse and Mental Health Services Administration. (2016). Facing addiction in America: The Surgeon General’s report on alcohol, drugs, and health. Washington, DC: U.S. Department of Health and Human Services.
- Substance Abuse and Mental Health Services Administration. (2020). Behavioral health treatments and services.
- Healthcare.gov. Mental health & substance abuse coverage.
- Center for Substance Abuse Treatment. (2006). Detoxification and substance abuse treatment. Treatment Improvement Protocol (TIP) Series 45, DHHS Publication No. (SMA) 06-4131. Rockville, MD: Substance Abuse and Mental Health Services Administration.
- National Institute on Drug Abuse. (2019). Treatment approaches for drug addiction.
- Centers for Medicare and Medicaid Services. (2019). Medicare coverage of substance abuse services.
- Healthcare.gov. Inpatient rehabilitation care.
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