How to Pay for Drug and Alcohol Rehab
Paying for drug and/or alcohol rehab can be pricey; and for some, may be a deterrent to getting the help they need. According to the Substance Abuse and Mental Health Services (SAMHSA), approximately 14.8 million people aged 12 or older had an alcohol use disorder (AUD) in 2018.1 However, only around 6.5% of adults with AUD actually seek treatment for the disorder.2
While there are many reasons people may choose not to go to rehab, cost can be one of the biggest challenges they face. As operator of AlcoholRehab.com, American Addiction Centers (AAC) is dedicated to making treatment accessible to everyone in need. We accept many insurance plans and can work with you on a manageable payment schedule so that finances aren’t a roadblock to getting help.
Whether you choose to seek treatment with AAC or at another facility, the following will help you navigate how to pay for drug and alcoholism treatment.
Does Insurance Cover Rehab?
In 2010, when the Affordable Care Act passed, substance use disorder (SUD) treatments were classified as an essential health benefit. This meant that all marketplace plans were required to offer coverage for SUDs treatment and could no longer discriminate against pre-existing drug and/or alcohol addiction.3
Health insurance for substance abuse treatment may cover the below (at approved facilities):
- Inpatient care.
- Outpatient care.
- Medical detox, including medications.
- Co-occurring mental health conditions.
- Follow-up counseling.
- Maintenance addiction medication.
However, you may have more coverage than you think based on your insurance provider and specific policy. Typically, any medical services that are deemed unnecessary may not be covered such as extra services at upscale treatment centers (e.g., certain holistic care services, gourmet food, or other non-medical amenities).
Ways to Pay for Drug and Alcoholism Treatment
Those using private insurance can call their member services representative to see what types of treatments are covered within their specific policy. The most common healthcare plans are HMOs and PPOs—both offer a variety of options.
Though HMO plans typically have lower premiums than PPOs, if seeking a specialist or physician outside of your network, a referral from your primary care physician must be sent over first. When using a PPO, patients can see a healthcare provider in or out of their network without referrals but will typically have higher monthly premiums and co-pays.
It may also be beneficial to contact a substance abuse treatment facility since, in some cases, they can work with your provider to figure out your payment options.
Over 70 million people are covered by Medicaid, a government-funded insurance option for those who otherwise would not be able to afford private insurance.4 The program helps individuals of low-income families get quality healthcare based on program eligibility standards.
Following the passing of the ACA, Medicaid programs are also now required to provide coverage for substance abuse treatment. Depending on your specific plan, using Medicaid can greatly decrease the cost of addiction treatment and may even cover the costs entirely. Visit the Medicaid website to determine if you and/or your dependents qualify.
Medicare is a national health insurance program in the U.S. for those aged 65 or older, those younger than 65 with a disability, and people younger than 65 that have end stage renal disease.5 There are certain guidelines that must be adhered to in order to cover the cost of alcoholism treatment, such as:6
- The provider must create a plan relaying the type of services and treatment the patient needs, as well as how often they’ll need it.
- Treatment must be provided by a Medicare-approved facility/provider.
- The provider must state that treatment is medically necessary.
Medicare coverage is offered and broken down in three ways: Part A, Part B, and Part D.
- Part A helps cover inpatient treatment at a hospital or inpatient rehab center.
- Part B helps cover outpatient treatment services through a clinic or a hospital outpatient center.
- Part D can help pay for drugs to treat substance use disorders when medically necessary.
Some additional services covered include patient education about treatment and diagnosis, psychotherapy, medically administered prescription drugs, and post hospitalization follow-up.6 Your Medicare administrator can share the full list of items covered.
Personal Costs to Consider
Whether you use private or government-funded insurance, there are still certain things you’ll have to pay for out-of-pocket. Typically, policyholders are responsible for the following:
- Premiums: The monthly or annual cost to have insurance.
- Copays: The reduced fee paid in order to be seen by a doctor or to get service.
- Deductibles: The amount of money the policyholder must pay before coverage starts.
- Lifetime limitations: Certain insurance plans only pay for coverage up to a certain amount, leaving the policyholder to be responsible for the remaining balance.
How to Use Insurance for Treatment
Once you’ve established which insurance provider you’ll be using and verify your coverage, consider the following:
- Have a conversation about your treatment needs: One of the stipulations for getting insurance to cover treatment is that it must be deemed medically necessary. Because of this, this will be your first step in the process and is typically covered by insurance. Your doctor will perform an assessment to determine the degree of abuse or addiction, as well as what type of treatment is needed.
- Find a treatment program: While factors such as amenities, cost and location are essential, it’s also important to make sure that your specific level of care is treated at the facility of your choosing.
- Contact the treatment center to discuss your level of coverage: Since coverage can vary between persons, the facility you choose will work with you to determine how much of your specific program is covered. In some cases, they may also help you create a payment plan or schedule should insurance not cover certain portions of the program.
To verify your insurance coverage with AAC, use the form below.
Contact AAC Admissions Navigators
If you’re unsure of what coverage you have or how to best utilize the services under your plan, our Admissions Navigators are available 24/7 to chat about your treatment options. Or you can contact one of our facilities directly to speak with an insurance specialist who can help you navigate the specifics of your policy.
. Substance Abuse and Mental Health Services Administration. (2019). The 2018 National Survey on Drug Use and Health (NSDUH).
. National Institute on Alcohol Abuse and Alcoholism. (2019). Alcohol Facts and Treatment.
. HealthCare.gov. (n.d.). Mental Health & Substance Abuse Coverage.
. Medicaid.gov (n.d.). Medicaid.
. U.S. Department of Health and Human Services. (2014). Who is eligible for Medicare?
. MedicareInteractive.org (n.d.). Treatment for Alcoholism and Substance Use Disorder.