Learn About Insurance Options

Addictions Content Team Info icon
Calendar icon Last Updated: 09/15/2021

Reading Time: 6 minutes

Insurance can help you pay for treatment, and in many ways, make the process of doing so much easier. However, it is important to understand the options you have as far as insurance and addiction treatment and which may be best for your particular needs.

Why Do I Need Insurance for Rehab?

Your insurance plan can actually make the cost of rehab much more affordable. Treatment is much less expensive for the government and society at large than its alternatives, such as incarcerating addicted persons. This is one reason why seeking help through medical care is considered less costly in the long run.

However, the cost for someone who is paying for rehab completely out of pocket can be considerably high. Insurance companies can help cut down on that cost and allow patients to receive the help they need without going into debt in order to obtain it.

Your provider will also be likely to have specific rehab centers, programs, and other treatment options within their network that fit your individualized needs and will be partially––if not completely––paid for. It is important to choose a program within your network in order to gain these benefits.

Why Do Insurance Providers Cover Addiction Rehab?

Insurance Options

Health insurance can cover a large percentage of addiction treatment costs.

The Affordable Care Act of 2010 included “substance use disorders as one of the ten elements of essential health benefits,” meaning all health insurance plans sold on the Healthcare Marketplace or provided by Medicaid must cover treatment, prevention, and care for this issue. Now, if you choose to purchase a private or public plan, it must cover your treatment for addiction.

Insurance companies also understand that they benefit by covering addiction treatment. Healthier patrons mean better financial outcomes for the company, so treating––and possibly even preventing addiction––can create many benefits for the company itself as opposed to letting the issue continue unabated. Addiction can be devastating, not only to the individual but their entire family, so making treatment for addiction a part of one’s essential health benefits is only safer and healthier for everyone in their lives.

What Insurance Options Exist for Me?

There are three different types of insurance options: public, private, and group. If you do not currently have insurance but are suffering from addiction and other issues associated with substance abuse, it would behoove you to find a plan that fits your needs in order to receive help in paying for your treatment. Remember to follow these simple rules when choosing a rehab center and an insurance provider.

  • Choose the treatment plan that best fits your overall needs, not just your budget. You should also take many of these same needs into account when choosing a rehab program for your safe and effective recovery.
  • Understand that more expensive plans sometimes cost more because they provide more options to patients, including additional treatments and facilities.
  • Allow yourself to ask questions before signing on with a specific insurer or choosing a specific treatment program.
  • Make sure the treatment program you choose is covered under your plan by calling for an assessment of your needs and benefits.
    • This is extremely important, as many people have decided on an option for recovery only to find that they have chosen a facility that is not within their network. You don’t want to be ready for your treatment program and then find out that you need to pay for everything yourself.

Public Insurance

Public insurance covers options subsidized by the government, including Medicare and Medicaid. Individuals who qualify for these options normally have lower incomes and need help from the government in order to afford quality care. Individuals who are retired or who are living with disabilities might also qualify.

Some facilities offer substance abuse treatment at no charge or a sliding fee scale based on income and other factors. Many individuals with public insurance plans can benefit from these types of programs and can receive cheaper care that is still effective for their overall recovery. Private, nonprofit rehab centers may also provide free care to patients, especially if they are utilizing a public insurance option.

While public insurance plans may not be available to all individuals, it can be beneficial to consider whether it could be an option for your needs. Many people are able to attend addiction treatment now with the help of their insurance plans, especially because addiction treatment is currently considered an essential health benefit.

Private Insurance

Private insurance is any type of plan that is purchased by an individual or an employer and is not subsidized by the government. Often, these plans are more expensive, but because there are so many available, it is likely you will be able to find one that fits your budget and allows you to safely and affordably attend the rehab program that is best for your recovery.

Private insurance companies often have specific rehab facilities, treatment methods, and programs that they will pay for, but it is important to remember that, usually, more options will be available to you if you have a private insurance company. Most private companies will pay for both inpatient and outpatient care as well as holistic methods, long-term treatment, etc. Luxury treatment options may also be available to you through your private insurance plan: these are high-end rehab programs that provide gourmet meals and hotel-like accommodations to patients.

This does not mean that a private insurance program will always pay for the entirety of your treatment, but in many cases, care is much more affordable with this option and (sometimes) may even be free. Because there are so many private insurance options available to individuals––and treatment options available through these plans––you are likely to find one that fits your needs. After all, many insurance plans can be catered to the needs of the individual, just like treatment.

Group Insurance

Group insurance covers a determined group of individuals, whether this is employees of a particular company, members of a society, or another type of group. Group insurance options can sometimes be very beneficial, depending on the specific situation, but in some cases, individuals are afraid to take advantage of this option because of the stigma associated with admitting the need for addiction treatment. However, it is important to consider how effective your program is and whether or not it will help you more, in the long run, to seek help through your group insurance program.

What If I Have Out-of-Pocket Costs?

Insurance Options

You will likely have to pay out-of-pocket for part of your treatment.

Even if you have an insurance plan, you will probably have some out-of-pocket cost. However, if you choose the best options for your needs that are covered by your insurance, they should not be high. Still, you may not be able to pay them all at once, and there are some additional options available to you.

When paying out-of-pocket costs after your insurance provider has picked up their share, you may want to ask the treatment center of your choice about financing. If you choose to finance your costs, you can pay a decided amount upon entering treatment and then the rest in increments afterward. This way, you can receive the help you need without having to worry about paying for the entirety of your out-of-pocket costs up front.

Whatever you decide, it is important to remember how effective addiction treatment is and how much it can benefit your recovery. Time in a rehab center not only helps to minimize one’s chances of relapse, but it also decreases one’s criminal behavior and improves social and vocational functioning, helping patients to create a better life. And with your insurance plan, you will be able to afford the best treatment option for your safe, effective recovery.