Does health insurance cover drug rehabilitation?
- The Cost of Rehab vs. The Cost of Addiction Health insurance typically covers substance abuse rehabilitation and various forms of mental health treatment.
- 1 Does hospital cover include rehab?
- 2 Is addiction considered a pre existing condition?
- 3 Can you get life insurance if you have been to rehab?
- 4 What does inpatient rehab mean?
- 5 What happens if I don’t have private hospital cover?
- 6 What percentage does health insurance cover?
- 7 Why do insurance companies not cover mental health?
- 8 Is therapy covered by insurance?
- 9 How do you get life insurance when you have been denied?
- 10 Does life insurance Cover overdose death?
- 11 What if someone dies right after getting life insurance?
- 12 What is the 60 rule in rehab?
- 13 Do you stay overnight in rehab?
- 14 How do you know if you need inpatient treatment?
- 15 SAMHSA’s National Helpline
- 16 Paying For Rehab With The Affordable Care Act
- 17 What Is The Affordable Care Act (ACA)?
- 17.1 What Affordable Health Care Medical Insurance Covers
- 17.2 Percentage Of Addiction Expenses Covered By Obamacare
- 17.3 Who Is Eligible For Coverage?
- 17.4 Looking for a place to start?
- 17.5 How Does The Affordable Care Act Broaden Treatment?
- 17.6 Who Accepts Affordable Care Act Plans?
- 17.7 Finding A Rehab Center
- 18 How to Get Insurance to Pay for Drug Rehab
- 19 Asking Your Insurance Provider
- 20 How to Get Insurance to Pay for Drug Rehab?
- 21 Getting Health Insurance that Covers Drug Rehab
- 22 How to Get the Best Drug Rehab Insurance for Your Money
- 23 What Type of Insurance Should You Get?
- 24 At The Recovery Village, You’re covered
- 25 Blue Cross Blue Shield Insurance Coverage for Drug and Alcohol Rehab
- 26 Blue Cross Blue Shield HMO and PPO Plans
- 27 What Will Blue Cross Blue Shield cover?
- 28 How Long Does Blue Cross Blue Shield Insurance Cover Rehab Program?
- 29 Blue Cross Blue ShieldIn-Network vs. Out-of-Network Rehab Centers
- 30 How To Check Your Blue Cross Blue Shield Rehab Coverage?
- 31 Frequently Asked Questions
- 32 What is Medicare?
- 33 Utilizing the Affordable Care Act
- 34 What are the Benefits of State-Funded Programs?
- 35 Find Strength in Support Groups
- 36 Call a Helpline for Information
- 37 Alcohol Rehab Insurance Coverage for Addiction Treatment
- 38 How to Find Insurance Plans Accepted by Rehabs
- 39 Find Rehabs That Accept Insurance
- 40 Is Addiction Considered a Pre-existing Condition?
- 41 Can I Go to Rehab Without Insurance?
- 42 Medicare for Alcoholism: Is It Covered?
- 43 Medicaid for Alcoholism: Is It Covered?
- 44 What Are Out-of-Pocket Expenses For Rehab Treatment?
- 45 How to Use Insurance to Pay for Alcohol Rehab
- 46 Ready for Rehab? Take Our Alcohol Addiction Assessment
- 47 Sources
Does hospital cover include rehab?
Outpatient services are not covered by private health insurance hospital cover, so if you wish to be covered for psychiatric treatments or rehabilitation without being admitted to hospital, you will need to take out private health insurance extras (ancillary) cover that includes these treatments.
Is addiction considered a pre existing condition?
Under the ACA, addiction is no longer considered a pre-existing condition for insurance purposes.
Can you get life insurance if you have been to rehab?
If you’ve previously been to rehab or are still getting clean, you may have to wait to apply for a life insurance policy until that part of your life is far enough in the past that you will qualify for coverage.
What does inpatient rehab mean?
Inpatient rehabilitation generally refers to physician and therapy services you receive during a stay in a hospital. Outpatient rehabilitation refers to services you receive when you are not admitted to the hospital, such as physician services and physical, occupational, and speech therapy.
What happens if I don’t have private hospital cover?
If you don’t have private cover, then as your income grows over time, the amount you pay to the Government in extra taxes increases so fast that getting private cover can become cheaper than paying that tax surcharge. But choosing the right plan at the right cost is not simple.
What percentage does health insurance cover?
Between 2018 and 2020, the rate of public health insurance coverage increased by 0.4 percentage points to 34.8 percent.
Why do insurance companies not cover mental health?
A couple of reasons: One, there are shortages of mental health professionals in general, and particularly in certain parts of the country. Two, many mental health and substance use providers do not accept insurance because they do not get paid enough by insurance companies for their services.
Is therapy covered by insurance?
Therapy, one of the common treatments for mental illnesses costs about Rs 1,500-2,000 per session and is excluded from medical insurance policies. Currently, almost all insurance companies exclude treatment for mental illnesses from health insurance.
How do you get life insurance when you have been denied?
Getting Coverage After Being Denied Life Insurance
- Work with a licensed insurance agent.
- Apply with a different insurer.
- Look into a workplace life insurance plan.
- Try again later.
- Consider a different life insurance policy.
Does life insurance Cover overdose death?
Your life insurance policy will pay out death benefits to your beneficiaries if you die from a motor vehicle accident, drowning, poisoning, accidental drug overdose, or another tragedy.
What if someone dies right after getting life insurance?
If a life insurance policy is in force, the beneficiaries named in the policy should receive the full amount of the death benefit (minus any loans against the policy), regardless of how long the policy existed before the insured person died. If the policy is new, there won’t be any accumulated savings.
What is the 60 rule in rehab?
The 60% Rule is a Medicare facility criterion that requires each IRF to discharge at least 60 percent of its patients with one of 13 qualifying conditions.
Do you stay overnight in rehab?
Sleeping in is not part of the program, so expect to rise early in the morning to enjoy a healthy breakfast. Some programs offer morning classes such as yoga or meditation to help you begin the day in a relaxed state of mind.
How do you know if you need inpatient treatment?
5 Signs That You May Need Inpatient Treatment For Depression
- Persistent sadness or anxiety.
- Feelings of hopelessness or pessimism.
- Feelings of guilt and worthlessness.
- Loss of pleasure.
- Restlessness or irritability.
- Significant sleep changes.
- Significant appetite changes.
SAMHSA’s National Helpline
- What Is Substance Abuse Treatment and How Does It Work? A Booklet for Children and Their Families This program was developed for family members of those who suffer from alcoholism or drug addiction difficulties. Questions regarding substance abuse, including its symptoms, different forms of therapy, and rehabilitation are addressed in this section. This publication addresses the issues of children whose parents have drug misuse or addiction disorders. Addiction to alcohol and drugs may occur in even the most loving of families. This book describes how alcohol and drug addiction have an impact on the entire family. He describes the process of drug and alcohol addiction therapy, how family interventions may be a first step toward recovery, and how to assist children in homes afflicted by alcoholism and drug misuse. It’s Not Your Fault (National Association of Colleges and Employers) (PDF | 12 KB) Assures kids who have parents who misuse alcohol or drugs that “It’s not your fault!” and that they are not alone in their struggles with substance addiction. A resource list is provided, which encourages kids to seek emotional assistance from other adults, school counselors, and youth support organizations such as Alateen, among other places. It Hurts So Much: It Doesn’t Have to Be This Way The organization provides information on alcohol and drug addiction to youngsters whose parents or friends’ parents may be struggling with substance misuse issues. The author encourages young people to look out for one another by talking about their problems and joining support organizations such as Alateen. When There Has Been an Attempt: A Guide to Taking Care of a Family Member Once you have received treatment in the emergency department, Aids family members in dealing with the aftermath of a relative’s suicide attempt by providing information and resources. Provides an overview of the emergency department treatment procedure, a list of questions to ask regarding follow-up care, and information on how to limit risk and maintain safety while at home. Family therapy can be beneficial for people who are recovering from mental illness or substance abuse. This course examines the function of family therapy in the treatment of mental illness and substance misuse. A family therapy session is described in detail, along with the people that conduct them. It also includes information on the usefulness of family therapy in the rehabilitation process. Please visit the SAMHSA Store for further resources.
Paying For Rehab With The Affordable Care Act
Several choices are available under the Affordable Care Act, popularly known as “Obamacare,” to assist with paying for addiction treatment.
What Is The Affordable Care Act (ACA)?
The Patient Protection and Affordable Care Act (ACA) is a health-care-system law implemented in 2010 that covers addiction treatment, and it is becoming an increasingly popular method of paying for drug and alcohol rehabilitation. Addiction treatment may be covered under the ACA, which might reduce the cost of your treatment. Addiction is no longer considered a pre-existing illness for the purposes of insurance under the Affordable Care Act. The Affordable Care Act (ACA) sponsors insurance policies that are available for purchase through an online platform known as the Health Insurance Marketplace.
Because of need-based tax incentives, many Affordable Care Act plans are less expensive for customers.
The pricing and restrictions for Medicare and Medicaid coverage are distinct from those for medical insurance plans purchased via the Marketplace.
What Affordable Health Care Medical Insurance Covers
According to the Affordable Care Act, addiction treatment must be covered in the same way that any other medical service is. Some of the benefits you may have from these insurance policies are as follows:
- Home visitation for addiction screening and brief intervention, as well as addiction treatment medications. Clinic visits, as well as alcohol and drug tests, are also available.
In addition to outpatient therapies such as medical detox programs, ACA health insurance policies include inpatient services as well. A number of states have their own Health Insurance Marketplaces that are different from Healthcare gov’s platform. In each state, there are differences in Medicare and Medicaid coverage, which determines the differences between state and federal medical programs.
Break free from addiction.
You have a number of possibilities. Today is a good day to discuss them with a treatment provider. (855) 826-4464 (toll-free)
Percentage Of Addiction Expenses Covered By Obamacare
Anyone looking for medical insurance can enroll in a health plan authorized under the Affordable Care Act. The five types of Health Insurance Marketplace plans that are now available are as follows:
- Plans are divided into four categories: Bronze plans provide 60 percent expense coverage, Silver plans provide 70 percent expense coverage, Gold plans provide 80 percent expense coverage, and Platinum plans provide 90 percent expense coverage. Catastrophic plans provide 60 percent total average cost coverage.
*This option is only available to people under the age of 30 or those who have special circumstances.
Who Is Eligible For Coverage?
The Affordable Care Act (ACA) tax credits are available to Americans with incomes ranging between the federal poverty level (FPL) and four times the federal poverty level (FPL). The FPL varies depending on the size of the household. The following figures, taken from the Medicaid government website, show the extent of federal poverty in 2015:
|ACA Income Eligibility|
|Family Size||Max. Annual Income|
Silver Plan members who earn less than 2.5 times the federal poverty threshold are eligible for “cost-sharing” assistance. For example, a single person earning $29,425 or less per year would be eligible; a two-income household earning $39,825 or less per year would also be eligible.
These cost-sharing strategies help customers save money by lowering their deductibles, co-payments, insurance premiums, and other out-of-pocket expenditures.
Looking for a place to start?
Contacting a treatment provider is completely free of charge right now. Make a phone call to (855) 826-4464 or click here.
How Does The Affordable Care Act Broaden Treatment?
The Affordable Care Act lowers the cost of addiction treatment, expands treatment alternatives, and transfers many of the benefits of employer-sponsored health policies to individual medical insurance coverage. The Affordable Care Act also permits young individuals under the age of 26 to continue on their parents’ health insurance plan. Addiction treatment is included in these enhanced benefits, even if you have “pre-existing health issues.” Every year, hundreds of new inpatient and outpatient health centers are opened as a result of ACA financing to accommodate the rising demand for treatment.
Affordable Care Act Statistics
11.7million Since February 2015, about 12 million Americans have signed up for health insurance through the Health Insurance Marketplace. 87percent More than 87 percent of those who sign up for health insurance through the Affordable Care Act’s website qualify for financial aid. 32million The Affordable Care Act has provided access to substance abuse treatment for 32 million Americans.
Who Accepts Affordable Care Act Plans?
A large number of addiction treatment facilities accept Health Insurance Marketplace coverage. If you don’t currently have an ACA-sponsored plan, you can apply for one online during the open enrollment periods that are scheduled throughout the year. If you are unable to register during the standard registration period, you may obtain a registration schedule and request a special registration form at Healthcare.gov. A person who is addicted can obtain one of these medical insurance policies by following the steps outlined below:
Logging on to the Website
- In order to begin the process, go to Healthcare.gov and access the Health Insurance Marketplace
Creating an Account
- Create an online account with the Health Insurance Marketplace
Completing Your Application
- Fill out the Marketplace application and look at the health plans that are offered
Once you have been accepted for an Affordable Care Act-sponsored plan, you should consult with an Insurance Marketplace representative to evaluate which health insurance package is best for you and your family. When choosing an Affordable Care Act coverage plan, one of the numerous considerations to consider is whether you want to enroll in an inpatient or outpatient treatment.
Finding A Rehab Center
Recovery from addiction may be a lengthy and tough journey. Choosing the most appropriate recovery program is critical to achieving — and maintaining — sobriety. It is not every program that offers the same treatment options or accepts every insurance plan that is worth considering. If you have insurance, our treatment experts can assist you in determining which treatment facilities accept your plan. Make contact with a treatment provider right away to locate a treatment center.
How to Get Insurance to Pay for Drug Rehab
Most individuals approach addiction and recovery from the perspective that it is something humiliating and perhaps damning. Many people go to great lengths to conceal their addiction and rehab. Unfortunately, this frequently results in such individuals not receiving the assistance they require. If you are able to accept that you have a problem and that you want assistance, paying for rehab should not be a barrier to receiving treatment. So, here are some pointers on how to acquire insurance to cover the cost of drug rehabilitation.
- If you are hooked to drugs or alcohol, you are putting yourself in danger.
- In order to maximize their profits, insurance companies should cover at least a portion of your drug rehab expenses.
- It’s also needed by law for as long as the Affordable Care Act is in effect, which is for the foreseeable future.
- Your best course of action is to contact your insurance provider to explore your alternatives; however, you may be able to do so with the assistance of your selected rehabilitation center as an alternative.
- You may reach us via phone, chat, or fill out a form.
- When it comes to drug rehabilitation, what do insurance companies cover?
- What is covered in this situation will vary depending on your treatment facility and your insurance coverage.
Basic health insurance policies will provide far less coverage and may only cover specific forms of rehabilitation treatment.
In many circumstances, you will be required to pay copays and deductibles, which will vary based on your insurance plan.
Because it is occasionally medically required, most insurance companies will pay at least a portion of the costs associated with this procedure.
It typically consists of a detox period followed by behavioral therapy and counseling in a residential setting.
Outpatient Care–Outpatient care is a series of appointments with therapists and counselors that take place after you have completed a treatment program in your home or a sober living setting.
The majority of insurance companies will cover at least a portion of outpatient care.
Even though most insurance companies will not cover every aspect of your care, they will cover a significant portion of it, which will significantly reduce the financial stress associated with receiving medical treatment.
Here, you may also get individual coverage for:
- Services including as screening, intervention, detoxification and detox medicine, inpatient and outpatient care, individual and group counseling, therapy, and recovery maintenance are all available.
Additionally, your insurance coverage will differ depending on whether your insurer is a Health Maintenance Organization (HMO) or a Preferred Provider Organization (PPO) (PPO). When you obtain treatment or care through an HMO, your main physician must refer you to the facility, but a PPO does not need this. Both companies exclusively deal with a restricted number of service providers.
Asking Your Insurance Provider
In most circumstances, you may simply phone your insurance carrier and inquire about what they cover, why they cover it, and where they cover it. You should be prepared to reveal the sort of therapy you’re seeking, as well as any rehabilitation clinics you’re considering, and you should have a list of questions prepared in advance of your appointment.
Some good questions to ask include:
- What kind of rehabilitation facilities do you cover in my region
- Do you have a list of particular rehabilitation institutions that you cover in my area
- Do you cover a certain rehabilitation center
- Which treatments are covered by my insurance plan and for how many days
- What proportion of my treatment costs is covered by my insurance plan
- What forms of therapy are covered under this plan? Therapy? Counseling? Therapy for the whole family
- What kind of medical coverage do you have? Is detox covered by my insurance policy? What is the amount of my copay and deductible?
Your representative will most likely be able to lead you through the responses, which will give you a fair indication of the forms of therapy that are supported by the organization in general. If you inquire, your insurance company will most likely also assist you in locating a list of rehabilitation centers that are covered by your policy in your region.
How to Get Insurance to Pay for Drug Rehab?
Despite the fact that you cannot force your insurance provider to pay for drug rehabilitation, you may present some compelling arguments in support of doing so. In the majority of circumstances, this implies that you will have to obtain insurance or preapproval for treatment, and then appeal the decision if your insurer denies your request.
- Examine the regulations and procedures outlined in your insurance policy. Follow their instructions to the letter
- Consult with your doctor about your treatment choices. Request a written letter from your doctor outlining why you require therapy and what the potential costs to your health will be if you do not receive it. Request a formal recommendation from your doctor for you to be admitted to a rehabilitation center. Keep all written correspondence to a minimum.
It’s also vital to read your contract carefully to learn about any exclusions that may be contained within your policy before filing an appeal. For example, if you are entering rehab for the first time, your insurance company may not pay the cost of your therapy. Some individual states additionally permit private insurers to restrict reimbursement for events in which the individual was under the influence at the time of seeking treatment or in which their drug usage contributed to the need for emergency care for themselves or others in need of treatment.
Getting Health Insurance that Covers Drug Rehab
Insurance companies are no longer allowed to legally reject you coverage because you have a pre-existing condition under the Affordable Care Act (ACA). You may now apply for and obtain an insurance coverage that will cover the cost of drug treatment while you are suffering from an addiction to prescription drugs. It is possible that you may need to go through this process rather than just attending rehab under your existing insurance coverage; nonetheless, this is an alternative if you are unable to attend treatment under your existing health policy.
The Mental Health Parity and Addiction Equity Act of 2008 requires companies with 50 or more employees to provide coverage for substance abuse and mental health as part of their insurance plans as a condition of employment.
Despite the fact that most providers do not market drug misuse insurance coverage, organizations like as Blue Cross Blue Shield, Humana, Aetna, UMR, Vela Point, Beacon Health, United Healthcare, GHI, BCBS, and others are accepted by a large number of rehabilitation centers.
Insurance companies are required by law to cover at least a portion of your drug rehab costs, so you should be able to apply for and receive coverage unless your specific situation is not covered or your insurer has a specific clause in its policy that prohibits them from providing coverage in the first place.
You should also get in touch with the provider to find out what they cover, when they cover it, and how they cover it so that you can make the best possible choice of treatment facility.
For more information, please call Beginnings TreatmentCenters immediately and talk with one of our knowledgeable and experienced intake advisers. We are happy to assist you with any inquiries you may have. There is assistance available right now. pay for drug rehabilitation
How to Get the Best Drug Rehab Insurance for Your Money
Let’s be honest: drug and alcohol rehabilitation is not a low-cost endeavor. Fortunately, adequate insurance may go a long way toward paying such expenses. However, getting the correct insurance that delivers the coverage you want (at the price you require!) may be a difficult task in and of itself. As a result, we’ll be discussing the finest sorts of rehab insurance to help you get into the best drug treatment possible today. Insuring for drug treatment should have the following features:
Find Out If Your Insurance Covers Rehab Now
When it comes to drug rehabilitation, there are a variety of charges to consider. Every insurance plan is unique, and some may only cover a fraction of these expenses. In this section, we will go over how to acquire insurance to pay for therapy as well as everything you need to know about rehab insurance coverage.
Before you can begin treatment, you’ll need to detoxify your body from the chemical that caused your addiction. Because many drugs have highly severe withdrawal periods, it is common practice to provide these treatments in a hospital setting.
A range of treatment options are available, ranging from outpatient care, in which you visit the doctor a few days a week, to inpatient programs, in which you reside in a treatment facility for the duration of your therapy. Depending on the quality of care you receive, the prices might range from $1,000 to more than $25,000 each year. The majority of insurance policies support outpatient therapy, however they handle inpatient programs and hospitalization on a different basis.
In order to combat withdrawal symptoms and drug cravings throughout detox and treatment, you may require one or multiple prescription drugs at this time. The term “pharmacotherapy” is commonly used to describe the treatment of various sorts of pharmaceuticals when it comes to insurance. Not all insurance plans will cover prescriptions, but coverage is the best case scenario.
What Type of Insurance Should You Get?
Making certain that you have the appropriate insurance might help ensure that you get into the best drug rehab. Insurance may be divided into two major categories: private insurance and public insurance. Private insurance is a type of insurance that is purchased by individuals. It is possible to obtain private insurance by purchasing it yourself or via your place of employment. You are accountable for the entire cost or a portion of it. When it comes to coverage, most public insurance plans include the same basic ” essential health benefits ” as defined by the Affordable Care Act.
These benefits include mental health and substance abuse therapy, as well as prescription drugs.The following is a brief review of the most common forms of health insurance, as well as the overall advantages and disadvantages of each type of coverage:
Private insurance can be purchased on an individual basis or as part of a group plan, such as one that you might enroll in via your place of employment.
It is often more expensive than public health care, but it frequently provides the most comprehensive rehab insurance coverage for the money spent.
- What does it cover and how much does it cost? Individual and small group health insurance policies are required to provide coverage for the essential health benefits under the Affordable Care Act (see above). However, “grandfathered health plans,” which are insurance policies that were in effect before March 23, 2010, may be exempt from this requirement. Grandfathered health plans are not particularly prevalent, however they can be found in some group insurance policies on rare occasions.
Many insurance plans work in conjunction with specific health-care providers who are part of a network. Managed care is the term used to describe this arrangement. Managed care programs may be divided into three categories:
- Health maintenance organizations (HMOs) often only cover treatment received from providers who are members of their network. Additionally, they tend to be more economical as a result of this
- Preferred provider organizations (PPOs) prioritize in-network providers, however they may still pay certain expenses associated with out-of-network providers. If you want to see a health-care provider who is not in your insurance network, you may be required to pay up front and then seek reimbursement from your insurance company thereafter. Point of service implies that you can use an HMO or PPO every time you want medical attention. This is the most adaptable strategy
Public Insurance: Medicare
Medicare is a government-sponsored health insurance program for adults over the age of 65, as well as for those people under the age of 65 who have impairments. Prices vary per plan, but are often less expensive than other types of insurance coverage available.
- What does it cover and how much does it cost? Prescription medicine is covered under Part D. Coverage is separated into three parts: Part A provides inpatient treatment, Part B covers outpatient care, and Part D covers prescription medication. Because Part D is an optional benefit, you may elect to forego pharmaceutical coverage.
Public Insurance: Medicaid
Medicaid is a government-sponsored health insurance program for low-income families.
- What does it cover and how much does it cost? The Department of Health and Human Services (HHS) states that Medicaid must include the same essential health benefits as the Affordable Care Act. Medicaid, on the other hand, differs from state to state, and as a result, the types and amounts of coverage may differ.
At The Recovery Village, You’re covered
When looking for insurance-covered treatment centers, please get in touch with us at The Recovery Village ® so that we can go through your alternatives with you. We accept most major insurance plans and will work directly with your insurance carrier to ensure that you receive the greatest possible coverage for your treatment. More information about our admissions procedure may be found here.
Blue Cross Blue Shield Insurance Coverage for Drug and Alcohol Rehab
There are a variety of elements that influence the drug treatment coverage given by a Blue Cross Blue Shield (BCBS) plan. Among these considerations are the state in which you reside, the sort of BCBS insurance plan you have, and your individual drug misuse treatment requirements. If detoxification treatments are required for drugs such as opiates, alcohol, or benzodiazepines, a portion or the entire cost may be paid if it is found to be medically necessary by a physician. 1 (in the section labeled “Does Blue Cross Blue Shield Cover Mental Health/Substance Abuse Treatment?
Some Blue Cross Blue Shield insurance plans may also cover relapse prevention services and drug education programs, according to the fourth paragraph under “Using Blue Cross Insurance to Find and Cover Rehab.” Using Blue Cross Insurance to Find and Cover Rehab (fourth paragraph under “Using Blue Cross Insurance to Find and Cover Rehab”) Some programs, on the other hand, may impose a lifetime restriction on the use of drug rehabilitation treatments.
- 2 (top of page)In the United States, one in every three people is covered by a BCBS insurance plan, whether it is for an individual or a family.
- 1 (top of page)The government BCBS plan provides coverage to more than 5 million federal workers, retired federal employees, and their spouses, as well as their dependents.
- 2 (top of page)BCBS plans are available in a variety of tiers, each with its own set of monthly premiums and deductibles to choose from.
In the following table, you will find a breakdown of the various insurance plan levels offered by BCBS: 3 Apart from the type of coverage selected, the monthly premium and plan deductible you pay under BCBS are also influenced by whether you select a Health Maintenance Organization (HMO) plan or a Preferred Provider Organization (PPO) plan.
Blue Cross Blue Shield HMO and PPO Plans
HMO and PPO plans are both available through BCBS. You can choose a main care physician (PCP) who will refer you to other doctors, hospitals, and specialist clinics within your network as required. An HMO plan lets you to pick a primary care physician (PCP). 4 HMO plans often have cheaper monthly rates but higher deductibles than other types of health insurance. 4 With a PPO plan, you will not be required to select a primary care physician (PCP) and you will not be restricted to a certain network.
PPO plans often have higher monthly rates but lower deductibles than other types of insurance.
Do Treatment Centers Need to Be In-Network with Blue Cross Blue Shield?
The Blue Distinction Center for Substance Use Treatment and Recovery, which was just established by BCBS, is a new program. 5You or a loved one may now access a database of nationally recognized and evidence-based drug rehabilitation facilities in one convenient location. 5Confirm your insurance coverage before deciding on a drug rehabilitation facility. Alternatively, you can contact BCBS by dialing the number printed on the back of your insurance card or by visiting the BCBS website. You may also get in touch with the drug rehabilitation clinic directly.
You may learn more about them by visiting their website or by calling and speaking with an Admissions Navigator.
What Will Blue Cross Blue Shield cover?
In certain cases, BCBS may pay for a percentage or the full cost of drug treatment, depending on your unique plan. The degrees of rehabilitation care are as follows: 6
- The period of therapy, which can last anything from a few weeks to several months, is usually spent at an inpatient or residential rehab center where you or a loved one lives. You will get medical treatment 24 hours a day, seven days a week from medical specialists, as well as participate in individual and group counseling. This sort of treatment is most appropriate for people who do not have the necessary assistance at home, or for those who require continuous monitoring. Outpatient rehab – Outpatient rehab programs allow patients to continue living at home while attending a few sessions each week at an outpatient facility. Group therapy is the primary emphasis of outpatient rehabilitation. It is intended for people who do not have a serious addiction and/or do not have strong family support at home. Outpatient treatment programs that are more organized than a typical outpatient program, but less rigorous than an inpatient facility are referred to as intensive outpatient programs (IOPs) or intensive outpatient treatment programs (IOPs). While it is not necessary to live at the treatment center, it is necessary to make more regular trips to the institution (at least 9 hours a week). IOPs also include medical personnel such as physicians, nurses, therapists, psychologists, and social workers who provide treatment to the patients. The term “participatory hospitalization program” (PHP) refers to an additional kind of outpatient therapy for persons who require more monitoring than a typical outpatient program can provide, but who do not require as much supervision as an inpatient program can provide. This sort of therapy is often carried out in a hospital environment and necessitates roughly 20 hours of weekly treatment. Additionally, medication-assisted therapy may be used to alleviate withdrawal symptoms. It involves both individual and group counseling.
Does Blue Cross Blue Shield Insurance Cover Mental Health Care?
In accordance with the Affordable Care Act, all insurance plans must include coverage for behavioral health care, which includes treatment for mental illness and drug misuse concerns. Whether you are searching for a heroin drug rehab center or a treatment program that tackles a co-occurring problem, which implies that someone has both mental health and substance abuse difficulties that occur at the same time, you must have some form of insurance coverage. 1 (third paragraph) For people who seek to address both the mental health issue and the drug misuse issue at the same time, treatment that addresses both the mental health issue and the substance abuse issue is not only useful, but it is also required.
1 (See “Benefits of Integrated Treatment” for further information.) Individual therapy and other therapies for persons with co-occurring disorders are covered by a large number of BCBS insurance policies.
It is possible that you or a loved one will have to pay some charges, such as a copayment or the remaining balance of the plan’s deductible, even if you have BCBS insurance plan mental health coverage.
How Long Does Blue Cross Blue Shield Insurance Cover Rehab Program?
In the case of BCBS insurance, or any other insurer, there is no time limit on how long it will pay drug treatment services. This is due to the fact that numerous factors influence coverage, including the specifications of the specific plan, the drug rehab facility selected, and the individual’s treatment requirements. But according to the results of certain studies, those who stay in treatment for three months or more are more likely to have favorable treatment outcomes (ie., abstinence from drugs and/or alcohol) than those who leave treatment sooner.
By calling the drug treatment facility directly, you may also find out if your insurance is accepted.
What if My Blue Cross Blue Shield Policy Does Not Cover Alcohol and Drug Rehab Centers?
If your BCBS coverage does not cover heroin treatment or drug rehab, you can pay with cash or a credit card if you do not have insurance. Payment options and scholarships are also available at certain drug rehabilitation programs if full payment is not doable up front. You or your loved one may also want to look into charitable organizations and grants that may be able to aid with the cost of drug recovery programs. You or a loved one should not be prevented from obtaining early drug rehab treatment because of a lack of funds.
Blue Cross Blue ShieldIn-Network vs. Out-of-Network Rehab Centers
With a vast network of providers, BCBS insurance is easily accessible. In-network providers are those who are affiliated with a certain health plan. Providers who are not part of this network are referred to as out-of-network. You or a loved one with a BCBS HMO plan may be needed to acquire a reference from your primary care physician in order to receive drug rehab services, and you may only be able to access drug rehab services at facilities that are in-network. 4 With a BCBS PPO plan, you may not be required to obtain a reference and may seek treatment at any facility, whether in-network or out-of-network.
You may also get in touch with the drug rehabilitation clinic directly.
How To Check Your Blue Cross Blue Shield Rehab Coverage?
There are a variety of options available for you to determine your or a loved one’s BCBS benefits. You can go to the BCBS insurance papers that you received when you first joined in your insurance plan for further information. It’s also possible to visit their website or get in touch with them directly by contacting the number on the back of your BCBS insurance card. AAC may also check to see whether you are covered for drug addiction treatment under BCBS.
AAC provides a number of options for determining what sort of drug misuse treatment coverage you have via your BCBS plan. Please visit their website and complete the online insurance verification form available on their site. Alternatively, you can contact them at and chat with an admissions guide.
Frequently Asked Questions
Medicaid is the most comprehensive health-insurance program in the United States. 5 In this combined federal and state program, low-income applicants who meet the following criteria are eligible for free or low-cost insurance coverage: 6
- 65 years of age or older
- 19 years of age or younger
- Taking care of a child
Medicaid eligibility has been increased by the Affordable Care Act to accommodate a wider range of groups and income levels, depending on your state. You should reapply for Medicaid if you applied for coverage before to 2010 or in a different state and were denied coverage. The increased coverage that is now available should be taken into consideration. Question:Does Medicaid provide coverage for drug addiction rehabilitation? Answer:Yes. Behavioral health services for those with drug use problems are covered in every state, albeit the specifics vary from one to the next.
Medicaid is not accepted by many treatment centers.
Enrollment Instructions: You may apply for Medicaid online by going to Healthcare.gov or Medicaid.gov and filling out the necessary paperwork.
Medicaid does not have a time limit on how long you may be enrolled.
What is Medicare?
Medicare is a government insurance program that offers coverage for anyone who are eligible for it if they meet the following criteria:
- 65 years of age or older
- Somebody of any age who has a disability
- Anyone living with a disability
- Anyone of any age who has end-stage renal disease (ESRD) or Lou Gehrig’s illness (Lou Gehrig’s disease)
Medicare benefits are divided into four categories:
- Part Ais provides hospital care, whereas Part Bis provides general medical coverage. Known as Medicare Advantage, Part Ci is a different route to acquiring coverage than Parts A and B
- It is also known as Medicare Supplement Insurance. Prescription medication coverage under Part Dis
Check out this video for more information and an in-depth look at Medicare’s several components. We are here to support you throughout your rehabilitation process. For the majority of individuals, learning about insurance is overwhelming and frightening. Don’t be concerned; there are several resources available to make the process as simple as possible. How to Become a Member If you believe you are eligible for Medicare, you may submit an application online at Medicare.gov. The procedure is straightforward and may be completed in the comfort of your own home.
New applicants to the Medicare program must enroll within specific periods of time.
The following is a schedule of open enrollment dates:
- The Medicare Initial Enrollment Period (IEP) is a three-month period that begins three months before your 65th birthday and ends three months after your 65th birthday. If you have been receiving Social Security payments for more than two years, you will be automatically enrolled in Medicare
- If you have been receiving benefits for less than two years, you will be automatically registered in Medicaid. General Enrollment Period (GEP): If you were unable to enroll during the IEP, you can enroll during the GEP, which runs from January 1 to March 31 every year. If you join during this period, your Medicare coverage will begin on July 1
- Otherwise, it will begin on August 1. Medicare Special Enrollment Period (SEP): Qualifying life events (QLEs) provide you the opportunity to enroll in Medicare or modify your plan outside of the yearly General Enrollment Period (GEP) for a limited time. The following are examples of QLEs, but they are not restricted to them:7
- Losing your present insurance coverage
- Adding or deleting additional insurance coverage
- Making a change to your Medicare plan
- In the case of Medicare Open Enrollment, after you have selected a plan, you are not required to stick with it indefinitely
- You can make changes to your Medicare coverage if your health needs change over time. Open enrollment takes place every year from October 15 to December 7, and you can make changes to your plans during this period. Medicare Supplement Open Enrollment: If you are enrolled in both Medicare Part A and Part B, you have the option to enroll in supplementary insurance at any time during the year. Supplemental insurance might assist you in paying for expenses that are not covered by Parts A and B.
As a result, what exactly is the distinction between Medicare and Medicaid and the health insurance markets (also known as “exchanges”) established under the Affordable Care Act? Take a look at this comparison chart:
|Who oversees the program?||Federal Government||State Governments|
- Age 65 or older
- Any age with certain impairments, ESRD, or ALS
- Any age with certain disabilities, ESRD, or ALS
- Persons with low incomes, families with children, the elderly and people with impairments, as well as pregnant women, are all included in this category. For example, in certain areas, coverage is extended to all persons who earn less than a specified amount.
|Does this insurance cover substance abuse treatment?||Yes, if the following criteria are met:|
- In addition, the hospital is a Medicare-certified provider. A medical need dictates that therapy be provided, and your doctor develops a treatment plan for you.
- Therapies, post-hospitalization follow-up, outpatient prescription medicines, screening, short intervention, and treatment referral to treatment (SBIRT) are some of the services provided.
- It varies from state to state
- Nevertheless, the majority of states support inpatient detoxification, partial hospitalization, intense outpatient treatment, and case management.
- Inpatient treatment, outpatient treatment, counseling, and psychotherapy are all available.
|Who oversees the program?||Medicaid.gov||Medicaid.gov||Healthcare.gov|
|When can I enroll?||During the 7-month period around your 65th birthday. Most people who turn 65 are automatically enrolled in Parts A and B.||Any time of the year.||During open enrollment periods each year.View dates and deadlines here.|
|Are there special enrollment periods?||Yes.Click herefor more information.||Yes.Click hereto find your state’s Medicaid department.||Yes.Visit this websitefor more information.|
Utilizing the Affordable Care Act
The Affordable Care Act (ACA, sometimes referred to as “ObamaCare”) was signed into law by President Barack Obama in 2010. In addition, it extended Medicaid coverage and established affordable health insurance exchanges for those who do not have other options for insurance, such as private insurance via their employment or public insurance such as Medicare or Medicaid, to help them afford health coverage. For persons battling with addiction, the Affordable Care Act (ACA) was a big success since it mandates that all insurance policies offered via the marketplace must include drug abuse and mental health treatment.
- Because of the Affordable Care Act’s expansion of Medicaid, 1.29 million low-income Americans who are struggling with addiction now have access to drug abuse treatment.
- Visit this page to learn more about your state’s marketplace.
- By visiting Healthcare.gov, you may apply for health insurance through your state’s health insurance exchange.
- Once you have been accepted, you should enroll in a treatment plan that suits your therapy requirements as well as your financial position.
- Get started on your application as soon as possible.
If you miss out on open enrollment, you may still be eligible to enroll during a special enrollment period. The following are examples of qualifying life events:
- Losing insurance coverage
- Getting married, divorced, or having a child
- Being released from prison
- And many more events.
A complete list of events that qualify you for special enrollment may be found by clicking here.
What are the Benefits of State-Funded Programs?
State-funded rehab programs are institutions that get government funds or subsidies to operate treatment programs, which are frequently in conjunction with jails or the court system in order to provide court-ordered addiction treatment to those who need it. In order to conserve resources, these institutions often do not offer the same amenities (private rooms, lower staff-to-client ratios, and cutting-edge treatment procedures) that private treatment facilities do. Try not to dismiss them out of hand; if you require therapy but have limited financial means, state-funded clinics may be an alternative worth considering.
- Take advantage of the situation if this is your only choice.
- Be encouraged if you call to enroll at a state-run facility only to be told that all of the available spots have been taken by other applicants.
- If a state-funded facility is completely booked, you can usually be placed on a waiting list.
- However, it is preferable than doing nothing.
- As long as you are on the waiting list, there is a chance that you will be admitted to treatment in the near future.
- Because you are on a waiting list for formal treatment does not exclude you from seeking help through 12-step programs or other recovery organizations in your neighborhood while you are waiting for treatment.
- In fact, you may come across folks who work at treatment facilities in the region or who are aware of other resources that might assist you in your recovery.
Find Strength in Support Groups
Attending a 12-step or non-12-step group is commonly advised as a complementary therapy option for those undergoing addiction treatment, but anybody is welcome to attend these free group meetings. Even if financial or insurance constraints prevent you from engaging in formal treatment right immediately, you may still benefit from the supporting community that these organizations provide by attending meetings. When it comes to joining a group of new individuals to talk about your personal experiences with addiction, it’s perfectly normal to be apprehensive.
It is possible to be inspired by those who have been sober for a long period to modify your own behaviour and quit using substances.
Since then, the stages have been used to all sorts of drug and behavioral addictions, as well as to the family members of people who suffer from addictions of any kind or severity. The following are examples of 12-step groups:
- Alcoholics Anonymous, Narcotics Anonymous, Cocaine Anonymous, Crystal Meth Anonymous, Celebrate Recovery, Gamblers Anonymous, Heroin Anonymous, Al-Anon, Nar-Anon, Co-dependents Anonymous, are all examples of 12-step programs that are available.
It is possible that you will find other recovery support groups more attractive if you are uncomfortable with the spiritual concepts or any other parts of 12-step recovery programs. Despite the fact that these gatherings are non-religious, they give a comparable level of support as 12-step sessions. The following are examples of non-12-step groups:
- Management of Moderation
- Recovery 2.0
- Recovery International
- SMART Recovery
- Secular Organizations for Sobriety
- LifeRing Secular Recovery
- Women for Sobriety
Call a Helpline for Information
These helplines provide free and confidential support services; there is no requirement to have insurance. If you’re seeking for additional information on how to proceed with therapy, or if you just want to speak with someone who understands what you’re going through, calling one of these helplines might be a fantastic place to start.
- There is a National Helpline for substance abuse and mental health services administered by the Substance Abuse and Mental Health Services Administration (SAMSHA) at 1-800-662-HELP (4357). The hotline is available 24 hours a day, seven days a week and can provide support in both English and Spanish. Aside from that, the SAMHSA’sbehavioral health treatment services locatorallows you to conduct an online search for substance abuse and mental health treatment programs in the United States
- And the Alcohol and Drug Helplinecan assist you in locating a treatment center regardless of your insurance coverage, financial situation, or age. You may reach them at any time of day or night by dialing 1-206-722-3700. It is a resource for teenagers, families, and parents to call the Boys Town National Hotline. Representatives are professional counselors who may be reached at 1-800-448-3000, 24 hours a day, seven days a week. Help is available in both English and Spanish
- Counselors may give aid in both languages, and they can direct you to a treatment center if necessary. The National Suicide Prevention Lifelineis a wonderful resource for free, confidential support and resources. Get in touch with them 24 hours a day at 1-800-273-8255
- The National Runaway Safe Line offers crisis counseling services. 1-800-RUNAWAY is the number to call to contact the Safe Line.
Various Other Resources The Americans with Disabilities Act (ADA) is a federal law that protects people with disabilities. Are you concerned about losing your work as a result of getting treatment for substance abuse? People who are suffering an addiction are recognized to have a handicap under non-discrimination laws, and their rights are protected by the Americans with Disabilities Act (ADA). Employees who seek therapy are protected from being dismissed under the Americans with Disabilities Act and the Rehabilitation Act.
- This non-profit organization assists people in locating rehabilitation services.
- The participating departments are mentioned on this page, and they can assist you in receiving appropriate care.
- You are immediately eligible for Medicaid coverage if you are receiving Supplemental Security Income (SSI).
- 15 Please see this link for further information on SSI and Medicaid coverage.
Alcohol Rehab Insurance Coverage for Addiction Treatment
Individuals’ health insurance often covers alcohol rehabilitation (either completely or partially), regardless of their income. This is due to the fact that addiction is a disease that needs medical therapy in the same way that heart disease or cancer necessitates medical treatment. However, there are a variety of criteria that determine the quantity and type of coverage that each insurance plan provides for alcoholism treatment and rehabilitation. Learn more about the coverage and alternatives that apply to you.
- Private pay and personal loans can help fill up the gaps left by insurance coverage, making therapy more financially realistic for people in need of assistance with their recovery.
- In 2019, more than 20 million Americans aged 12 and older were affected by a substance use disorder.
- 1 The expense of health-care services for alcohol addiction treatment has become a significant barrier to recovery for many people.
- Many people who battle with alcoholism, on the other hand, are jobless or struggling financially.
Similar to this, even persons who earn a consistent salary may find the expense of therapy prohibitively expensive when compared to their other financial obligations. Fortunately, health insurance frequently covers at least a portion of the costs of addiction treatment.
How to Find Insurance Plans Accepted by Rehabs
First and foremost, examine the policy. Call the insurance company and inquire about the sorts of addiction treatment that are covered under the policy’s terms and conditions. Despite the fact that these private insurance plans frequently provide the most extensive coverage, the policies are typically more expensive. With this in mind, it is likely that if a given plan offers comprehensive rehab coverage, the benefits will be accompanied with high premiums, which will be borne by the policyholder.
In addition, depending on your plan, TRICARE may also cover rehabilitation for veterans.
Individuals who are self-employed, those who are not covered by their employer’s health insurance, and those who do not otherwise have health insurance may be eligible to obtain coverage for addiction treatment through the Affordable Care Act Marketplace or state exchange plans.
However, if the individual relapses and is required to return to treatment–which is typically a necessary part of the recovery process 1–insurance companies may restrict subsequent therapies from being covered under the policy.
Find Rehabs That Accept Insurance
The majority of rehab facilities take some type of insurance. Many of our rehab facilities are in-network with insurance companies, which means that they may get reimbursement for the costs of care. Explore our treatment clinics in your area to get the most appropriate therapy for your specific requirements.
Is Addiction Considered a Pre-existing Condition?
In accordance with the Affordable Care Act, which became effective for plans beginning on or after January 1, 2014, health insurance companies are no longer permitted to reject coverage or charge higher premiums for anyone who have pre-existing diseases. 3 In the past, insurance companies used pre-existing diseases (such as addiction) as a justification to refuse people health insurance coverage or to levy costs that made purchasing insurance prohibitively expensive.
Can I Go to Rehab Without Insurance?
If you don’t have health insurance, you may be able to get help with the costs of treatment through a variety of state-funded programs. Medicare and Medicaid are examples of such schemes. Furthermore, most treatment centers allow a variety of financing choices, including payment plans, loans, and government aid. Please contact us immediately if the expense of rehab is preventing you or someone you care about from seeking treatment.
Medicare for Alcoholism: Is It Covered?
Addiction therapy is covered through Medicare Parts A and B, as well as via private insurance. Part A contributes to the cost of inpatient drug misuse treatment in a hospital setting. Part B of the ACA supports partial hospitalization or outpatient addiction treatment treatments for those who are addicted.
4 Aside from that, Medicare Part D offers coverage for drugs that doctors determine to be medically essential for the policyholder’s alcoholism treatment. Some drugs, such as methadone, are not covered by Part D, but are covered by other insurance plans.
Medicaid for Alcoholism: Is It Covered?
In the United States, Medicaid is a public health insurance program for low-income families that is jointly financed by the states and the federal government. It covers the fundamentals of alcohol addiction rehabilitation, including inpatient care, outpatient visits, and other services. Medicaid participants are not required to pay a co-pay for addiction treatment treatments in the majority of states. Some institutions, however, may not accept Medicaid as a means of reimbursement.
What Are Out-of-Pocket Expenses For Rehab Treatment?
A significant percentage of the costs of alcoholism treatment is covered by many insurance policies; nevertheless, there are other charges to which the policyholder is accountable for. These are some examples:
- Premiums are the cost of having insurance
- They are a recurring expense. Payments for coinsurance or co-payments: The payment of a lower charge to access a doctor or service. There is a certain amount that the policyholder is expected to pay before coverage begins, which is known as the deductible. Limitations on coverage for the rest of one’s life: Some insurance policies only pay for coverage up to a particular point, beyond which the policyholder is responsible for all costs.
How to Use Insurance to Pay for Alcohol Rehab
After confirming the coverage limits for the individual policy, consider using insurance to assist with the cost of treatment. Here’s how it’s done:
- First, consult with a doctor to evaluate whether or not therapy is required. A doctor conducts an assessment–which is often reimbursed by insurance–to identify the extent of abuse or addiction as well as the necessity for medically essential rehabilitation. This information satisfies the criterion for coverage and, as a result, aids in the decision-making process regarding the most appropriate facility for the individual.
- Second, locate a suitable rehabilitation program. Inquire with your doctor about rehabilitation options, or use theFind Treatment Near Youtool to look for treatment options in your region. Is there another option? Check with the Department of Behavioral Health or the Department of Health and Human Services in your state or town to discover a convenient regional facility. Always double-check that the rehab program offers expert medical therapy to guarantee that insurance will pay the cost of the treatment.
- Third, assess whether or not you will be able to utilize insurance. Upon locating the most appropriate institution that offers the desired level of care, double-check to ensure that they not only accept insurance, but that they also accept the exact plan.
- Finally, consult with the treatment center to establish whether or not insurance will pay the costs. Those working for a reputed treatment facility are professionals who may collaborate with insurance companies to establish the degree of coverage for a particular program. Depending on the situation, these professionals can assist consumers in navigating payment choices that are not covered by insurance, such as deductibles, co-pays, and other out of pocket expenditures. Some facilities also have a variety of funding alternatives, so be sure to learn about them before enrolling.
Check to see whether your insurance is accepted in the network now!
Ready for Rehab? Take Our Alcohol Addiction Assessment
To find out if you or someone you care about is suffering from an alcohol use disorder, please complete our free, 5-minute “Am I an Alcoholic?” self-assessment questionnaire below (AUD). A total of 11 yes or no questions are asked in the examination, and the results are meant to be used as an informative tool to determine the severity and likelihood of an alcohol-related driving accident. The test is completely free, completely confidential, and no personal information is required in order to obtain the results.
- Administered by the Substance Abuse and Mental Health Services Administration (SAMHSA) (2019). Statistics on substance abuse and mental health indicators in the United States, based on the National Survey on Drug Use and Health conducted in 2019, published by The Office of the Assistant Secretary for Planning and Evaluation. (2013) United States Department of Health and Human Services reports that the Affordable Care Act has expanded mental health and substance use disorder benefits, as well as federal parity protections, for 62 million Americans. Pre-Existing Conditions under the Affordable Care Act
- Medicare.gov. Services for Substance Use Disorders and Mental Health