Do Insurance Providers Cover the Cost of Rehab?

When you’re ready to get treatment for substance use disorder, the first question on your mind is whether insurance will cover your rehab stay. The answer is usually yes!

Thanks to the Affordable Care Act, all long-term health insurance plans are required to cover treatment for pre-existing conditions, including substance use disorder and mental health disorders. That includes:

• Insurance through the Healthcare Marketplace
• Insurance through work
• Insurance through Medicare or Medicaid

The only exception is short-term plans that don’t cover pre-existing conditions, but those insurance plans are uncommon and usually only used in between a coverage lapse. 

There’s an incorrect perception that health insurance doesn’t cover rehab. That hasn’t been true since the Affordable Care Act passed in 2010.

Before that, insurance companies could deny claims based on pre-existing conditions or other demographics. They denied many claims for addiction treatment because substance use disorder is a pre-existing condition. Starting in 2010, insurance companies were (and are) required to cover addiction treatment as long as your doctor deems it medically necessary. 

Most plans are PPOs (Preferred Provider Organization plans), which designate providers as in-network or out-of-network. If you go to an addiction facility that’s in-network, more of your care will be covered and you’ll pay less. Out-of-network treatment centers cost more than in-network providers.

Because addiction coverage specifics vary from provider to provider, it’s best to use our insurance verification tool to check your coverage and find rehabs that accept your insurance.

Addiction Insurance Providers

You generally don’t have to look for a specific provider that covers substance abuse, since all long-term plans are required to provide coverage for addiction treatment.

The length of treatment that’s covered depends on your plan and on your medical care team letting the insurance company know that your treatment is medically necessary. To learn the specifics about coverage from a given provider, call the Member Services phone number listed on the back of your membership card.

The billing department at your treatment center will handle the insurance claims process for you in most cases. That includes submitting the claim to the insurance company via fax and following up on it via phone until it’s approved.

There are dozens of health insurance providers in the United States. Some of the biggest ones like UnitedHealthcare cover treatment in every state, while others are regional and only cover treatment in your local area (and you must live there to qualify).

Most Common Health Care Plans That Cover Rehab

The most common types of health care plans that cover rehab are HMO (Health Maintenance Organizations) and PPO (Preferred Provider Organizations). 

Generally, PPO plans are more flexible and HMO plans are more affordable.

With a PPO plan, you can get coverage for treatment that’s within your preferred provider network or you can choose an out-of-network provider in exchange for less coverage (so you pay more, but you get the treatment you want.)

HMO plans limit your choices to providers that are in network and won’t cover out-of-network providers at all. They also require you to live in a certain regional area and get care from your primary care physician before you get a referral to rehab.

You can purchase an HMO or PPO plan on the Healthcare Marketplace during open enrollment periods or after a major life change. Beyond PPO and HMO, your health care plan choices might include:

• Medicare: Medicare is available to people who are 65 and older, or people who have certain qualifying disabilities, like Lou Gehrig’s disease or end-stage renal disease.
• Medicaid: You might qualify for Medicaid if you are low-income or have a low-income head of household (since Medicaid covers everyone in the family.) People under 18 who live alone also qualify for Medicaid.
• COBRA: If you recently lost your health insurance due to a major life event, the Consolidated Omnibus Budget Reconciliation Act (COBRA) gives you the option to resume your health plan (called continuation coverage) as long as you qualify and work for a qualifying employer.

If none of these options works for you, paying out-of-pocket with financing may allow you to get treatment without causing financial stress. Remember, the long-term costs of not treating substance use disorder are much bigger than the costs of rehab.

What Types of Rehab Facilities Are Covered?

There are many types of rehab facilities that might be covered by insurance, including:

• Residential inpatient treatment centers: Inpatient facilities are the most intensive level of treatment. You’ll receive 24/7 care and all-day access to intensive treatment.
• Detox treatment centers: Medical detox centers help you get through the withdrawal process before inpatient or outpatient treatment begins. Everyone should attend detox before rehab.
• Outpatient treatment centers: At outpatient rehab, you attend part-time while living at home. Many people attend outpatient rehab so they can attend to their responsibilities, like work or caring for children.
• Dual diagnosis treatment centers: Around half of people with substance use disorder have at least one other mental health diagnosis. Dual diagnosis rehabs screen and treat for disorders like depression and anxiety.
• Medication-assisted treatment clinics: MAT clinics treat patients with a combination of medication (such as Suboxone, methadone, or buprenorphine) and therapy on an outpatient basis.

To get the specifics of your plan’s coverage for different rehab facility types, verify your insurance through our tool and we will provide you with all available options.

Finding a Rehab That Accepts My Insurance

Once you know that your insurance covers rehab treatment, it’s time to find a rehab that accepts your insurance. Some rehabs are selective about the insurance plans that they accept, so many people find that it’s challenging to find a rehab that does take their insurance.

You have two options to find a rehab:

1. Search from facility to facility, calling around until you find one, or
2. Use our easy tool to find your coverage and we will point you to the right treatment center

Frequently Asked Questions About Insurance Coverage for Rehab

Still have questions about finding insurance coverage for addiction treatment? We’ve compiled the most commonly asked questions and answered them for you:

How much does rehab cost with insurance?

It’s hard to predict how much rehab will cost with insurance for two reasons. First, different rehabs have different costs, so it’s dependent on where you’re going. Second, insurance plans differ in coverage, so it depends on your exact plan, too.

The best way to find out how much insurance will cost with insurance is to contact the treatment center and ask them to verify your coverage. To find a treatment center, use our handy coverage checker tool.

Can I use my insurance for a loved one that has no coverage?

You generally can’t use your insurance to give coverage to a loved one who doesn’t have it. The exception is if the loved one is a household member and you’re covered by Medicaid, in which case all of your household members have coverage, too.

Can I go to rehab without insurance?

You can go to rehab without insurance. If you attend rehab without insurance, then your payment options include:

• Self-pay: All rehabs allow you to pay for your treatment directly if you choose. Some rehabs offer a self-pay discount, which can be an incentive to take this route.
• Payment plans: Some treatment centers offer in-house payment plans that allow you to pay for your treatment over a period of time instead of all at once.
• Rehab scholarships: The most well-known rehab scholarship organization is 10,000 Beds. You can apply no matter where you live in the United States as long as you meet their criteria, which includes a 30-day treatment commitment and a lack of support and resources.

Going to rehab without insurance can be daunting, but it’s worth the investment into your future.

Affordable Treatment is Within Reach

Don’t be afraid of the process of paying for treatment. We can help you find affordable treatment by verifying your coverage using our rehab insurance verification tool. This is the first step on the path to the rest of your life, so get started checking your coverage now!