Does Your Health Insurance Plan Cover Substance Abuse Treatment?
Health insurance plans vary from one another considerably. Nonetheless, all health insurance plans in the United States do cover mental health disorders, addictions, and substance abuse treatment. In fact, the Affordable Care Act requires health insurance companies to cover addiction treatment. This means that no matter what health insurance provider you go with, you are guaranteed to have addiction treatment covered.
Despite that requirement, there are still differences among health plans in terms of how long they pay for alcohol or drug rehab, which types of treatment they cover, and even which rehabs they are willing to pay for. If you are interested in a specific type of treatment or a specific outpatient rehab center, it is still important to make sure that it is covered by your health plan. You can answer this question by contacting your health insurance provider directly or speaking to the treatment center you want to enroll in.
Southern California Rehabs Covered By Health Insurance
There are many types of types of addiction treatment available. Different treatment approaches can be effectively utilized to help people on different ends of the addiction severity spectrum. People with comorbid mental health disorders also often require specialized treatment. Drug and alcohol addiction treatment is delivered in a wide variety of settings. Health insurance companies are required to cover a wide range of addiction treatment approaches.
Given the sheer number of rehabs in the United States (more than 14,500 throughout the nation), it is no surprise that there is variation in terms of their treatment approaches and methods. Southern California is a great place to get sober, because there are more drug rehabs per capita than any other region of the United States. This means that there are many different rehabs to choose from, ensuring that any individual can get the specialized treatment they require.
Addiction treatment at a rehab generally involves a variety of treatment modalities. Most commonly, rehabs offer a combination of behavioral therapy and medical treatment. Rehabs also strive to comprehensively address many components of a person’s life to help them recover completely from the effects of addiction. These components include:
- Their substance abuse
- Seeking employment
- Healing and developing relationships
- Finding safe housing
- Long term aftercare therapy and treatment
It is important to choose a rehab that offers this kind of comprehensive treatment. For most people, simply getting physically sober is rarely enough. It is crucial to develop coping skills and relapse prevention techniques, to address underlying mental health issues, and to rebuild one’s life from the ground up. Quality rehabs covered by health insurance provide effective, integrated, and comprehensive treatment to ensure that clients not only get sober, but stay sober.
Which Health Insurance Plans Cover Drug and Alcohol Addiction?
Physical and mental health conditions not only affect the people suffering from them, but they indirectly damage the lives of their friends, family members, loved ones, and surrounding community. This is even truer for addiction, which causes significant behavioral changes that lead to increased criminality, economic devastation, and shattered family lives. Addiction can devastate communities, and in many cases it deals blows to the entire nation.
The United States — and much of the world — is currently experiencing an opioid epidemic. Prescription opioid abuse had led to decreased life expectancy in the United States, and it recently surpassed car accidents to become the second greatest cause of preventable death in the country. Since addiction is a recognized public health concern, the federal government has made it a priority to tackle the addiction epidemic head on. As a result, health insurance companies are required to pay for drug and alcohol addiction treatment.
Both private and employer-sponsored health insurance plans cover addiction treatment. They are also required to help people recover from the consequences of addiction, which include mental and physical health problems. Since the passing of the Affordable Care Act, more Americans than ever have access to health insurance to pay for their addiction treatment. In 2019, 92% of Americans had coverage from a health insurance plan. All of these plans cover mental illnesses and addictions, though there is considerable variation among them.
The most prevalent types of healthcare plans are HMO and PPO. Substance abuse treatment programs are covered by both types of plans, but they differ in terms of their benefits:
- HMO (Health Maintenance Organization). HMO plans allow patients to have a choice in terms of their primary care physician. This doctor is responsible for meeting most of their medical needs, is up to date on their health history, and helps them get access to other essential resources. When a person needs to see a specialist or a physician outside of the network, the primary care physician writes a referral. For people covered by an HMO, it is the primary care physician who is responsible for recommending addiction treatment. HMO plans have low deductibles and often an overall lower cost than PPO plans.
- PPO (Preferred Provider Organization). PPO plans give patients flexibility in terms of their healthcare providers, allowing them to see providers both inside and outside of their network without needing a referral. This means PPO plans sometimes give people more options in terms of addiction treatment. Patients can choose from a wide variety of different treatment programs. The main con of PPOs is that they generally have higher deductibles than HMO plans.
Health insurance plans are all different, but employer-subsidized insurance plans and private insurance plans both cover addiction treatment under the Affordable Care Act. The ACA also specifies that addiction is not considered a pre-existing condition. This means that people who suffer from a substance use disorder cannot be denied health insurance. The ACA also ensures that people who are covered under Medicare and Medicaid have access to the drug or alcohol addiction treatment they need.
What Drug Addictions Are Covered By Insurance?
Addiction care is considered one of the ten essential health categories that insurance companies are required to cover. This applies to health plans on the insurance marketplace, but the vast majority of private health insurance plans are also required to follow those same rules. Health insurance companies do not distinguish between different types of addictions. They do not make a distinction between “covered” and “non-covered” drug addictions. It does not matter what substance a person is struggling with. If they have a diagnosed substance use disorder, they are guaranteed addiction treatment.
The origin of a person’s addiction is irrelevant when it comes to obtaining health insurance coverage. If health insurance companies made distinctions between different causes for addiction, it would lead to a number of problems. With other health conditions there are often many different causes. Obesity, for instance, can be caused by hormonal or gland abnormalities, and it can be caused by poor eating habits. Health insurance companies are required to provide treatment for obesity, whether it is caused by a genetic problem or simply overeating. Instead of blaming people for their problems, it is more helpful to simply provide them with the care they need.
Health insurance companies recognize that addiction is a legitimate mental health disorder – not a moral failing. If an individual has received a diagnosis of a substance use disorder by a qualified medical professional, they deserve treatment. Substance use disorders can be diagnosed when an individual experiences negative consequences as a result of their drug use, and when they struggle to control their substance abuse on their own despite a desire to do so. Health insurance plans cover addictions to any substance, but some of the most common types of addictions include:
- Adderall Addiction
- Alcohol Addiction
- Cocaine Addiction
- Benzodiazepine Addiction
- Ambien Addiction
- Ativan Addiction
- Amphetamine Addiction
- Codeine Addiction
- Fentanyl Addiction
- Clonazepam Addiction
- Crack Addiction
- Hydrocodone Addiction
- Heroin Addiction
- DMT Addiction
- Marijuana Addiction
What Do Private or Employer-Subsidized Plans Cover?
Private or employer-subsidized plans do not necessarily guarantee full coverage. When it comes to addiction treatment, health insurance plans never offer an absolute “yes or no.” Instead, each specific health plan offers a specific set of benefits, often with certain stipulations. Coverage stipulations can include:
- The plan may require patients to use only in-network rehabs and doctors
- Longer periods of treatment can change coverage
- Medical detox may not be covered
- If a patient has attended rehab before, their coverage may be affected
- The health insurance plan may recommend a specific type of treatment
Fortunately, most rehab facilities employ professionals who make it their mission to determine what a patient’s health insurance policy will or will not cover. Sometimes patients struggle to find out what their plans will provide. This is especially true for people who are suffering from addiction and do not have the clearest heads. Rehab programs for addiction aim to support patients as they navigate the often confusing world of health insurance. This is why the best way to determine what benefits you’re covered for is to contact a rehab facility directly.
How Does Addiction Treatment Work Under the Affordable Care Act?
The Affordable Care Act guarantees that addiction treatment will be just as comprehensive as other medical treatments. The ACA makes sure that mental health and addiction treatment is prioritized just as much as any other physical health condition. Addiction cannot be classified as a pre-existing condition, so health insurance plans cannot deny people care based on their addiction. ACA coverage includes but is not limited to the following:
- Medications for addiction
- Drug and alcohol testing
- Clinic visits
- Family counseling
- Home health visits
- Medications for lessening or curbing cravings
The Affordable Care Act also helps patients who are experiencing dangerous and debilitating withdrawal symptoms enroll in medical detox programs. Many states also provide their own health insurance programs. This means that individuals can choose between state and federal medical plans. State plans vary in terms of who qualifies for Medicaid and Medicare, which are based on age, income, and household size. People who are not covered by Medicaid and Medicare are free to purchase an ACA plan on the health insurance marketplace. In many cases, people who have low incomes can qualify for subsidies that reduce the cost of premiums, deductibles, co-payments, and other addiction treatment expenses.
Can I Get Addiction Treatment Without Insurance?
The number of people in the United States who have health insurance plans has dramatically increased since the passing of the Affordable Care Act, but there are still countless people who are not covered by any health insurance plan. Fortunately, there are other options available for these individuals. Free rehabs exist that are run by or subsidized by charitable organizations. Many addiction rehabs are also willing to negotiate payment plans for individuals who prefer to pay for their treatment out of pocket.
In some cases, people who are paying for addiction treatment out of pocket need financial help. They can do so by negotiating a payment plan with their rehab sometimes, but there are plenty of other resources available. Taking out a personal loan or crowdfunding treatment fees are both common options. More often than not, close friends, loved ones, and family members are willing to lend a helping hand. They are likely eager to see their addicted loved one achieve sobriety, and helping them get treatment is a sound investment.
If you are not covered by insurance and are confused about how to pay for your addiction treatment, reach out to a rehab that seems to fit your needs. They will likely either be able to help you figure out your options so that you can attend their treatment program, or they can put you to a rehab that is more feasible for you.
What Kind of Addiction Treatment Does Health Insurance Cover?
Addiction treatment covers many different levels of severity. The two most common types of rehab programs covered by insurance plans are inpatient rehabs and outpatient rehabs. Inpatient rehabs provide acute care for finite periods of time, and they require participants to live on the premises. Outpatient care also provides high quality evidence-based care, but it is more flexible because clients can live in their own homes and attend their treatment program at more convenient hours. Outpatient programs are less expensive because clients are not paying for their lodging. While some people do need to attend inpatient rehab for a period of time, most people benefit from transitioning to outpatient treatment immediately afterwards. Outpatient treatment is also just as effective as a first line treatment for addiction. For these reasons, health insurance plans often cover a wider variety of outpatient rehabs.
Outpatient treatment programs are categorized by the level of care they provide. Health insurance plans often cover people as they transition from one level of care to another. This allows clients to develop stronger foundations for their sobriety as they rebuild their lives. As clients progress through multiple levels of outpatient care, their programs become increasingly more flexible.
Outpatient rehabs that are covered by health insurance include:
- Partial hospitalization programs (PHPs). Partial hospitalization programs are designed to meet the needs of people with severe addictions that have completely incapacitated them. PHPs employ physicians and other medical professionals who can treat physical and mental ailments, address withdrawal symptoms, and handle other crises as they arise. Partial hospitalization programs generally meet multiple days a week for a significant portion of the day. Health insurance companies cover partial hospitalization programs as a first line treatment for addiction, and they are also often willing to pay for PHP treatment as a transitional program after an individual has graduated from residential treatment.
- Intensive outpatient programs (IOPs). Intensive outpatient programs are the second highest level of care offered by outpatient rehabs. They are designed to meet the needs of people whose addictions have made it difficult for them to function in everyday life. These programs use a wide variety of evidence-based therapies to help clients develop new coping skills and address underlying issues. IOPs meet a few times a week for a few hours each day. Health insurance companies will often cover an intensive outpatient program even after a person has graduated from a more acute level of care.
- Outpatient programs (OPs). Outpatient programs are standard rehab programs that generally meet one day a week for one to two hours. These programs are designed to support people who suffer from addiction but have some degree of functionality in their lives. They are also ideal for those who have graduated from PHPs or IOPs and are looking for continued support as they expand their lives in the outside world. Health insurance plans are often willing to pay for outpatient programs for extended periods of time.
- Aftercare services. Outpatient rehabs help clients develop long term plans for their lives after rehab. Aftercare services, which include 12-step meetings, support groups, and outpatient therapy, help people maintain their sobriety for the years and decades after finishing a formal treatment program. The elements of aftercare treatment are often cost-free, but should a need arise, healthcare companies are generally willing to pay for elements of a person’s aftercare plan.
Does Health Insurance Cover Comorbid Mental Health Conditions?
According to the National Institute on Drug Abuse, approximately half of all people with addictions experience a mental health disorder at some point, and vice versa. Mental illness and addiction are so intertwined that it can be impossible to treat one without treating the other as well.
The Affordable Care Act not only requires health insurance companies to cover addiction treatment, the legislation also guarantees that people with mental health conditions get the same level of care as they would normally get for a physical ailment. This policy, which is known as parity, means that if a visit to a doctor for a cold costs a patient 20$, then visiting a doctor about depression must also cost $20. Parity laws apply to all kinds of health insurance plans, including employer-based health insurance plans, Medicaid and CHIP, and plans bought through health care exchanges.
One of the most common questions is whether or not a specific mental health disorder will be covered. Parity laws don’t specify exactly which types of mental health conditions plans must cover. As with drug addiction, however, it is simply not efficient for health insurance companies to make fine distinctions. Rather than specifying which conditions are covered and which are not covered, plan administrators generally provide blanket coverage. While it is generally best to discuss the specifics of your case with your plan administrator, any diagnosed mental health issue is almost guaranteed to be covered.
Health insurance companies also recognize that many people who need addiction treatment are dual diagnosis. The term dual diagnosis refers to clients who have been diagnosed with a substance use disorder as well as one or more additional mental health disorders. Covering treatment for comorbid conditions is in the best interests of the client, but it is also in the best interests of the insurance company. If a mental health disorder is left untreated, it can easily cause a client to relapse and return to substance abuse. This means they will need to return to treatment again — costing the health insurance company more money. For clients with comorbid conditions, health insurance companies strive to treat both conditions simultaneously.
Comprehensive treatment for comorbid mental health conditions is offered by many outpatient rehabs for addiction. It is known as integrated treatment. When outpatient rehabs offer integrated treatment, they provide dual diagnosis clients with evidence-based behavioral therapies to address both their addictions and their mental health conditions. In many cases, they also prescribe medications to alleviate the symptoms of one or more of these conditions as well.
Are Treatment Medications Covered By Health Insurance?
During addiction treatment, it is often necessary for some clients to take medications. For dual diagnosis clients, medications can help alleviate the symptoms of an underlying mental health condition. However, medications are often useful for directly treating a substance use disorder as well. Certain medications can alleviate the withdrawal symptoms for many drugs. They can also reduce the extent of the cravings people experience when they stop taking their substance of choice. When these medications are recommended by a physician or rehab, health insurance companies typically do cover the cost.
While a person is enrolled in a rehab program, these medications are generally prescribed in the context of a medication-assisted treatment plan. Medication-assisted treatment is a form of addiction treatment that combines elements of behavioral therapy with medications. The medications make it easier for people to stay physically abstinent, and they also reduce distracting cravings and withdrawal symptoms. This makes it easier for clients to benefit from behavioral therapy and develop a strong foundation of sober tools. Most health insurance companies cover medication-assisted treatment, because it is effective and because medications, while expensive, are often less costly than therapy.
Medications are most commonly prescribed to help people withdraw from alcohol and opioids.
Opioid dependency medications include:
These drugs do not cure opioid use disorder, but they can be safely used for years to prevent people from returning to opioid abuse. These medications are, in fact, opioids — but they are opioid antagonists, which means their main effect is to prevent recreational opioids from activating opioid receptors in the brain. This reduces cravings and mitigates withdrawal symptoms. Over time, many clients taper off of opioid dependency medications under medical supervision.
Alcohol use disorder medications include:
These drugs do not cure alcohol use disorder, but they reduce the impact of alcohol abuse and they help people reduce their intake of alcohol. These drugs are most effective for people who are participating in a medication-assisted treatment program at an outpatient rehab.
Find Outpatient Treatment Covered By Insurance Near Me
If you or a loved one is suffering from a substance use disorder, it is important to get treatment as soon as possible. Many people are reluctant to seek addiction treatment, because they are under the impression that they must be “strong” and manage their substance abuse on their own. Others feel intense shame around their substance use disorder — or around the idea of asking for help. It is important to recognize that substance use disorders are not personal failings; they are legitimate mental health disorders that are covered by health insurance plans. While there are many reasons why people are sometimes reluctant to get help, finances should not be one of them.
Given the number of rehab programs in the United States, and in Southern California in particular, it is important to choose one that meets your unique needs. NuView Treatment Center, located in West Los Angeles, is an outpatient rehab that offers all levels of care, including acute care in our partial hospitalization programs (PHPs) and intensive outpatient programs (IOPs) and more flexible care in our outpatient programs (OPs) and aftercare planning. At NuView Treatment Center, we believe that there is no one-size-fits-all approach to addiction treatment. We provide clients with individualized treatment plans that are designed to address their personal history and circumstances.
At NuView Treatment Center, our highly qualified and compassionate staff make use of the latest evidence-based treatment modalities. Our services include:
- In-depth addiction assessments
- Cognitive-behavioral therapy
- Dialectical-behavioral therapy
- Group therapy
- Mindfulness-based therapy and other holistic therapies
- Dual diagnosis treatment
- Medication-assisted treatment (MAT)
- Progress assessments
- Substance abuse counseling
- Drug and alcohol education
- Drug screening
- Court-ordered/DUI rehab
- Telemedicine for addiction
- Relapse prevention
- Life skills training
Recovery from addiction and comorbid mental health disorders is possible at NuView Treatment Center. Our treatment programs are also covered by most health insurance plans. Health insurance companies that cover addiction treatment at NuView Treatment Center include:
- Blue Cross Blue Shield
- Horizon Blue Cross Blue Shield
- Ameriben Solutions
- Asuris Northwest
- IU Health Plans
- Nippon Life Benefits
- Sharp Usable Administrators
- Sanford Health Plan
- Quartz Health Solutions
- Prominence Health Plan
- Presbyterian Health Plan
- Optima Health
- And many more…
If you are ready to change your life and escape the vicious cycle of addiction, contact NuView Treatment Center today. Even if you are unsure if you are covered by your health insurance plan, our staff can help you navigate your coverage options and benefits.