Does Health Insurance Cover Long-Term/Extended Stay Drug Recovery Programs?

One of the biggest deterrents that keeps people from seeking the addiction treatment they need is the cost. Many people fear their insurance won’t pay for the program, or they struggle to find in-network providers. In this post, we go over everything you need to know about in-network drug recovery, including how you can get the help you need even if you don’t have health insurance.

Does Health Insurance Cover Substance Abuse Treatment?

Yes, most health insurance plans do, in fact, cover substance abuse treatment costs — whether you’re struggling with drug abuse or alcohol addiction. They also typically cover mental health conditions.

Common insurance providers that will usually cover at least a portion of the cost of addiction treatment include:

• Blue Cross Blue Shield
• Cigna
• Aetna
• Humana
• United Healthcare
• TRICARE
• Medicaid
• Medicare

Even if you’re covered by insurance, you can still expect to pay for a portion of your addiction treatment in the form of:

• Premiums: the amount you must pay for the insurance.
• Co-pays: smaller fees you’ll pay for access to a doctor or service.
• Deductibles: what your insurance company requires you to pay before it starts covering your healthcare expenses.
• Lifetime limitations on your policy: Some plans put limitations on the dollar amount they will cover. After this threshold is reached, you are responsible for the additional costs.

Plans vary in terms of how much of the treatment will be covered and the amount you’ll be asked to pay out-of-pocket. Check with your insurance provider before you enter a treatment program to can gain a better understanding of what’s covered. Your provider can also help you find an in-network drug recovery program.

Alternatively, you can call us at (866) 305-7134 and speak to one of our knowledgeable admission counselors. We will ask for your insurance details and may be able to tell you when you call if your provider is in our network. If we can’t tell you right away, we will take down your information and call you back as soon as we have an answer. Call us today to find out.

Insurance Providers and Recovery Programs

Health insurance protects consumers from unexpected, high medical costs.[1] It does not discriminate between somebody needing help for injuries sustained in a car accident and someone needing help for drug addiction. If you have purchased insurance, you should feel no shame using your benefits to seek the care you need to kick your addiction to the curb.

Speaking with your plan administrator is a great start, but don’t forget the resources available to you at the addiction treatment center too. These specialists are experienced in streamlining the payment process so that you and your loved ones can focus entirely on your journey to sobriety.

Types of Rehab That Insurance Covers

There’s a wide range of addiction treatment options in the U.S., and health insurance covers most of them. These include:

• Inpatient rehab: Also called a residential treatment program, inpatient rehab requires patients to check into a program for 30-90 days to receive around-the-clock support and care as they fight their addiction.
• Detox: Drug and alcohol detoxification, or detox, is the process of letting the body rid itself of drugs and alcohol. Detox’s purpose is to safely manage withdrawal symptoms in a controlled clinical setting.
• Medication-assisted treatment: Withdrawing from some drugs, including heroin and opioids, is often so intense that it may jeopardize the patient’s life. It can also be so uncomfortable that it causes the patient to start using the drug again to negate the side effects. Medication-assisted treatment can stabilize the nefarious side effects of withdrawal while blocking the effects of the drug.
• Co-occurring mental health treatment: There is a direct correlation [2] between substance abuse disorders and mental health disorders. In fact, statistics show that nearly 8 million Americans suffer from a co-occurring disorder [3]. Co-occurring mental health treatment allows a patient to seek help for their addiction and mental health condition at the same time.
• Therapy: Therapy is an extremely important part of recovery. Therapy takes place on an individual, group, and/or family basis. In therapy, patients connect with others going through the same things they’re experiencing. They work with a professional to get to the bottom of their addiction and what’s causing it. They also learn healthy coping mechanisms and work to repair their relationships with their families.

Going to Rehab Without Insurance

If you don’t have health insurance, you can still get help for your addiction. There are a number of state-funded and even free rehab programs across the country. Many states offer assistance for people who don’t have insurance and are looking for low-cost addiction treatment.

To find out what’s offered in your state, Google your location and “low-cost rehab” or “low-cost substance use programs,” and you can scroll through pages and pages of programs available to you.

There are also a few other ways to pay for rehab if you have no insurance, including:

• Loans: Some people choose to take out a personal loan from a bank or borrow from a loved one to pay for rehab.
• Payment plans: Treatment centers exist to help you. As such, most treatment centers will work with you on a monthly payment plan if you tell them you are uninsured and interested in self-paying. Most will even provide you with a discount for paying this way. The admissions office will typically work with your income, employability, and other personal factors to come up with a payment plan that works for you.
• Scholarships: Some treatment centers have scholarships that people in need can apply for. Certain states also offer scholarships to help people pay for their treatment. Additionally, there’s a federal block grant available to people from all 50 states, D.C., Puerto Rico, and the U.S. Virgin Islands. It’s known as the Substance Abuse Prevention and Treatment Block Grant (SABG) [4].

When You’re Covered by Multiple Forms of Insurance

People covered by multiple types of insurance may wonder if they can use a mixture of insurance providers to pay for rehab. The answer is yes. This is commonly referred to as “coordination of benefits.” This type of coverage greatly increases your chances of finding an in-network provider. If any of the following apply to you, you are likely eligible for dual insurance coverage:

• You are under the age of 26 and covered by your parent’s insurance in addition to your own coverage.
• You are under the age of 26, your parents are divorced, and you are covered by both parents’ plans.
• You’re married and covered under your insurance plan and your spouse’s.
• You are over the age of 65 and are covered through an employer-sponsored insurance plan and Medicare.

People with two separate health insurance plans will have one as their primary coverage plan, while the other will be designated as secondary coverage. The primary provider is responsible for paying first, up to the plan’s limits, and the secondary provider will cover the remaining costs. But keep in mind that even after both insurance plans pay, there may be some remaining out-of-pocket costs for you to handle.

Types of Insurance Plans

There are a number of different insurance plans, but the three most common that people use to cover drug and alcohol treatment are:

Preferred Provider Organizations (PPOs)

These insurance plans let patients see in-network providers in addition to out-of-network providers, with no referrals needed. PPOs offer more flexibility because patients can see any doctor they choose to, regardless of whether they are in the network. However, you will pay less if you see an in-network provider.

PPO plans come with higher monthly premiums and lower co-pays for services received. They also often require higher deductibles than the other types of insurance coverage.

Health Maintenance Organizations (HMOs)

HMOs allow patients to choose who they’d like as their primary care physician (PCP) and see that doctor for most of their needs. This is especially helpful when it comes to creating and maintaining a relationship with a doctor who is aware of the patient’s entire health history. When you see a specialist outside of the network with an HMO plan, you will need to get your PCP to write you a referral.

HMOs generally involve lower or no deductibles and offer coverage at lower rates than PPOs. The most significant benefit of an HMO is the lower premiums, especially for people who don’t seek specialty care or care from providers that are out-of-network.

Point of Sale (POS) Plans

POS plans share a lot of similarities with HMO plans. The major difference is that people with POS plans can sometimes see providers that are out-of-network, depending on the case. The rules vary from POS provider to POS provider, so it’s essential to check with your plan administrator before you decide to see an out-of-network provider.

The Cost of Rehab vs. the Cost of Addiction

Although the cost of rehab may seem high, it’s important to remember that it is nothing compared to the cost of addiction. Addiction costs thousands of dollars for the substances alone — statistics show that the societal cost of addiction is more than $532 billion per year [5]. But that doesn’t even account for all of the other likely costs of addiction, including broken relationships, job loss, physical accidents — and most importantly — the toll on your health and your life.

There is no price that makes it worth losing your life or your loved ones. Don’t forget, working with an in-network provider can lower the cost of your treatment program significantly. When you’re ready to discuss your options, we’re here.

Free yourself from addiction and its grips today when you learn more about the drug and alcohol rehabilitation programs at Olympus Recovery.

How Olympus Recovery Can Help

At Olympus Recovery, we recognize the needs and experiences of each individual client, and our program keeps those in mind. The curriculum was created with decades of experience in substance abuse treatment and helps each of our clients reach new heights in their recovery. If you have any insurance-related questions, are looking for an in-network provider, or would like to learn more about admissions to our facility, please contact us today.