You’ve decided to go to rehab—it’s one of the most life-changing decisions you’ll ever make!
However, there’s still some legwork ahead of you to figure out the logistics of going to rehab, including paying for insurance costs.
That sounds like a lot for a layman, but the answers are easy to find.
Your insurance company, the rehab center you’re attending, and some light legwork can help you know what to expect so you can plan accordingly.
Paying for insurance and treatment doesn’t have to be hard. Here’s what you should know:
How Much Does Rehab Cost?
The cost that you’re responsible for depends on whether you use insurance or not. Most insurance plans cover a portion of rehab treatment (or even all of it).
You might be responsible for the entire cost of treatment if you:
- Don’t have insurance
- Choose a rehab that doesn’t accept your insurance
- Attend a program that isn’t covered by your insurance
How Much Does Rehab Cost With Insurance?
The cost of rehab varies dramatically, so there’s no real way to tell you how much you’ll pay with insurance.
In a few cases, your insurance plan may cover the cost of rehab completely. In more cases, insurance covers a portion of the cost of treatment.
That leaves a patient-responsible portion of the treatment that can range from a few hundred dollars (for outpatient drug detox programs) to $80,000 or more (for long-term residential programs).
However, there’s a LOT of variation in that range, so don’t make any conclusions about what you’ll pay before checking with your chosen rehab and insurance company.
How Much Does Rehab Cost Without Insurance?
In some cases, the cost of rehab can be the same without insurance as it is with insurance.
That’s because some rehabs offer reduced-cost billing for patients who pay for treatment out-of-pocket. If you’re thinking about attending rehab without insurance, be sure to talk to the rehab coordinator about your cost and let them know that you’re uninsured.
There are also low-cost rehabs that are state-funded, as well as private rehabs that offer low-cost programs or income-based treatment.
You should take advantage of low-cost rehab if you exhaust your other resources and won’t be able to attend treatment otherwise. However, these rehabs tend to have a long waiting list; you may spend weeks or months waiting for a spot to open up.
The problem with low-cost rehab is treatment is time-sensitive. If you’re in a crisis, your mental health won’t wait.
When you can’t wait for a low-cost program spot to open up, you may be able to find alternative ways to pay for regular treatment.
What Programs Pay for Drug Rehab?
It’s impossible to list every program that can pay for drug rehab because they span so many different organizations.
In addition to federal programs and national private programs, there are plenty of state- and local-level programs out there too.
Rehab Scholarship Programs
These programs cover the partial or entire cost of rehab for people who meet their criteria and apply for a competitive or need-based scholarship. You don’t have to pay these funds back.
The only problem is, scholarship programs tend to be competitive. Apply for these as early as you can, since it may take time to hear back.
10,000 Beds is the most well-known rehab scholarship program. Their applications only open up on Mondays, so check often to see if you can apply.
Veteran Rehab Programs
The Veterans Affairs office provides treatment for substance use disorder for veterans and their immediate family members. The VA pays for 100% of this treatment.
- Medication-assisted treatment programs
- Medically-managed detox programs
- Short-term outpatient treatment
- Long-term residential treatment
- Outpatient counseling and therapy
- Continuing care programs for relapse prevention
These services are provided through VA-approved facilities only, and there’s often a waiting list.
To qualify for the VA’s rehab programs, you must:
- Apply for VA Health Care if you’re not already covered
- Talk to your VA primary care doctor or find one if you don’t have one
Special VA programs are available for vets who served in:
- Operation Enduring Freedom
- Operation Iraqi Freedom
- Operation New Dawn
If you served during one of these operations, contact your local VA medical center and ask to speak to the coordinator for your operation’s program.
Senior Rehab Programs
If you’re 65 or older, you may qualify for Medicare. Medicare is the socially-funded insurance program for senior citizens.
Under the Affordable Care Act, Medicare is required to pay for your rehab treatment if it’s medically necessary (which simply means that you need to ask your primary care doctor for a referral). That might mean partial or full coverage.
The specifics vary by state, but you should know that:
- The enrollment period is limited and varies from state to state
- You can choose your own plan, which makes it easier to pick a rehab that’s covered and that accepts Medicare
- You may be responsible for premiums or deductibles, but the cost of rehab is very likely to be cheaper with Medicare than without it.
Check out the federal Medicare website to find specifics about the program in your situation and state.
State Rehab Programs
Medicaid is the state-funded health insurance program for people who have financial need. Like Medicare, Medicaid is required to pay for a portion (or all) of your medically-necessary addiction treatment.
The eligibility limits for Medicaid vary from state to state, but if you earn less than the poverty level, you might qualify. Check with your local social assistance office for more information.
Correctional Rehab Programs
Correctional institutions (like prisons or jails) often work with third-party organizations to provide part-time treatment for substance use disorder to people who are incarcerated.
The most common program is SMART Recovery, which is developed with the National Institute on Drug Recovery and federally approved.
However, there are other groups (like 12 Steps) that meet at prisons and jails too. The specific programs available to you may depend on the locality of your correctional institution.
Can You Go to Rehab Without Insurance?
You may be able to go to rehab without having insurance. Many treatment centers will work with you if you’re paying out-of-pocket or have an outside scholarship.
That might mean setting up a payment plan or other financing to pay for the remaining cost of treatment.
If you’re looking to get the cost of rehab covered fully, insurance is the most certain way to make it happen. Most people who attend rehab without insurance don’t get their treatment fully covered.
You might think you have no options for getting insurance, but you can become insured by:
- Enrolling in your employer’s health plan
- Applying through the Healthcare Marketplace with tax subsidies
- Applying for Medical Assistance or Medicaid in your area
- Applying for Medicare if you’re 65+
Many of these options result in low-cost premiums or even no premiums at all depending on your income and situation.
What to Look For When Choosing an Insurance Provider for Substance Abuse Treatment
If you’re not satisfied with your insurance or you don’t have insurance right now, you’re probably thinking about what criteria to use when you’re shopping for a plan.
You may be able to shop for an insurance plan right now if you have specific life-changing circumstances. Other opportunities to pick a new plan include:
- Getting a new job (though the provider will be chosen for you)
- Qualifying for Medical Assistance
- Open enrollment periods, which often take place through October to December (but check with your state for this year’s dates)
If now’s the right time to get a new provider or plan, here’s what you should be thinking about:
Premiums and Deductibles
All insurance plans have premiums and deductibles.
A premium is the weekly, monthly or yearly cost that you contribute to stay on the plan.
A deductible is the amount that you must cover yourself before the insurance company starts covering treatment.
Often, a plan with a high premium has a low deductible, and vice versa.
In- and Out-of-Network
Your insurance plan will dictate which doctors and providers (including addiction care providers) are in-network or out-of-network.
An in-network provider is typically covered at a higher rate, which means you may pay a smaller copay or coinsurance (the portion that you’re responsible for covering).
An out-of-network provider is covered at a lower rate (so your copay is higher) or in many cases, not covered at all.
What Can the Plan Cover?
The exact care that your plan covers varies depending on your plan. However, it’s typical for insurance companies to cover:
- Medical detox
- Medication-assisted treatment
- Outpatient treatment
- Residential treatment
- Outpatient therapy and counseling
Your insurance provider will have guidelines on coverage for:
- Types of treatment, including those listed above
- Length of treatment
- Relapse prevention and emergency care
- Aftercare or continuing care
Picking a Rehab Before Shopping for Insurance Plans
You might find that shopping for an insurance plan before picking a rehab is like shopping in the dark, and you’re not wrong! It can be hard to figure out what your rehab choices are without being an insurance expert.
If that feels true for you, consider choosing a rehab first, then picking an insurance plan that covers it.
Your rehab of choice can help you navigate which insurance providers they accept, which ones they’re in-network with, and what level of care they can provide. Talk to your chosen rehab’s admissions office to compare your insurance provider options.