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Does American Family Insurance Cover Drug Rehab?
American Family Insurance (AFI) is a national insurance provider with plans that offer addiction treatment coverage in most states.1
Thanks to the Affordable Care Act (ACA) passed in 2014, insurance providers must cover some level of addiction treatment coverage in their insurance plans. This includes behavioral health treatments like psychotherapy and counseling, along with detox services and substance use disorder treatment.
According to the ACA guidelines, all insurance plans in the Marketplace are required to:
- Cover substance abuse treatment
- Offer coverage even in instances of pre-existing conditions
- Refrain from putting a yearly or lifetime dollar limit on coverage of substance use disorder services
Specific coverage will vary, depending on the type of American Family Insurance policy you hold and the state in which you live.1 Learn more about using your AFI plan below.
Using American Family Insurance Drug Rehab Coverage
There are many types of treatment, including:
- Inpatient treatment programs
- Outpatient treatment programs
- Detox programs
- Aftercare programs
- Medication-Assisted Treatment
In most cases, you can get a diagnosis from your doctor and a referral for the type of treatment that seems most appropriate. Once you decide on a proper treatment plan, your provider will confirm your American Family Insurance drug rehab coverage and pre-authorize your care, meaning you can relax, knowing that a specific amount of your care is covered.1,2
The Cost of Treatment With American Family Insurance Drug Rehab Coverage
After passing the ACA, pre-existing mental and behavioral conditions were considered essential health benefits. That meant insurance companies like American Family Insurance were no longer allowed to impose spending limits on the coverage of those conditions, including addiction treatment. That means your out-of-pocket costs (the cost of treatment you’re responsible for paying) for drug rehab or medical detox services should generally be the same as your out-of-pocket costs for a medical procedure. The insurance company should pay the same percentage towards a drug rehab that they pay a medical procedure.
Keep in mind, however, you are responsible for paying all deductibles, copayments, and/or coinsurance.
Should You Seek Addiction Treatment Out of State?
Generally, only local facilities fall into an insurance provider’s network because these are programs that have contracted with the insurance company. The shared contract determines the amount they are allowed to charge people with American Family Insurance. The lowest prices will be local.1,2
However, if your plan covers out of network providers, you may feel more settled placing some distance between your life and your rehabilitation. Be sure to thoroughly verify whether or not out of state treatment is covered. If not, local addiction treatment is the option that will allow you to use AFI drug rehab coverage to the fullest extent.
What Treatment Lengths Are Covered by American Family Insurance?
American Family Insurance understands that dependence on different substances requires different lengths of treatment. Determining factors in the number of days your policy covers include the type of plan you hold and the deductible it carries.
Standard lengths of residential (inpatient) care include:
- 28-30 Days: This generally covers both detox and a treatment phase.
- 60 Days: This generally covers treatment for an addiction that requires more care and allows for more in-depth therapy.
- 90 Days: Treatment of this length allows for involved care that delves into underlying roots of the addiction and preparation to safely transition back home.
Will American Family Insurance Cover Luxury Addiction Treatment?
Some rehab centers offer additional amenities that you wouldn’t normally receive at a standard inpatient program. A luxury rehab focus on the look and feel of the treatment center itself, offering upscale amenities that often attract celebrity clients. American Family Insurance generally does not cover these types of luxury addiction treatment, although it is always wise to verify your policy coverage just in case.1,2,3
- Health Insurance: Families, Groups & More. (n.d.). Www.amfam.com. Retrieved January 13, 2023, from https://www.amfam.com/insurance/health/coverages
- Faqs – Health Insurance. (n.d.). www.amfam.com. Retrieved January 13, 2023, from https://www.amfam.com/resources/faqs/health-insurance
- Fan fearlessly campaign | American Family Insurance. (n.d.). Fan Fearlessly Campaign | American Family Insurance. Retrieved January 13, 2023, from https://newsroom.amfam.com/american-family-insurance-presents-new-community-shelter-a-check-for-fan-fearlessly-campaign/