person filling out insurance policy wondering does insurance cover rehab

Does Insurance Cover Rehab?

Are you or a loved one addicted to drugs or alcohol? You know there’s help at a drug rehab center in Worcester, MA. But how do you pay for treatment costs? Does insurance cover rehab? It can feel overwhelming figuring out what your health insurance coverage for rehab is.

The Affordable Care Act for Rehab Insurance Coverage

The Affordable Care Act (ACA), also known as ‘Obamacare,’ is healthcare legislation that aims to “make affordable health insurance available to more people.” According to the Kaiser Family Foundation, only 9% of Americans didn’t have a health insurance plan in 2016 (compared to 13% in 2013). That means you probably have it too. Mental and behavioral health is covered by the ACA. That means a plan from the health insurance Marketplace or your employer will be helpful to you if you’re addicted to drugs or alcohol.

The amount of coverage you can get depends on your ACA-sponsored health plan and the insurance company that provides it. The ACA legislation also increased funds and treatment options for people covered by both Medicare and Medicaid. The ACA has given 32 million Americans access to substance abuse treatment and allows people 26 and younger to stay on their parents’ plan.

Does Insurance Cover Rehab for All Addictions?

Most health insurance plans include coverage for addictions, and if addiction treatment is covered, it doesn’t matter what the addiction is. The substance of abuse in question could be an illicit drug, a prescription drug, or alcohol—you can receive specific substance abuse treatment in MA. Specialized programs include:

It’s highly unlikely your insurance policy separates substances into those that are covered and those that aren’t. Doing this would make plans much more expensive, and it would take underwriters far longer to draw them up if these kinds of distinctions were used. By covering all drugs, health insurance plans can stay affordable and straightforward.

Does Insurance Cover All Types of Addiction Treatment Facilities?

Not every facility works with each insurance provider. Some insurance providers make agreements with specific recovery centers. If you want to know whether a particular addiction treatment center in Boston, MA can assist you, contact your insurance provider or the addiction treatment center directly. At Washburn House, are staff is happy to answer any questions you have about insurance coverage! There are also many different levels of addiction treatment:

Some insurance companies cover all these types of care, but others don’t. A specific insurance provider might include only counseling or set a limit on how often (and for how long) you can access a treatment facility. It’s always worth getting in touch with your insurance company to make sure you’re clear on these kinds of details.

Does Insurance Cover Medication-Assisted Treatment (MAT)?

Maintenance medications help you function in your daily life while recovering from an addiction. Sometimes these medications are still necessary after you’ve completed a rehab program. These drugs include SUBOXONE® (buprenorphine) and ANTABUSE® (disulfiram). The former is a prescription opioid that is used to treat addiction to illegal opiates, such as heroin, while the former is used to treat alcoholism.

Both drugs can be quite expensive: A box of 30 SUBOXONE film strips costs around $151. Fortunately, most health insurance providers can cover SUBOXONE as part of insurance coverage for rehab for people recovering from addiction. If you have or are seeking a health plan sponsored by the ACA, then your plan should cover the cost if you meet one or more requirements, including:

  • A long history of drug addiction
  • Failed attempts at recovery
  • An official diagnosis of a mental health disorder
  • Lack of a support network

Medicare and Medicaid may only cover the cost of SUBOXONE if it’s considered medically necessary. Medicare doesn’t usually provide coverage for SUBOXONE if you’re in outpatient treatment. It may include the cost if you’re in an inpatient clinic or as part of an emergency recovery plan. With Medicaid, coverage can vary depending on the state. A private health insurance company may be able to cover the cost of SUBOXONE, but this depends on a variety of factors, such as:

  • Medical necessity
  • Whether prescription medications are covered
  • If a co-payment is required
  • If SUBOXONE is an approved medication according to the plan

This is a potential downside to a private health plan, but the extra money you pay for such a plan can come back to you in terms of the high-quality rehab centers your provider can connect you with.

Coverage for Mental Health Issues

Mental health problems often co-occur with drug and alcohol addiction. These problems can either lead to substance abuse or be worsened by it. To recover from addiction, you may need a certain kind of treatment for a specific mental health condition, like depression, anxiety, or post-traumatic stress disorder (PTSD). One of the central goals of the ACA was parity of esteem. That means mental health is treated just as important as physical health. If your plan says it covers mental health treatment, then it covers all mental health conditions.

To get and stay sober, you have to address the underlying cause of your addiction, which could be, in part, a mental health issue. Also, if your mental health is particularly poor during your recovery, working through your issues with a trained therapist can help you develop vital coping mechanisms. These coping skills keep you from falling back into self-destructive substance abuse after treatment.

Insurance Coverage for Rehab

Does insurance cover rehab? Yes, but insurance coverage for rehab varies. Choosing the right health insurance plan doesn’t have to be a headache or cause for stress. First, find out what recovery program(s) is best for you. Then consult your insurance company or a treatment facility to see if the insurance covers rehab. Use your coverage to its full advantage. Leave your addiction behind in the past and move forward toward health and rejuvenation. Verify rehab insurance today!

Call 855.298.3104 to speak with addiction treatment specialists about Washburn House’s programs.

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