Will Rehab Be Covered by My Insurance?

Drug addiction is a public health problem, and health insurance will generally cover at least a portion of the costs associated with rehab. This is true for both private health insurance that an individual might receive through his or her employment, and public health insurance that is available through Medicaid. The health insurance that is available through the private health exchanges that were established as part of the Affordable Care Act (a/k/a “Obamacare”) will also cover rehab to a greater or lesser degree. Finally, public and private funds and grants that are separate and apart from insurance might be available to cover a portion of the costs of rehab.

Rehab is Almost Always Covered by Insurance

Although this insurance coverage is generally available, the question of whether your insurance will cover rehab cannot be answered with a simple “yes” or “no”. In the United States, rehab costs an average of $7,000 per month. Some rehab programs, including the type of celebrity rehab programs that are occasionally highlighted on reality television programs, can cost $70,000 or more per month, but in all likelihood, no public insurance coverage and very few, if any, private insurance plans will cover luxury costs. Moreover, most rehab programs are described as requiring at least twenty-eight days, but in reality many recovering addicts need two or three months in rehab before they are ready to return to their active lives, and even then they may need to stay temporarily in a neighborhood recovery facility, and they will likely need ongoing therapy for several months or years after their initial rehab. Even at the average monthly cost of $7,000, the aggregate costs of rehab over a longer period of time can easily exceed $75,000. Even if your insurance covers rehab costs, you will need to understand the full scope of those costs over the duration of your recovery and then compare those costs to the limits of coverage in your plan.

Addicts who do not have private health insurance will be relegated to public programs and grants, all of which are legally obligated to provide insurance coverage for rehab that is at least equivalent to the coverage they provide for other mental health services. Public health insurance that is offered through Medicaid, as well as the benefits provided by that insurance, varies from state to state.

Ask Your Insurance Provider

Addicts who are looking for answers to this insurance coverage dilemma should first talk to their insurance carriers to determine plan deductibles and copays, and annual and lifetime benefit limits. This will at least provide general information on what the insurance company will pay for and what out-of-pocket costs the recovering addict will incur. He should also determine the insurance carrier’s criteria for qualifying for that coverage. Some insurers have established a higher threshold that must be met before coverage begins.

If a recovering addict is relying on Medicaid or another public program, he should determine what information he needs to supply to the insurance carrier about the addiction treatment provider that he wants to use. Medicaid might have stricter limitations on the types of programs that it will cover, and it will likely reject programs that are not administered by individuals who do not have the requisite licenses. The recovering addict should also ask if any one person is coordinating his rehab coverage. Finally, if privacy is a concern, he should ask whether of his information or treatment therapies will be shared with other groups.

Rehab therapy can be expensive, but whether with or without insurance, it is never as expensive as a drug or alcohol habit.

For assistance in understanding your insurance coverage options for rehab therapy, please call Sustain Recovery Services at (949) 407-9052. We can review your insurance plans and provide an outline of the rehab costs that those plans will likely cover.