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Payment and Insurance Options for Addiction Treatment
A 2013 National Survey by the Substance Abuse and Mental Health Agency (SAMHSA) found that the number one reason why those struggling with substance use disorder (SUD), addiction, or dependency did not receive the treatment they wanted was due to the inability to afford rehab treatment at a specialty facility.
But how much does rehab cost? And does insurance cover drug rehab? Also, will there be any out-of-pocket costs if you are covered?
This article explores these questions in more detail. There are plenty of options out there when it comes to funding substance abuse treatment.
Don’t let the worries about cost keep you from getting back the life you love.
How Do I pay for Addiction Treatment?
There really is no one answer to the question of how much addiction treatment may cost. Ultimately, the costs vary based on the following factors:
- Type of Treatment (i.e. Detox, Residential/Inpatient or Outpatient)
- Duration or length of treatment (i.e. 30-day drug detox, 3 months outpatient, etc.)
- Location of the program
- Amenities offered at the facility
Rehab costs can range anywhere between $3,000 to $100,000. A 30-day detox program could be between $250 and $800 per day; while a residential treatment program could cost between $5,000 and $80,000 depending on the length of stay.
Don’t let these numbers overwhelm you though when it comes to getting help. It is possible to find ways to afford treatment costs of care, no matter your needs. From your state or local government offering free treatment to low-cost support, to programs like Alcoholics Anonymous (AA) and faith-based support groups, there are more ways than one to find a solution to financial obstacles when it comes to entering treatment.
Inpatient Treatment vs Outpatient Costs
Inpatient treatment (or Residential Treatment) is considered to be more costly, but most beneficial for those struggling with more severe or longer-term substance use disorders. Inpatient treatment allows individuals to recover away from environmental triggers that may contribute to one’s substance abuse problem. Because of this, the costs associated with inpatient treatment are often more than the costs of outpatient.
Outpatient treatment however is viewed as a continuum of care and allows individuals the flexibility to attend treatment in a structured setting while still learning to live on one’s own. This form of treatment is most appropriate for those who are not in need of full-time treatment or have independent responsibilities to maintain. As a result, it is often less costly than full-time residential treatment.
Choosing which level of care is best for you depends entirely on your unique needs and treatment goals.
Does Health Insurance Cover Substance Abuse or Addiction Treatment?
Yes, many health insurance plans do cover the cost of treatment for substance use disorders (SUDs) and mental health needs. Some private healthcare providers may cover a portion of the costs for treatment, while others may cover it entirely. To find out the extent of your private health insurance coverage, contact your provider or visit their website today.
If you are unsure of what payment plan is right for you there are many treatment centers that can help you find out which facilities are in-network, saving you time. Some may even offer easy access services directly on their websites. Riverside Recovery of Tampa offers an insurance coverage check here: Insurance Coverage Check.
Again, the costs of rehab vary greatly depending on what level of care is needed but regardless of whether or not you have health insurance, there is a multitude of options available to help cover costs. To find out the full range of your options, check with your insurance provider to understand the details of what is covered under your plan.
Paying for Treatment with Health Insurance
There are a number of insurance providers who offer alcohol rehab and substance abuse treatment coverage. The benefits provided under health insurance plans are designed to make health care more affordable and accessible. Major insurance companies that offer coverage at Riverside Recovery of Tampa for drug and alcohol abuse treatment include the following:
- Blue Cross Blue Shield
- Aetna
- Cigna
- Humana
Cigna has a Behavioral Health division that is dedicated to providing tools and resources for substance abuse treatment. Like Cigna, other private health insurance companies have divisions dedicated to behavioral health where you can learn exactly what plans and levels of coverage are available to you regarding substance abuse treatment. Visit their individual websites to learn more, or, check with your HR department and/or insurance provider to learn more about your mental health policy networks, deductibles, and co-payment plan.
In addition to private health insurance plans, there are public insurance options where partially or fully subsidized costs are provided by the federal government. These public insurance include Medicaid, Medicare, and plans offered through the Health Insurance Marketplace.
Affordable Health Care Act (ACA)
In March 2010 the Affordable Care Act (ACA) was enacted with the aim of putting into place comprehensive health insurance reforms. These reforms included making health insurance more affordable to more people, lowering health care costs, guaranteeing more choices for people, and enhancing the quality of health care for all Americans (The Office of National Drug Control Policy).
Also known as “Obamacare”, the ACA mandated that health insurance policies must provide drug and alcohol addiction coverage. This means that all health insurance offered on Health Insurance Exchanges or provided by Medicaid must include services for SUDs.
In addition to this, as a result of the ACA, insurance applicants can no longer be penalized for pre-existing conditions. This allows those who are struggling with substance abuse to benefit from applying for a healthcare policy successfully. This applies to private insurance policies, Medicaid, Medicare, state-financed, and military health insurance.
The ACA provides ten essential health benefits to be included in these policies and substance use disorder treatment is one of these ten benefits. As such, health Insurance policies must treat addiction and mental health disorders with the same level of significance as any other medical condition.
The Mental Health Parity and Addiction Equity Act (MHPAEA)
The Mental Health Parity and Addiction Equity Act (MHPAEA) was introduced in order to make it easier for Americans struggling with mental health and substance use disorders to get the care they need. This was effectively done by prohibiting certain discriminatory practices that previously limited insurance coverage for behavioral treatment and services.
According to Medicaid.gov, MHPAEA requires coverage for mental health and substance use disorders to be no more restrictive than the coverage that is generally available for medical or surgical conditions.
Federal statutes require Medicaid and Children’s Health Insurance Programs (CHIP) to comply with mental health and substance use disorder parity requirements. These requirements are outlined in the MHPAEA. Essentially, large group health plans must not impose any limits on mental health benefits in a way that they are less favorable than limits imposed on medical/surgical benefits.
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Medicare and Medicaid
Medicaid is a state-funded health insurance option that is available to those eligible through their state. Because Medicaid is offered through individual states, policies may vary from state to state.
According to Medicaid.gov nearly 12% of Medicaid beneficiaries over the age of 18 struggle with substance use disorders (SUDs). Fortunately, the expansion of Medicaid under the ACA ignited a wave of changes in the way states approached substance abuse service coverage. These benefits after the ACA meant that coverage must now include mental health and substance abuse services to meet the requirements of the Mental Health Parity and Addiction Equity Act (MHPAEA).
Most Florida Medicaid plans cover addiction treatment services however the coverage does not include any premiums a person may have to pay out of pocket. Because Medicaid is primarily for those with a lower income, premiums and copays will generally be quite low. Both outpatient and inpatient treatment options will have different requirements under Medicare coverage, you can check with your state to find out more about the qualification guidelines.
Medicaid
According to Medicare.gov, Medicare covers certain screenings, services, and programs that aid in the treatment of recovery of mental health and substance use disorders. Although there is no distinct benefit category for Medicare regarding substance abuse treatment, such services are covered by Medicare when deemed “reasonable and necessary”.
Although Medicare pays for the treatment of alcoholism and SUDs, in both inpatient and outpatient cases, there are specific rules that limit its coverage and reimbursement plans. Medicare‘s coverage of services for mental and behavioral health as well as SUDs is not as extensive as its coverage for other services, according to the Center for Medicare Advocacy.
In an article on the Centers for Medicare & Medicaid Services (CMS)’s website, the CMS provides a full range of services including those provided for substance abuse disorders.
These services for substance abuse disorders available under Medicare include:
- Inpatient Treatment (if reasonable and necessary)
- Including professional services provided during that care whether part of the inpatient stay or separately; and medication provided as part of inpatient treatment
- Outpatient treatment (depending on the provider of the services)
- Partial Hospitalization Program (PHP)
- Intensive outpatient psychiatric day programs offered as an alternative to inpatient hospitalization may be available in your local hospital outpatient department and Medicare Certified Community Mental Health Centers (CMHCs).
Generally, Medicare is available for people over the age of 65, younger people with disabilities, and those with End State Renal Disease (permanent kidney failure requiring dialysis or transplant). There are two parts to Medicare, Part A (Hospital Insurance) and Part B (Medicare Insurance), and the eligibility requirements for both differ. To learn more about Medicare eligibility visit their website or reach out to one of our staff members today.
Although these state and federally-funded insurance programs can provide payment options for substance abuse treatment, each program provides a different set of requirements necessary to qualify for eligibility.
Medicare
According to Medicare.gov, Medicare covers certain screenings, services, and programs that aid in the treatment of recovery of mental health and substance use disorders. Although there is no distinct benefit category for Medicare regarding substance abuse treatment, such services are covered by Medicare when deemed “reasonable and necessary”.
Although Medicare pays for the treatment of alcoholism and SUDs, in both inpatient and outpatient cases, there are specific rules that limit its coverage and reimbursement plans. Medicare‘s coverage of services for mental and behavioral health as well as SUDs is not as extensive as its coverage for other services, according to the Center for Medicare Advocacy.
In an article on the Centers for Medicare & Medicaid Services (CMS)’s website, the CMS provides a full range of services including those provided for substance abuse disorders.
These services for substance abuse disorders available under Medicare include:
- Inpatient Treatment (if reasonable and necessary)
- Including professional services provided during that care whether part of the inpatient stay or separately; and medication provided as part of inpatient treatment
- Outpatient treatment (depending on the provider of the services)
- Partial Hospitalization Program (PHP)
- Intensive outpatient psychiatric day programs offered as an alternative to inpatient hospitalization may be available in your local hospital outpatient department and Medicare Certified Community Mental Health Centers (CMHCs).
Generally, Medicare is available for people over the age of 65, younger people with disabilities, and those with End State Renal Disease (permanent kidney failure requiring dialysis or transplant). There are two parts to Medicare, Part A (Hospital Insurance) and Part B (Medicare Insurance), and the eligibility requirements for both differ. To learn more about Medicare eligibility visit their website or reach out to one of our staff members today.
Although these state and federally-funded insurance programs can provide payment options for substance abuse treatment, each program provides a different set of requirements necessary to qualify for eligibility.
Marketplace Health Insurance Plans
All plans offered in the Marketplace must cover 10 essential health benefits, one of those categories includes mental health and substance use disorder services (including behavioral health treatment, counseling, and psychotherapy). These essential health benefits are the minimum requirements for all Marketplace Health Insurance plans and specific services covered in each category can vary based on your state’s requirements.
What Is the Health Insurance Marketplace?
According to Benefits.gov, the Health Insurance Marketplace is a resource where individuals, families, and small businesses can compare health insurance options. The Marketplace helps people find health coverage plans to fit their needs. All health plans in the Marketplace offer the same set of essential benefits services including doctor visits, hospitalization, and more. People who visit the Health Insurance Marketplace can compare insurance plan prices, benefits, quality, or additional features before choosing one.
Local and State-Funded Rehab Programs
In addition to the options above, there are many state governments that offer inpatient and outpatient treatment programs free of charge as well as state insurance policies to those who need them. The Substance Abuse & Mental Health Services Administration (SAMHSA) provides a Directory of State Agencies to help you find qualifying programs in your state. There are also substance abuse rehab centers that offer rehab scholarships, and facilities that receive local grants to help offer treatment at a reduced cost or even free for those struggling with addiction.
Eligibility requirements for state-funded rehab also vary by state and so it is best to check with a center in your area for more information about what scholarships, grants, and programs are offered. To learn more be sure to Google your state, city, or county to find low-cost substance use disorder programs and services.
Other options for covering the costs of treatment are:
- Scholarships
- Loans and/or payment plans
- Financial support from family and Friends
Get Help Today
If you or a loved one are ready to begin treatment but are unsure of where to start with funding, we’re here to help. Whether through private or government-funded resources, Riverside Recovery of Tampa is here to help you navigate your options on your road to recovery. Reach out to our admissions team today to learn more about insurance coverage options and treatment today.
Addiction Insurance FAQ
You can submit your insurance information on our insurance verification form to find out if you’re covered. You can also contact our admissions team for more information and verification benefits.
Yes, absolutely 100% confidential treatment. Many people suffering from substance abuse are often nervous to request time off from work for seeking addiction treatment. The 42 Code of Federal Regulations protects the privacy of all substance abuse patients at facilities receiving aid from the federal government. The State of Florida also provides comprehensive privacy laws for all persons receiving mental illness treatment. No one will have access to your information regarding your condition and treatment without your written consent.
Generally, health insurance policies cover some or all of the costs of psychiatric treatment, recognizing addiction and mental health issues as essential benefits.
HealthCare.gov–Health benefits & coverage
U.S. Department of Health & Human Services–Who’s eligible for Medicare?
Substance Abuse and Mental Health Services Administration (SAMHSA)–2013 National Survey on Drug Use & Health: Detailed Tables
