Will Your Insurance Cover Rehab?

Sadly, one of the most daunting parts of starting addiction treatment is its cost. Many people struggle to get the help they need simply because they don’t know how they’ll pay for it. The good news is that the cost of going to rehab doesn’t have to be a major barrier to treatment. If you have private pay health insurance, or if you’re capable of getting it, you’ll have access to a broad range of rehab centers and program types. As of 2017, the Affordable Care Act has made it unlawful for health insurance companies to penalize those who have either substance use disorder or alcohol use disorder as known conditions.

Thus, anyone who’s struggling with addiction can find, apply for, and obtain coverage despite these pre-existing issues. The Affordable Care Act also requires private pay health insurance companies to cover the costs of addiction treatment. With drug addiction and alcohol addiction recognized as chronic mental health disorders, both issues are currently covered conditions. However, to get the most from your health insurance benefits, it’s important to know what your plan will and will not cover, and whether or not any limitations exist. One of the best ways to do this is by contacting your insurer directly. You can also call rehab facilities that have partnered with your health insurance company to get a break down of your out-of-pocket costs when attending.

What to Expect When Using Your Health Insurance for Rehab

No matter which type of private pay health insurance you’ve bound, certain costs will always be considered out-of-pocket expenses. These include your:

  • Plan deductible
  • Co-payment
  • Prescription fees

Plan deductibles are one-time, upfront charges that policyholders must pay before their actual benefits kick in. For instance, if your health insurance plan came with a $500 deductible, you’ll have to pay $500 of your treatment costs upfront before your provider will pay the rest. Co-payments are charges that policyholders must pay every time they go to a health facility for treatment. People in inpatient programs often only pay this charge just once on the day that they arrive. If you choose to go to an outpatient center, you may be charged a co-payment each time you show up for on-campus activities.

If you have questions about when co-payment charges will apply, contact your health insurance company to find out. Prescription fees represent the uncovered portion of each prescription you receive. More often than not, these charges are nominal when compared to the actual costs of prescription medication themselves. However, it’s important to remember that multiple prescriptions may be issued during the duration of your treatment. In rehab, people are frequently given medications for sleep support, mood support, and withdrawal support among other things. If you are diagnosed with a co-occurring mental health disorder such as schizophrenia, bipolar disorder, general anxiety disorder, or major depressive disorder, additional prescriptions will likely be issued. When shopping for health insurance plans, it’s best to buy top-tier coverage. Most health insurance companies offer standard, low-cost policies with minimal benefits, medium-grade policies that offer a more generous array of benefits but cost a bit more, and top-tier plans that provide fewer benefits and have lower deductibles and co-payments.

Although your monthly or annual premiums will be much higher for a top-tier plan, more of your rehab costs will be covered, and you’ll have far less out-of-pocket spending to do overall. It’s also important to note that your plan may have specific requirements concerning the type and amount of coverage you receive for addiction treatment. There may be limitations on the duration of your treatment or you may be required to only work with in-network providers.

Health maintenance organization (HMO) plans have tightly defined networks of facilities and providers that policyholders can work with. PPO plans or preferred provider organization plans have both defined networks of healthcare providers and options for policyholders to receive out-of-network care. Understanding your plan type and making sure that you adhere to its terms and conditions is important for making maximum use of your coverage. Many people who attend rehab cover the costs of their treatments by using a combination of health insurance, cash, and credit and debit card payments.

There are also many charitable organizations that offer partial, needs-based scholarships on a first-come, first-served basis. To find out more about paying for rehab or to find the right rehab for you, give us a call at 833-497-3812 today.