Insurance Coverage for Alcohol Rehab
If you are struggling with alcohol abuse or an addiction to alcohol, you may be concerned about the cost of attending rehab. Alcohol rehab can be costly, so using health insurance can be one way to make treatment more affordable. Learn more about what may be covered through insurance and how to check your coverage.
Does Insurance Cover Rehab for Alcohol?
Most health insurance plans do offer coverage for substance use disorders. Although coverage depends on your plan and individual needs, the majority of health insurance plans do offer at least some coverage for treatment of substance use disorders, which is viewed as an essential health benefit.1 This is further protected by the Mental Health Parity and Addiction Equity Act (MHPAEA), which states that insurance plans offering coverage for mental health and substance use disorders must provide equivalent coverage to what they provide for physical health conditions.1, 2
Health insurance comes in a variety of plans. Two of the most common types of plans are the Health Maintenance Organization (HMO) and the Preferred Provider Organization (PPO).4 An HMO plan has a network of doctors and facilities that you have to visit in order for your care to be covered, unless you are experiencing an emergency.4 A PPO plan allows you to go to any doctor or facility you choose, although using an in-network provider will involve fewer out-of-pocket expenses.4
If you are considering alcohol rehab, insurance commonly covers the following types of treatments:3
- Medical detox, where you receive treatment that involves medication and monitoring by medical staff as you withdraw from alcohol and any other substances you may be using. Detox may be followed by additional treatment to help you maintain sobriety.
- Inpatient treatment, where you stay at a facility for a specified length of time while staff provides around-the-clock supervision and intensive therapy in group and individual sessions.
- Outpatient treatment, where you live at home while receiving group and individual counseling sessions that are less intensive than in inpatient settings. You attend scheduled sessions at a clinic rather than spending a whole day in a facility.
- Co-occurring mental health treatment, where both substance use and mental health disorders are treated at the same time. This type of treatment, which involves counseling and can also include the use of medication, has been shown to be more effective than treating either disorder separately.
- Medication-assisted treatment (MAT) combines medication and counseling to help you maintain sobriety. Medications can be used to help you detox from certain substances and reduce cravings. Other medications block the effects of alcohol or other drugs or cause unpleasant side effects if you drink alcohol.
- Behavioral therapy, where you participate in group and individual counseling sessions to maintain sobriety and learn coping skills. You develop relapse prevention techniques, incorporate positive and healthy activities into your life to replace substance use, strengthen relationships and communication skills, and improve various areas of your life that may have been affected by substance use.
The Affordable Care Act (ACA) and Alcohol Rehab
The Affordable Care Act (ACA) is a major healthcare reform that increased access to health insurance by reducing the costs and expanding access to Medicaid for low-income adults.5 Put into effect in 2010, it includes a range of protections that apply to most or all marketplace health insurance plans.5,6,7 These rights and protections prevent insurance plans from denying coverage to people with pre-existing health conditions, including substance use disorders.
So, if you have an alcohol use disorder, you can still obtain health insurance and access to treatment options.1,6,7 ACA also ensures that most plans provide equivalent coverage for mental health and substance abuse treatment as they do for medical care and makes it illegal to cancel your coverage if you get sick.1,6,7
Largest Insurance Providers in the U.S.
There are close to 1,000 insurance providers in the United States, with the top providers making up the majority of the market.8 The 10 largest insurance providers in the United States are:8,9,10,11,12,13
- Anthem (around 40 million members).
- Centene (over 25 million members).
- UnitedHealthcare (70 million members).
- Humana (6.6 million members).
- HCSC (almost 17 million members).
- CVS Health Corp. (Aetna) (22.1 million members).
- MCNA Health Care (over 8 million members).
- Kaiser Permanente (more than 12 million members).
- Molina Healthcare, which has 3.6 million members).
- Cigna (20.4 million members).
How Much Does Addiction Treatment Cost?
The cost of addiction treatment can vary widely based on a number of different factors. Some of the significant influences on the cost of treatment are:3,14
- The setting. Attending an inpatient facility, where room, board, and around-the-clock monitoring are provided, will cost more than attending an outpatient facility, where you live on your own and attend scheduled appointments at a facility. Additionally, different facilities charge varying amounts for treatment.
- Amenities. Treatment at facilities that include a wide range of amenities and luxuries costs more to attend than facilities that provide only basic amenities.
- Your insurance coverage. If you have health insurance, it may cover a significant part of the cost of your treatment, or even the full cost, as long as you attend a facility that accepts your insurance.
- The length of treatment. Staying in treatment for a longer period of time will cost more than a shorter period of treatment, but it also increases the likelihood of a better outcome.
If your insurance doesn’t cover the full cost of treatment, there are other options for payment. Some programs may offer sliding-scale fees based on what you can pay, and some will work out a payment plan to give you additional time to pay for treatment.14 Scholarships may be available to help cover the cost of treatment. Some facilities offer low-cost treatment to people who cannot access treatment otherwise but may have long wait lists and minimal amenities.
Does Insurance Cover Relapse?
A relapse is when you’ve stopped drinking and/or using drugs and then return to using.15 Relapse can be a common occurrence in the recovery process, but that doesn’t mean the treatment didn’t work.3,16 Instead, it’s more of a sign that something in the treatment plan needs to be changed to meet your needs.3,15,16
If you’ve experienced a relapse, some things to do right away include speaking honestly about the relapse with supportive friends and family, discussing it with your self-help sponsor, and contacting a rehab facility to talk about the possibility of re-entering treatment or altering your treatment plan.3,15,16
Some treatment providers may offer additional treatment for free or at a discounted rate if you relapse after completing their program such as American Addiction Centers (AAC).17 AAC has a 90-day promise which allows patients who’ve spent 90 consecutive days in treatment with AAC to come back for a complimentary 30 days of treatment in the event of a relapse.*
*Terms and conditions may apply and results may vary.
Check Your Benefits and Insurance Coverage
The best way to be sure of your benefits and insurance coverage is to check it directly. This can be done by calling the telephone number on the back of your insurance card and speaking to a customer service representative. They can answer any questions you may have about your behavioral health and substance abuse benefits.
Your insurance company may also have an online portal for members. You can access this by visiting the website, creating an account or logging into your current one and viewing your benefits. Many sites will also allow you to contact someone either by telephone, an online chat, or email to discuss any further questions you may have. If you’re unsure of how to get the conversation started, here are few questions you may want to ask:
- What type of treatments are covered for substance use?
- Do I need to get a referral?
- Do I need prior authorization to go to rehab?
- What is my copayment for treatment?
- How long can I stay in treatment?
- What happens if I relapse after completing treatment?
Discuss Your Treatment Options
If you’re ready to discuss your treatment options, American Addiction Centers can help. AAC is a nationwide provider of addiction treatment centers and works to ensure recovery is accessible to every person in need.
Call our admissions navigators today at 866-871-7659 to learn more about our facilities, what may be covered with your insurance provider and how to begin the process of getting treatment for your or a loved one. We’re available 24/7 and all calls are 100% confidential. To help us better serve you, fill out the instant insurance verification form below prior to your call so our navigators can share with you your specific treatment options.
. Healthcare.gov. (n.d.). Mental health and substance abuse coverage.
. Centers for Medicare and Medicaid Services. The Mental Health Parity and Addiction Equity Act (MHPAEA).
. National Institute of Drug Abuse. (2018). Principles of drug abuse treatment: A research-based guide. (Third edition).
. Healthcare.gov. (n.d.). Health insurance plan and network types: HMOs, PPOs, and more.
. Healthcare.gov. (n.d.). Affordable Care Act.
. Healthcare.gov. (n.d.). Rights and protections.
. The National Conference of State Legislatures. (2011). The Affordable Care Act: A brief summary.
. ValuePenguin. (2021). Largest health insurance companies of 2021.
. J.C. Lewis Insurance Companies. (2020). Top 5 health insurance companies in the U.S.
. Centene Corporation. (2021). Who we are.
. Health Care Service Corporation. (2021). Who we are.
. Managed Care of North America, Inc. (2021). Company overview.
. Molina Healthcare. (2021). Company information.
. National Institute on Alcohol Abuse and Alcoholism. (2021). Treatment for alcohol problems: Finding and getting help.
. Alcohol and Drug Foundation. (2021). Relapse.
. National Institute on Drug Abuse. (2020). Drugs, brains, and behavior: The science of addiction.
. Guenzel, N., & McChargue, D. (2021). Addiction relapse prevention.