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When looking for a treatment program that accepts your insurance, two important questions to consider are how much your insurance will cover and what your out-of-pocket costs will be. But, does health insurance cover rehab?
Nearly all health insurance policies cover some addiction treatment services. Learn how to find out what your insurance policy will pay for addiction treatment, how to find affordable drug and alcohol insurance for rehab if you don’t have insurance, and how to pay for addiction treatment if you do not have insurance.
What Is Drug and Alcohol Rehab Health Insurance?
Alcohol rehab insurance includes mental health and substance use disorder (SUD) coverage provided by private, employee-paid group health plans, and through the Affordable Care Act’s Marketplace.
You don’t have to have separate insurance for addiction, because the ACA designates mental health and addiction treatment as an essential health benefit, which means that nearly all health insurance plans must cover it.
Insurance for rehab will cover treatment for a person’s addiction to:
While the vast majority do, not all health plans offer coverage for SUD treatment. If you or a loved one is in need of rehab, the first step is to ask how does insurance cover alcohol rehab and other addiction treatment services under your plan.
If your plan does not have any coverage, you may consider switching to an insurance plan that does or finding a supplemental plan that includes insurance for rehab.
What Drug Rehab Services are Covered by Insurance?
Most insurance plans that include substance use disorder treatment cover the cost of treating SUDs, or addiction to drugs and alcohol, and mental health conditions.
Health insurance coverage for addiction treatment typically covers certain types of approved rehab facilities and treatment modalities, such as:
- Inpatient residential rehab
- Intensive outpatient programs (IOPs)
- Partial hospitalization programs (PHPs)
- Medical detox
- Dual diagnosis treatment
- Maintenance medication for addiction
- Counseling after rehab treatment
Services covered by drug and alcohol rehab insurance vary depending on the company and type of plan. Behavioral healthcare insurers such as APS Healthcare offer comprehensive recovery and mental health services through a network of clinics.
Parity Laws for Addiction and Mental Health Treatment
The Mental Health Parity and Addiction Equity Act (MHPAEA) was originally passed in 2008. This law states that insurance providers are required to offer coverage for substance use treatment at the same level that they cover other medical problems.
For example, if you have an insurance plan that covers 70% of your medical expenses, it must also cover 70% of your drug and alcohol rehab costs. This law was strengthened further in 2013 and again in 2024, with more protections such as ending exemptions for certain types of insurance plans.
Insurance coverage for rehab varies based on the type of plan you have. An HMO plan typically requires the least out-of-pocket cost through a limited network of healthcare providers. A PPO plan offers a wider selection of providers with cost differences between in-network and out-of-network providers.
Plans may also differ widely based on the amount of coverage provided for the length of stay at an inpatient rehab center or the number of visits at an outpatient clinic.
With the various types of plans and coverage, it’s important to understand what your insurance provider covers for rehab. Contact your insurance company’s member services for more information about what is specifically covered under your insurance plan before entering a SUD treatment program.
Are There Services That Drug and Alcohol Rehab Insurance Does Not Cover?
Healthcare coverage is usually not provided for anything deemed medically unnecessary, such as holistic care, recreational activities, gourmet meals, or non-medical amenities.
Examples of supplemental holistic care that may not be covered include:
- Yoga
- Massage therapy
- Music therapy
- Art therapy
- Mindfulness meditation
Other services that may not be covered include religious counseling, educational services, and vocational rehabilitation. Court-mandated treatment services and DUI courses are typically not covered either.
However, if a holistic method is part of evidence-based therapy, it may fall under your coverage. For example, dialectical behavior therapy (DBT) teaches one specific type of mindfulness. Mindfulness sessions with a DBT provider may be covered when mindfulness with a holistic provider would not be.
A return to drinking or using addictive substances after rehab is called a relapse. Relapse treatment may not be covered by insurance, despite varying levels of coverage.
If your current insurance plan does not provide the level of substance use and behavioral health treatment you will need, some insurers offer supplemental plans that can be added to your current plan to expand the coverage. Note that insurance cannot be applied retroactively, so you must enroll in a supplemental plan before entering rehab.
How Much Will Insurance for Rehab Pay?
Under the MHPAEA, health insurance companies and group health plans that offer coverage for SUD treatment must provide the same level of coverage for mental health services, including drug and alcohol addiction treatment, as they provide for medical conditions.
If your plan covers the cost of treating SUDs and mental health conditions, it is up to you to find out exactly what your insurance plan covers and what you will be responsible for paying out-of-pocket.
The amount your insurance pays toward your drug or alcohol addiction treatment can differ depending on several factors, such as:
- Your policy’s behavioral health benefits
- Your specific treatment needs
- Whether the treatment facility or provider you choose is in-network or out-of-network
- The length of your stay in residential rehab or the number of outpatient visits
How Do I Find Out About What My Insurance Plan Will Cover for Rehab?
A clear understanding of what is covered by your plan and what’s expected for you to pay for out-of-pocket can give you peace of mind while receiving inpatient or outpatient rehab care. You can check the coverage of your insurance plan by contacting your insurance provider.
How to Check Your Insurance Benefits
To find out specifically what your insurance plan will pay toward addiction treatment, follow these steps:
- Look at your insurance card and locate the contact information for your insurance company.
- If you prefer to speak on the phone, there should be a phone number you can contact to ask the company about your coverage details.
- If you prefer to go online, the insurance card should have a website for you to visit.
- Go to the website on your insurance card.
- Either log in to your account if you have one already, or set up an account.
- You’ll likely need the information from your insurance card to do this.
- Once you’re logged in, look for an area of the site where it says, “My benefits,” “Check my benefits,” “My coverage,” or something similar.
- The wording and location of this will depend on your insurance provider.
- This section of the site should allow you to look at what types of treatment are covered, whether there are coverage differences for in-network or out-of-network providers, and so on.
- If you have further questions about your coverage or if you want to make sure you understand your coverage, most insurers’ websites will have a chat feature where you can chat with a representative to ask further questions.
Here are some questions to ask when investigating what your coverage and out-of-pocket costs will be:
- Does your insurance provider have a list of in-network treatment providers they can send you or refer you to online?
- Does your insurance plan cover specific stages of treatment and levels of clinical care for rehab? Ask for these details so you’ll know exactly the services your plan will cover.
- Is there a maximum length of stay your plan will cover for inpatient rehab or a maximum number of outpatient visits?
- How does your insurance provider define “medical necessity” for addiction treatment coverage? Is a referral, pre-approval, or prior authorization required?
- What are your plan’s copays and out-of-pocket deductibles for the treatment you want to receive? Do you have a coinsurance responsibility after meeting your deductible? What is your out-of-pocket maximum?
If you are having difficulty finding an in-network provider of addiction treatment services you are seeking, ask your insurance company if they may have a behavioral health advocate who can help you find qualified treatment.
Understanding Your Insurance Coverage for Rehab
As you verify and learn about your health insurance coverage for addiction treatment, you may find that the coverage varies based on certain circumstances like what treatment provider you use and what level of plan you have.
Let’s look at a few of the distinctions you might find that can affect your costs.
Costs and Deductibles
With health insurance, it can be tricky to understand how much you’ll actually pay for services. This is why it’s important to talk to your chosen rehab and their admissions staff who can look at your benefits and determine what your out-of-pocket costs will be based on their pricing.
In general, though, here’s how it works:
Your insurance plan will have a deductible. Each year, you will pay out of pocket for your medical expenses (other than certain categories that it doesn’t apply to, like office visits or prescriptions in many cases) until you reach that deductible, and at that point, your insurance will start covering the expenses at a certain rate.
In-Network vs. Out-of-Network Coverage
The coverage rate may vary for different types of medical services, but by federal law, your insurance must cover expenses for mental health and addiction treatment at the same rate it does for other medical services.
In some plans, there is a different coverage rate for in-network providers compared to out-of-network providers. For example, your plan might cover 80% of the costs for in-network providers but only 70% of the costs for out-of-network providers.
As an example, let’s say you’re enrolling in a rehab program that costs $10,000. Your insurance plan has a $1,000 deductible and an 80% coverage rate for in-network providers, and this rehab is in network with your insurance.
In this case, you would pay the first $1,000 to reach your deductible. Your insurance would then pay 80% of the remaining $9,000, and you would pay the other 20%, which is $1,800. So your total costs out of pocket would be $2.800 instead of $10,000.
Out-of-Pocket Maximums
Many health insurance plans also have out-of-pocket maximums. This means that once you have paid that amount out of pocket, your insurance will start covering 100% of your medical costs for the rest of the year. So in the example above, if you have a $2,500 out-of-pocket maximum for the year, your total cost for the rehab would be $2,500.
Pre-Authorization and Medical Necessity
Some health insurance plans have certain stipulations on the care they will cover, which could limit your coverage or require you to meet certain criteria for a cost to be covered. One of the most common stipulations is requiring pre-authorization, sometimes called prior authorization.
This means that your provider must contact the insurance company and they must pre-authorize a cost before you start treatment. This allows the insurer to speak with your provider and make sure that the treatment is necessary before they provide the treatment. Whether or not you need a pre-authorization will depend on your insurance company and the type of service.
Medical necessity is a stipulation for insurance providers as well. They typically will only pay for services that they have deemed to be “medically necessary,” meaning that you need the treatment for your optimal health. This is why cosmetic procedures and luxury or holistic rehab services aren’t typically covered by health insurance, because they’re not deemed to be necessary.
What Do Plans Under the ACA Offer for Drug and Alcohol Rehab Insurance?
The Affordable Care Act (ACA), also known as Obamacare, introduced reforms to increase the availability of health insurance for more people. The ACA requires plans offered through the ACA Marketplace or Medicaid to provide coverage for certain essential health benefits, including treatment of substance use disorders.
If you’re eligible for an ACA insurance plan, you may find a plan that pays for treatment services for a drug or alcohol use disorder at a lower monthly premium than other commercial plans.
Your family’s income and household information determine whether or not you qualify for ACA coverage.
Some of the services covered by ACA plans include:
- Addiction assessment
- Brief intervention
- Medical detoxification (detox)
- Inpatient services
- Medications used to treat addiction
- Alcohol and drug testing
- Home health care visits
- Counseling for the family
- Medications that prevent cravings
The Affordable Care Act established an online marketplace where you can apply for ACA-sponsored insurance plans: HealthCare.gov. In addition to the federal site, several states operate their own Health Insurance Marketplace platforms. The ACA healthcare coverage application process varies by state, so you should check with your state to learn more.
How To Sign Up for an ACA-Sponsored Insurance Plan
To enroll in an insurance plan through the federal Health Insurance Marketplace, go to HealthCare.gov to start the application process by completing the following steps:
- Create an online account on the Health Insurance Marketplace website.
- Complete your application.
- View available health plans.
- Consult a Health Insurance Marketplace agent once approved for a plan sponsored by the ACA about the specifics of your coverage for SUD treatment.
Frequently Asked Questions About Insurance for Rehab
Will Insurance Cover MAT/MOUD?
Medication-assisted treatment (MAT) or medications for opioid use disorder (MOUD) refer to the technique of treating opioid addiction with medications like buprenorphine, Suboxone, or methadone.
The ACA requires nearly all health insurance plans to cover MAT, although the rate at which it’s covered may vary depending on your plan and the provider you choose.
Is Preauthorization Required for Addiction Treatment?
Preauthorization might be required before you can access non-emergency addiction treatment.
It depends on your insurance provider, so be sure to contact your insurance company to find out if preauthorization is needed.
What if I Cannot Get Drug and Alcohol Rehab Insurance?
Depending on your income and other financial obligations, you may not be able to afford the monthly premiums or deductibles of a commercial insurance plan, even one obtained through the ACA Marketplace. Some individuals also have other barriers to obtaining insurance, such as not having a current state or federal ID.
You still have resources that can help you to receive treatment for a drug or alcohol use disorder if you do not currently have the option to enroll in insurance, including:
- Some states offer treatment funded by block grants from the Substance Abuse and Mental Health Services Administration (SAMHSA). Call SAMHSA at 1-800-662-4357 for help locating a center that offers grant-funded treatment.
- At FindTreatment.gov, you can search for treatment centers that offer free care or a sliding-fee scale. You can also search for facilities that accept Medicaid or Medicare if you qualify for these programs.
- Certain treatment centers offer scholarships from affiliations with foundations or private sponsorships.
- Some treatment centers offer payment plans or discounted rates for self-pay clients.
For more information about addiction treatment, call
800-681-1058
(
Sponsored)
to speak with someone who can help. You can also check the Addictions.com directory to find treatment near you.
