Does Health Insurance Cover Detox?

One of the most common barriers for people seeking drug or alcohol rehabilitation is the cost. It’s not uncommon for many clients to decide to get help but be concerned that they can’t afford it. Beyond the cost of rehab itself, many people may be worried about missing work or losing their job, and thus their health insurance, if they go to rehab.

The value of professional rehabilitation and therapy is much more than just its cost on paper – it’s your opportunity to get clean, have the sober support and encouragement you need to stay sober and learn healthy coping skills when life gets challenging and stressful. If you’ve decided to seek help but aren’t sure how to pay for it, you may have more options than you think.

Will My Insurance Company Pay For My Detox?

Usually, yes. Private insurance companies (the insurance you get through your employer or purchase yourself if you’re self-employed) are required by the Affordable Care Act (ACA) to provide substance abuse treatment coverage. The extent of the coverage varies with each plan, but since the ACA considers substance abuse treatment as an essential healthcare benefit, it’s now prohibited for your insurer to completely deny coverage for rehab.

You’ll likely have to choose an in-network provider for detox and rehab, which can limit your choices. Or, you may have to wait for a room to become available, as detox centers have limited space. In addition, you may have to pay a co-payment, co-insurance, or some out-of-pocket costs for medications you receive. You may be required to have a referral from a primary care physician, too, to have your rehab deemed medically necessary.

Insurance Coverage For Mental Illness

Substance Use Disorder (SUD) is classified as a mental illness in the DSM-V, meaning it can be covered by your insurance plan’s mental health coverage. In addition, many people addicted to alcohol or drugs may have clinical depression or an anxiety disorder for which they may also need treatment to maintain sobriety. Many addicts may not know that they have an underlying mental illness and are self-medicating the symptoms of anxiety and depression.

The ACA mandates require insurance companies to cover mental health treatment, too, so you may be able to get treatment for your depression, anxiety, or other condition. Many addiction rehab centers offer dual-diagnosis or holistic care, meaning they treat their clients’ SUD and other mental health concerns.

Do Medicaid or Medicare Cover Addiction treatment?

The ACA regulations extend to Medicaid, as well. If you don’t have insurance and think your income may qualify you for Medicaid, you may apply, as this insurance coverage is open to anyone who meets the income threshold. On the other hand, Medicare is insurance coverage for people 65 and older or those with a qualifying disability. It, too, covers treatment for SUD.

To receive coverage for addiction therapy for Medicare or Medicaid:

  • Your primary care provider deems the services medically necessary
  • You receive services at a Medicare-approved, in-network facility
  • Your care provider sets up your treatment plan

Not all rehab facilities accept Medicaid or Medicare, and those that do may only accept a certain number of clients at one time.

What May Rehab Services Be Covered by Insurance?

Each plan is different and will have different percentages of your rehab covered. For example, some plans may cover 100% of your detox and rehab services once you meet your deductible, while others require a copay for each service. If you opt for an out-of-network provider, you may not have as much covered, if anything.

Your insurance plan may cover your detox differently, as well. If you require medically supervised detox in a clinical setting or a hospital, you may have a certain amount covered depending on where you go. Many insurance plans cover hospital treatment differently than treatment in other types of facilities, even if the services you’re receiving (in this example, medically supervised detox) are the same.

Another consideration for your rehab is determining what kind of treatment your provider covers. Although insurers are required to cover drug or alcohol rehab, they aren’t always required to cover inpatient treatment. If you’ve previously received outpatient treatment and relapsed, then your primary care physician may deem inpatient treatment medically necessary. Whether a doctor determines that a patient’s proposed treatment is medically necessary is usually the guideline insurance companies use to determine whether a procedure or treatment program will be covered.

Do You Need Drug or Alcohol Rehabilitation?

If you’re worried about your drug or alcohol use or if your addiction is negatively impacting your life, we can help. East Point Recovery Center offers several levels of treatment, depending on how severe your addiction is. And we accept many insurance plans, including out-of-network insurance. Don’t let worries about treatment costs prevent you from seeking the professional services you need for a healthy, sober life. Contact us today for a confidential assessment of your needs and to talk to a representative about your coverage and benefits.