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Rehab Payment Options: Insurance

Private health insurance, public health insurance, and payment plans are just some of the rehab payment options that are available to help cover the costs associated with getting treatment for drug or alcohol addiction.

For people struggling with a substance use disorder, attending a treatment program can be an important part of recovery. The cost of rehab can fluctuate widely depending on the facility, the level of care received, types of services offered, and the length of time spent in treatment.

Detoxification services, inpatient care, partial hospitalization programs, intensive outpatient treatment, and standard outpatient programs all have varying costs, which is why most treatment providers accept some level of insurance and will also work with patients to establish payment plans. Rehab centers may also customize the care provided to best suit the individual patient’s financial needs.

People support each other in therapy session

While it can be quite expensive to seek treatment for drug or alcohol addiction, it can make a huge difference in your quality of life and should be treated as an investment in yourself and your future.

Is Rehab Covered by Insurance?

Most private health insurance plans provide partial or full coverage for drug or alcohol rehab.

While there are a few exceptions, most private health insurance companies are required to cover substance use disorder treatment.1 The Mental Health Parity and Addiction Equity Act of 2008 was passed to ensure that insurance providers cover healthcare for mental illness and substance use disorders at levels comparable to physical health disorders.2 Parity laws apply to inpatient treatment, partial hospitalization programs, intensive outpatient and standard outpatient services, and residential services.1

Every insurance policy is different, so the coverage of rehab costs can vary considerably from patient to patient. A few of the factors that affect coverage levels are:

  • Type of policy: HMOs, PPOs, HRAs, and HDHPs will all cover different percentages of the total cost of treatment. Your insurance card should indicate the type of policy, your co-pay amount, and offer a phone number and website where you can get your coverage information in detail.
  • In-network providers: Most insurance companies have relationship with specific healthcare providers that are deemed “in-network.” Seeking treatment at an in-network facility will almost always reduce the out-of-pocket cost for which the patient is responsible.
  • Public insurance plans: Medicare and Medicaid are both forms of public insurance available to select people who qualify. Coverage on these plans can be quite different than on plans provided through an employer or purchased on the health insurance marketplace.

In the United States, there are several major health insurance companies that provide coverage. The 4 largest are:

  • Blue Cross Blue Shield—covers a third of all Americans through 36 independent Blue Cross Blue Shield companies and is available in every region of the country.3
  • Aetna—in operation since 1853, Aetna is now owned by CVS Health Corporation and works to bring cutting-edge care and treatment to enrollees.4
  • Cigna—covers over 170 million people with a focus on providing tailored treatment solutions for physical and mental health.5
  • United Healthcare—covers millions of Americans and strives to incorporate effective, new treatments and collaborate with care providers.6

Blue Cross Blue Shield

Blue Cross Blue Shield covers a variety of treatment types for substance use disorder, although your insurance plan may require a referral or prior authorization before you can receive treatment.

The type of treatment that will be covered is determined by assessing how severe your substance use disorder is, along with the presence of any co-occurring physical or mental health disorders that can play a role in your treatment needs.7

insurance claim form

Blue Cross Blue Shield may cover the following types of treatment, depending on your insurance plan and individual needs:7

  • Detoxification
  • Interim medication management and counseling if admission to a program is not available immediately
  • Medication-assisted treatment to manage the symptoms of withdrawal and/or cravings, as well as treating any mental health disorders, if applicable
  • Inpatient treatment in a hospital or facility setting
  • Outpatient treatment including counseling
  • Residential treatment involving a longer period of treatment at a facility where you will live
  • Sober living in a residence that provides more structure and support than you might get at home, to ease the transition back to independent living
  • Telephone or internet-based care for people who may not have access to local treatment facilities

Blue Cross Blue Shield has a substance use resource center that provides information and support, and can connect you to treatment and other resources here. A member services website can be accessed here to learn more about your benefits and providers who are covered under your insurance plan.

Aetna

Aetna covers evidence-based treatment and medically necessary clinical care for drug and alcohol addiction.8 Coverage eligibility is determined by having a treatment provider conduct an assessment to determine the appropriate level of care and identify any factors that may need to be factored into the treatment process.8 Your treatment provider can also submit prior authorizations that may be required for certain services.8

Aetna may cover the following types of treatment, depending on your insurance plan and individual needs:8

  • Detoxification, either in an inpatient or outpatient setting
  • Inpatient treatment in a hospital or facility setting
  • Partial hospitalization programs
  • Intensive outpatient treatment
  • Outpatient treatment

For more information, visit the Aetna member resources website, which you can find here. 

Cigna

Cigna provides coverage for addiction rehab, starting with a comprehensive assessment.9 This includes learning more about your substance use patterns (both current and previous), medical history, social factors that can impair recovery efforts, and what you want to get out of rehab.9

As with other providers, the initial assessment will help identify the most appropriate treatment recommendations for you.9 Cigna may cover the following types of treatment, depending on your specific insurance plan and individual needs:9

  • Detox, either in an inpatient or outpatient setting
  • Inpatient treatment in a hospital or facility setting
  • Partial hospitalization programs
  • Intensive outpatient treatment
  • Outpatient treatment
  • Medication-assisted treatment
  • Residential treatment allowing a longer period of care and support

You can learn more about substance use disorders on Cigna’s website here. Cigna also has a member services portal that you can access here that provides information on services offered under your insurance plan as well as specific facilities that offer such services.

United

United Healthcare offers coverage for substance use disorder rehab, provided that the treatment received is medically necessary, an accepted treatment for the diagnosis, and shown to be clinically effective.10

Prior authorization may be required for some forms of addiction treatment.10 Depending on your insurance plan and unique needs, United Healthcare may cover a variety of addiction treatment options, including:10 (p10, 14)

  • Detoxification services.
  • Inpatient treatment.
  • Partial hospitalization programs.
  • Intensive outpatient services.
  • Outpatient services.
  • Medication-assisted treatment.

United Healthcare offers a member services portal that you can access here to identify which services are covered by your insurance plan and help you find a provider that accepts your insurance.

Does My Insurance Cover Rehab?

Drug and alcohol addiction do not discriminate. Anyone can develop a substance use disorder, regardless of age, gender, race, ethnicity, educational level, physical or mental health, financial status, or any other factor.

Hopeful in Treatment

The important thing to do if you or a loved one displays signs of problematic drug use is to find a treatment program that can meet your needs. Although there is no “cure” for addiction, it is treatable. Many people who go to rehab are able to live healthy, productive lives free of drugs and alcohol.

Finding a treatment program can be a vital step toward recovery. If you are looking for addiction treatment, you may be wondering if your insurance will cover your care. Calling your insurance provider is a good way to determine what will be covered and if there are any requirements, such as prior authorization or referral.

Sources

  1. National Alliance on Mental Illness. (2020). What is mental health parity?
  2. S. Department of Health and Human Services. (2016). Facing addiction in America: The Surgeon General’s report on alcohol, drugs, and health. Washington, DC: HHS.
  3. Blue Cross Blue Shield Association. (2020). BCBS companies and licensees.
  4. (2020). Our corporate profile.
  5. (2020). Company profile.
  6. United Healthcare. (2020). About us.
  7. Blue Cross Blue Shield Association. (2020). Substance use resource center.
  8. (2018). Behavioral health provider manual.
  9. (2020). Treatment for substance use disorders.
  10. United Healthcare. (2020). Mental Health Parity and Addiction Equity Act.