There are many different factors to consider when thinking about seeking drug and alcohol rehab treatment. One of the biggest considerations for many people is the cost of treatment and whether insurance covers drug and alcohol rehab services. If you have Blue Cross Blue Shield (BCBS), this page may help you understand your healthcare benefits as they relate to addiction treatment coverage.
Blue Cross Blue Shield Health Plan has been providing healthcare benefits since 1929. BCBS can cover a variety of healthcare services, depending on your particular plan. Blue Cross Blue Shield covers more than 107 million people across the country, including Puerto Rico, and can tailor a plan to your specific needs.1
Does Blue Cross Blue Shield cover drug rehab? The simple answer is yes. It is important to note that there are several plans; some may cover these services with little to no out-of-pocket-costs while others cover only a small amount of these services and require significant out-of-pocket costs. To learn more about your Blue Cross Blue Shield mental health coverage, call the number on the back of your insurance card.
Please note: American Addiction Centers (AAC) strives to provide you with the most updated information on each carrier’s addiction insurance coverage, but policy changes and errors do occur. Please check with your insurance carrier directly to confirm coverage levels. AAC is not affiliated with or endorsed by the Blue Cross and Blue Shield Association or any of its licensees.
Coverage Levels and Coverage Plans
Blue Cross Blue Shield is comprised of 36 locally operated and independently owned companies that create plans specific to your state, local community, and individual healthcare needs.1 Plans vary according to state. The most common plans are Gold, Silver, and Bronze. Gold plans have the highest monthly costs and Bronze plans have the lowest. Factors that affect the rating include out-of-pocket costs (Bronze-40%, Silver-30%, and Gold-20%), whether it’s a preferred provider organization or health maintenance organization, and what types of services are covered under the plan. Some states have a Platinum plan, which has the highest monthly cost with the lowest out-of-pocket costs for services (90%).
If you are on Medicaid or Medicare, your behavioral health and addiction services may be covered as well. Medicare is a federally funded health insurance plan for people 65 and older or for younger people who have specific terminal illnesses.2 Medicare is comprised of 2 parts: part A and B. Private insurance companies, like Blue Cross Blue Shield, offer supplemental Medicare plans to help reduce the cost of healthcare for people who qualify for Medicare.2
Medicaid is a state and federally funded insurance program for low-income adults and children and the elderly. With regard to substance abuse treatment and rehabilitation, Medicaid is increasingly reimbursing for substance abuse services and reimburses the most among all insurance providers for mental health services.3 Medicaid comprises 2 separate types of benefits: mandatory and optional. Mandatory benefits are benefits that are required under federal law. Optional benefits are chosen by the state.4
Checking Your Insurance Benefits
Does insurance cover drug rehab? The easiest and most efficient way to check your benefits is to call the number on the back of your insurance card. You will be able to speak with a representative who can answer questions related to your healthcare coverage and provide you with information on in-network providers and services.
Blue Cross Blue Shield offers a Federal Employee Program (FEP) for federal workers, retirees, and uniformed service members. Under the FEP, you can choose among 3 plans: standard, basic, and FEP Blue Focus. With the standard plan, you can use in-network or out-of-network providers, and depending on your plan, you can expect to pay a co-pay for inpatient mental health or substance abuse services.5 It is the most expensive plan of the 3, with bi-weekly payments around $117.00 for an individual plan. Pre-certification is required for inpatient hospital services. Visit the standard FEP plan to learn more.
With the basic plan, you must use in-network providers for services to be covered.6 Pre-certification is also required for inpatient mental health and substance abuse services, and you can expect to pay a co-pay. Coverage for an individual is roughly $76 bi-weekly.
The FEP Blue Focus Plan is the least expensive option; you can expect to pay around $53 for individual coverage on a bi-weekly basis.7 However, services and providers must be in-network. While this plan has no co-pays for inpatient mental health or substance abuse services, you are required to pay a percentage of services rendered. For outpatient mental health and substance abuse services, there is a $10 co-pay per visit.
Does Blue Cross Blue Shield Cover Drug and Alcohol Addiction Treatment?
There are many different components of substance abuse and addiction services. Medical detoxification, inpatient residential treatment, and outpatient treatment are all common elements of addiction treatment. Generally speaking, Blue Cross Blue Shield health plans cover drug and alcohol addiction treatment.
However, that doesn’t mean that you won’t be responsible for co-payments or partial reimbursement of services rendered. The amount of Blue Cross Blue Shield therapy coverage you receive is based on many factors including the type of coverage you have, the state in which you live, and your particular insurance plan. To verify your addiction treatment coverage, click here, or use the form below.
If you are considering substance abuse treatment and are covered under Blue Cross Blue Shield, it is important to know your healthcare benefits in order to minimize out-of-pocket costs and receive the most appropriate services based on your needs. Not all plans are the same, and it is essential to understand what services are covered under your specific healthcare plan.
Verifying your insurance coverage can be done online or over the phone by calling the number on the back of your insurance card. Seeking treatment for an addiction can feel overwhelming, but understanding your insurance benefits can help reduce that feeling and make the process as seamless as possible.
- Blue Cross Blue Shield. (n.d.). The Blue Cross Blue Shield system.
- Blue Cross Blue Shield. (n.d.). Blue Cross Blue Shield Medicare.
- Centers for Medicare and Medicaid Services. (n.d.). Behavioral health services.
- Centers for Medicare and Medicaid Services. (n.d.). Mandatory and optional Medicaid benefits.
- Blue Cross Blue Shield Federal Employee Program. (n.d.). 2020 standard options benefits chart.
- Blue Cross Blue Shield Federal Employee Program. (n.d.). 2020 basic options benefit chart.
- Blue Cross Blue Shield Federal Employee Program. (n.d.). 2020 FEP blue focus benefits chart.
You are never too old to improve your health and quality of life!