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 / Alcohol / Does Insurance Cover Alcohol Rehab?

Does Insurance Cover Alcohol Rehab?

Unfortunately, 40 million people in the United States admit to having a drug issue, and 15 million have an alcohol use disorder (AUD). However, a significant portion of those who need assistance to get treatment for these disorders does not receive it. There are several reasons for this, but one of the main ones is often a worry about or an inability to afford the cost of treatment.

Insurance Coverage for Alcohol Addiction Treatment

Fortunately, because of extensive healthcare reform established in the last several decades, many people can utilize public or private insurance policies to pay part or all of their addiction treatment expenses. 

 

Since the country enacted the Mental Health Parity and Addiction Equity Act and the Affordable Care Act, healthcare plans that are privately funded and funded by the state are required to provide coverage for alcohol dependence, substance abuse, and other psychiatric issues.

 

Several health insurance policies only cover in-network therapy at a reduced rate or only provide coverage for in-network treatment facilities. However, the level of coverage offered by these insurance plans may vary significantly. As a result, policies on treatments like alcohol detoxification, inpatient rehab, and outpatient care may differ considerably from one state and one institution to another.

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Coverage for Alcohol Rehab Services

There may be differences in insurance coverage for various degrees of alcohol addiction treatment. However, most healthcare plans will pay for the following:

Alcohol Detox

Although you may go through detoxification in an outpatient treatment facility, it's often more beneficial when done in a secure residential setting with professional specialists on hand. Most health insurers provide some coverage when detox is necessary for your rehabilitation.

Outpatient Treatment

Some patients prefer to participate in an outpatient treatment program because it allows them to return home at night. Many clients find that the added structure and intensity of inpatient rehab aid them in overcoming the chronic phases of alcohol addiction. Your insurance will usually cover a certain number of therapy sessions or days.

Inpatient Rehab

Inpatient therapy could be a more feasible setting for alcohol addiction treatment, depending on the severity of your addiction. A portion of your treatment should be covered by insurance, with fewer co-pays, although the length of time may be limited.

Counseling and Psychotherapy

Many evidence-based therapeutic approaches, including cognitive-behavioral, family, dialectical behavioral, and group therapy, come in handy in treating alcoholism successfully. Through group therapy, individual therapy, and family counseling, people may learn how to prevent relapse, communicate, resolve problems, control triggers, and build better, recovery-oriented pastimes.

 

Extended stays in sober living facilities or alternative (non-evidence-based) treatment regimens are often not covered by insurance. Additionally, there can be varying degrees of coverage for upscale treatment facilities.

Medication

Prescription drugs that reduce withdrawal symptoms are part of medication-assisted therapy (MAT), carried out under medical supervision. Most insurance plans will at least partially cover the cost of a prescription if you need one for detox or to treat any accompanying symptoms.

Aftercare

Aftercare is a program that assists patients in continuing their recovery after finishing either an intensive inpatient or intensive outpatient rehabilitation program. Aftercare programs often include connecting recovering addicts with sober people, organizations, and support networks such as Alcoholics Anonymous (AA) to assist them in continuing their sobriety and sustaining recovery.

Medically Reviewed:

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Expert Contributor

Dr. Williams presently serves on the board of Directors for two non-profit service organizations. He holds a Master’s degree in Human Services from Lincoln University, Philadelphia, Pa, and a Ph.D. with a concentration in Clinical Psychology from Union Institute and University. In Cincinnati, Ohio. He is licensed to practice addictions counseling in both New Jersey and Connecticut and has a pending application as a practicing Psychologist in New Jersey.

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What Are Your Expected Out-of-Pocket Costs?

Any costs that your insurer does not cover are your responsibility. Your insurance company may additionally charge you extra fees. For instance:

Premiums

Premiums are the insurance fees for your policy. For the most part, insurance premiums are paid regularly (often monthly).

Coinsurance

The proportion of treatment expenses you are responsible for after your deductibles have been met is called "coinsurance." Typically, this sum is provided as a percentage of the total cost.

 

For instance, if your coinsurance is 30%, you will be responsible for 30% of your alcohol treatment cost, while your insurance provider will fund the remaining 70%.

Co-pays

As a policyholder, you may be responsible for a portion of your alcohol addiction treatment costs while the insurer covers the remainder.

Deductibles

Your deductible is the predetermined amount you must pay before your insurance coverage begins paying for your alcohol addiction treatment.

Out-of-Pocket Cap

It is the most significant sum that you will be responsible for paying in a single calendar year. Once this threshold has been reached, the insurer is responsible for covering any leftover expenses (excluding periodic premiums).

Lifetime Limitations

Because not all insurance plans have lifetime limits, your alcohol rehab costs may exceed the amount your provider is prepared to pay.

 

It's essential to remember that your out-of-pocket expenses might vary substantially depending on whether you're getting your covered services from an in-network provider or one outside the provider's network:

In-Network

They are specialists or treatment facilities in the network that often charge a reduced fee for medical services.

Out-of-Network

Insurers may charge higher copayments and coinsurance costs for providers not part of a particular network.

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How to Use Your Healthcare Benefits for Alcohol Rehab

It's vital to check with your insurance carrier before going to treatment to determine what the steps are for using your healthcare benefits. Locating a center that takes your insurance is usually the first step.

 

The institution or your insurance company might determine any required paperwork, such as pre-authorization or referral. With this information, you may check with the treatment facility and insurance company to see if you're covered. You should save all correspondence and receipts to make the claims procedure go more smoothly.

The Bottom Line

If you've just decided to get help for your addiction, you will be happy to hear that insurance will pay for some of the rehab costs. Because substance addiction illnesses fall under the mental health umbrella, your health insurance will likely pay for all or part of the associated costs of alcohol addiction treatment. Emergency treatments and mental health disorders are covered under the Affordable Care Act (ACA), which mandates their inclusion in all marketplaces for private insurance policies and Medicaid plans.

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