Does Health Insurance Cover Rehab?
If an insurance policy covers medical conditions, the law requires it also must cover the costs of substance abuse treatment to the same extent. How much is covered depends on your benefits plan, deductible and other variables.
The parts of rehab most insurance companies will fund partially or fully are:
- Drug Detox
- Inpatient Treatment
- Outpatient Treatment
- Group Counseling
The amount of coverage is also determined by what is deemed medically necessary. For example, it may be medically necessary for your teen to have a bed at an inpatient treatment program, but it’s not necessary for them to have a private room with daily linen service. Typically, your insurance company won’t cover these luxury extras.
Rehab Insurance Options
If your child decides to enroll in a drug treatment program, there are many insurance plans that will help you pay for some or all of the associated costs. This assistance depends on the type of health insurance you have.
Private insurance is a policy you pay for without any assistance from your employer or government programs. Thanks to the Affordable Care Act, it’s easier and more cost effective than ever to enroll in a private insurance plan.
Some people like enrolling in private insurance because it allows them to select the plan that will fit their needs best. Private plans may be more expensive than public or group insurance, but they also often allow the user more flexibility in choosing the healthcare providers you want to work with. Private plans may also pay more for rehab treatment than other plans based on your deductible. Some people also like using private insurance because, unlike a group plan in some cases, you may not need to inform your employer about the use of the benefit.
If you take part in an insurance plan offered through your employer as a part of its benefits package, you are enrolled in a group plan. The advantage of a group plan is mostly related to cost, because typically employers will split the bill with their employees and pay a significant portion of the premium.
Group plans offer a limited amount of flexibility — while employees can choose the type of coverage they want, the choice is typically limited to one or two different plans provided by just one insurance provider.
Some people may dislike using their group plan for rehab because in some cases your employer may become aware you’re using the benefit.
Public insurance programs like Medicare and Medicaid are provided by state and federal governments and are a more affordable option for health insurance. Just like an employer pays part of your premium in group insurance, the government pays part of your premium in public insurance.
Public insurance comes with many restrictions, however. Only certain people are allowed to enroll in these programs (which is typically determined by your household income, age, if you have a disability, etc.). Once you are enrolled, you are only allowed to use certain providers. If you have public insurance, it’s important to research which rehab facilities you can and can’t work with beforehand.
If public insurance only covers a limited amount of drug treatment options, you may also be able to get your teenager help by pursuing grants or taking advantage of free programming like self-help groups and 12-step programs. Some of the most prominent free drug programs are Alcoholics Anonymous, Narcotics Anonymous and Cocaine Anonymous. These self-help groups follow a 12-step program and typically meet in churches, schools or other public places at convenient times.
Paying For Rehab Without Insurance
Plenty of people who enroll in rehab don’t have insurance.
There are several ways you can pay for rehab out-of-pocket to make it more affordable, like:
- Payment Plans – Rather than paying one lump sum for a service, a payment plan will allow you to pay a smaller amount of money for your son or daughter’s rehab every month over a longer period of time.
- Sliding Scales – Some facilities may use sliding scales, which use how much you may reasonably be able to afford to determine how much you will be required to pay. Under this payment method, families with higher income will be expected to pay more for rehab those families with lower income.
- Financing Options – These can include credit cards, healthcare credit cards, healthcare savings accounts or personal loans.
- Scholarships – Some rehab facilities may offer recovery scholarships to their patients. Just like college scholarships, rehab scholarships are often competitive. You will likely be asked to submit financial information and an essay as a part of the application.
- Grants – Some government agencies like the Substance Abuse and Mental Health Services Administration and the U.S. Department of Health and Human Services offer grants to pay for a patient’s rehab costs. Just like a scholarship, grants often require an application that includes an essay and financial information.
What the Affordable Care Act Means for Rehab
The U.S. government passed a comprehensive healthcare reform law, the Affordable Care Act (or ACA), in 2010. It’s also commonly known as “Obamacare.” Parts of the new law began rolling out in 2013 and will continue to be implemented until the whole program is live in 2022.
The Affordable Care Act made significant changes to the health insurance system so now more Americans have more access to affordable healthcare than ever before. Under the Affordable Care Act, anyone can sign up for these benefits using the health insurance marketplace at HealthCare.gov.
Among the many changes the Affordable Care Act enacted, two significantly affect those struggling with substance addiction.
First, substance use disorders are listed as one of 10 elements of essential health benefits. This means every plan sold in the health insurance marketplace, including the government subsidized plans Medicaid and Medicare, must cover substance abuse services, such as drug rehab.
This was a huge change in the American healthcare system and caused a ripple effect in care accessibility: once substance use disorder services were included in benefits packages, more doctors were paid for their substance abuse services, so more doctors offices and clinics offered these services, giving more patients access to the treatment they need to overcome their addictions.
Second, the law says insurance companies can no longer discriminate against people with pre-existing conditions, including those with mental health and substance use disorders.
There are three key parts of this new rule:
- Addicts can no longer be denied medical insurance or charged extra just because they are already sick when they sign up for insurance
- There is no spending limit (yearly or lifetime) on treating your pre-existing condition
- Coverage of your pre-existing condition services starts as soon as your plan starts
Why Does the Government Fund Addiction Treatment?
Beyond improving the lives of individual Americans, it’s also societally beneficial for the government to fund public drug rehabilitation programs. Overall, research shows that even when the government spends $1 on rehab or other drug abuse services, it saves $12 in the long run.
For example, it may cost the U.S. government $4,700 a year to put one addict through rehab, but that same year in prison would have cost the government $24,000. Investing in a patient’s treatment in recovery also has long-term benefits like less drug-related crime, theft, drug-related accidents like overdose and lower criminal justice costs.
Is Drug Rehab An Option For My Teen?
While paying for rehab may be stressful, there are definitely options available. Above all else, communicate with rehab counselors and professionals to find out what treatment options are available for your teen. Call TeenRehabCenter.org today at (844) 229-6013 to discuss your options for financing your teen’s rehab; our recovery specialists can help you through this difficult time. There’s hope for your child, but it will take your patience and love to get them on the road to recovery.
- “Substance Abuse and the Affordable Care Act.” Office of National Drug Control Policy | The White House. The White House, n.d. Web. 1 Mar. 2016.
- “Mental Health and Substance Abuse Health Coverage Options.” HealthCare.gov. U.S. Centers for Medicare & Medicaid Services, n.d. Web. 1 Mar. 2016.
- “How Are Group and Individual Coverage Different?” Affordable Michigan Health Insurance Quotes | Bcbsm.com. Blue Cross Blue Shield of Michigan, n.d. Web. 1 Mar. 2016.
- “Where Do 12-step or Self-help Programs Fit into Drug Addiction Treatment?” National Institute on Drug Abuse (NIDA). National Institutes of Health, Dec. 2012. Web. 1 Mar. 2016.
- “Is Drug Addiction Treatment Worth Its Cost?” National Institute on Drug Abuse (NIDA). National Institutes of Health, Dec. 2012. Web. 1 Mar. 2016.
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