It’s easy to feel overwhelmed by the options and the cost when looking for addiction treatment or mental health care.
But understanding your insurance plan can set your mind at ease about costs before you find a treatment center.
That way, when a representative talks about out-of-pocket expenses such as your deductible, coinsurance, or copay, you have an idea of how this affects you.
Here’s what to know about health insurance coverage for addiction or mental health treatment.
Does Health Insurance Cover Addiction Treatment?
Yes, health insurance covers a variety of treatment services for substance use disorder. Because of the Affordable Care Act (ACA) and the Mental Health Parity and Addiction Equity Act (MHPAEA), health insurance providers must cover treatment options for addiction.
But, they may not cover all the options. And the details of your health insurance plan may leave you with vast out-of-pocket expenses.
Yet in general, insurance policies lighten much of the financial burden of services for drug and alcohol addiction.
In general, insurance will cover treatment options such as:
- Inpatient treatment
- Detox
- Outpatient treatment
- Addiction therapy
- Aftercare
At Otter House Wellness, we work with our clients to find payment solutions that make the best of their coverage and address their financial needs.
What Does Insurance Cover for Substance Abuse Treatment?
Health insurance coverage can address much of the cost of alcohol and drug addiction treatment, by paying behavioral healthcare providers directly for these services.
But some factors may affect how much of a drug and alcohol rehab program an insurance plan will cover. Some of these factors include:
- Health insurance provider: Some health insurance providers have general guidelines that may affect treatment, such as not paying for holistic care.
- Insurance plan: Your specific policy may also exclude a certain type of treatment such as alternative therapy or require authorization for treatment at a certain level of care.
- Deductible: Depending on your plan, your deductible may vary. Your deductible is what you pay to the provider and can be significant depending on the type of plan you have.
- In-network vs. out-of-network: Whether a treatment facility is in-network with an insurance company can affect the amount of your out-of-pocket expenses.
Types of Addiction Treatment Programs Covered by Health Insurance
While some plans may limit coverage, a typical insurance plan covers a range of treatment options at different levels of care.
Having insurance allows you to consider a range of options when putting together a treatment plan.
Most health insurance providers cover some form of the following addiction recovery programs.
Detox Programs
A rehab facility may offer non-medical or medical detox options. These options get you through the withdrawal period while keeping you comfortable and monitoring your symptoms.
While behavioral health services such as inpatient treatment are considered essential health benefits, an insurance company may require verification that detox is medically necessary.
Disclaimer: Otter House Wellness does not offer detox services, but we can refer you to treatment centers that do.
Inpatient Rehab
Inpatient alcohol and drug rehab includes such levels of care as hospitalization and residential treatment. Under the MHPAEA, inpatient treatment is considered an essential health benefit.
That means Medicaid, Medicare, and private insurance plans will address the cost of treatment, but may have limits on the length of treatment. Or, they may pay for 30 days but shift a greater portion of the financial burden to you after that.
Disclaimer: Otter House Wellness does not offer inpatient treatment services, but we can refer you to treatment centers that do.
Outpatient Programs
Outpatient programs include partial hospitalization programs (PHP), intensive outpatient programs (IOP), and outpatient programs (OP).
Outpatient treatment can also include services such as detoxification and medication-assisted treatment. Outpatient programs are generally cheaper than inpatient, which makes them more likely to be covered.
Dual Diagnosis Treatment
Dual diagnosis treatment involves the use of common evidence-based therapies such as cognitive behavioral therapy (CBT) to treat co-occurring mental health disorders.
Treatments that address addiction and mental health (a dual diagnosis) at the same time are covered by insurance companies, as they offer a way to address the root causes of both issues.
Aftercare
A growing body of research suggests that effective aftercare programs are essential to clients’ success in maintaining sobriety.
As an essential part of addiction treatment, many insurance companies will cover this service but may impose limits on how long it continues.
Addiction Therapies Covered by Insurance
A typical rehab center offers a variety of evidence-based therapies to treat substance abuse. As a foundational part of a rehab treatment program, insurance covers many types of therapy.
Addiction therapies covered by insurance plans include:
- Cognitive behavioral therapy (CBT): This form of therapy helps people address unhealthy thought patterns and build healthy ones in their place.
- Dialectical behavior therapy (DBT): DBT helps people with personality disorders address emotional regulation in healthy ways.
- Individual therapy: This therapy offers a confidential time in a safe setting for you and your therapist to address issues that may be difficult to talk about with others.
- Group therapy: Treatment that harnesses the power of therapist-guided peer support that enables you to learn from and encourage others.
- Family therapy: This form of therapy helps you and your family address damaged relationships and move forward supporting one another.
- Holistic therapy: This kind of therapy addresses the whole person, spiritually, socially, physically, emotionally, and intellectually.
Mental Health Treatment Insurance Coverage
Insurance also covers mental health treatment. Similar to addiction treatment, coverage for mental health services can include inpatient care, outpatient treatment, and therapy.
If you or a loved one are facing a mental health disorder, insurance coverage can help lift the financial burden by paying a treatment provider for mental health services.
Just be sure to understand the ways in which you may still be financially responsible for some of the cost, even though it is covered.
As with coverage for addiction treatment, your financial responsibility for mental health treatment costs may involve deductibles, copays, coinsurance, and any services not covered by your plan.
Mental Health Programs Covered by Insurance
Health insurance companies cover a variety of mental health treatments at a range of levels of care.
These treatments address many mental health disorders, including depression, mood disorders, and personality disorders.
Covered programs for mental health disorders include:
- Inpatient treatment: This includes both hospitalization and residential treatment for people struggling with acute mental health disorders.
- Outpatient treatment: Insurance plans help cover outpatient care as the first level of treatment or as a step-down from inpatient care.
- Aftercare: Aftercare, or continuing care is an important part of treatment because it helps clients manage mental illness after the intensive portion of treatment is finished.
- Therapy: A treatment provider may use several different clinical, evidence-based therapies to address mental illness which are covered by most insurance plans.
- Medications and medication management: Medication and medication management can also be covered through psychiatric care.
Otter House Wellness offers care for both mental health and addiction, and we work with health insurance providers to find coverage for the right treatment plan for you.
How Much Does Addiction or Mental Health Treatment Cost With Insurance?
Insurance coverage helps lower the out-of-pocket costs of addiction and mental health treatment programs. However, the actual cost of treatment with insurance will vary.
Several factors can affect your out-of-pocket expenses for treatment that is covered by insurance.
Factors that affect the cost of treatment with insurance include:
- Whether your treatment center is in-network: Insurance plans pass higher deductibles to clients when using out-of-network providers.
- The limitations of your policy: Your policy may have unique exclusions that affect the cost of treatment.
- Your deductible: Your deductible can sometimes be more for inpatient vs. outpatient services.
- Coinsurance and copay: The percentage that you owe after the deductible and the copays can sometimes vary.
Cost of Addiction or Mental Health Treatment With No Insurance
Without insurance, addiction and mental health treatment can be significantly more expensive. Treatment for inpatient drug or alcohol addiction can range from $5,000 to $20,000 per stay. Outpatient treatment programs typically cost around $1,800 per program.
Other studies have found that inpatient mental health treatment can have the same range in cost, making insurance very helpful in mitigating the expense of treatment.
Insurance Providers That Cover SUD and Mental Health Programs
Major insurance companies operating nationwide offer coverage for substance use disorder and mental health treatment.
These insurance companies include:
- Blue Cross Blue Shield
- Aetna
- Medcost
- Cigna
- GEHA
- Tricare
- NYSHIP
- UMDR
- Medicaid
- Medicare
- Humana
- Magellan Health
- CHAMPVA
Find Addiction & Mental Health Care Covered by Insurance
If you or a loved one are suffering from mental illness or addiction, you can find treatment today that is covered by insurance.
Otter House Wellness provides a continuum of outpatient programs for substance abuse and mental illness while working with insurance companies to keep the cost manageable.
Our treatment providers never lose sight of your individual needs in the treatment process, so reach out to us today to get started on your journey to wellness.
