Does Insurance Cover Addiction Treatment?

When you or a loved one are ready for recovery, you need a seamless process to get started. Any delays could mean doubts, and any doubts could mean a failure to enroll. That’s why it’s important to understand the economics of addiction treatment long before you look to get started. We’ve put together this brief guide to help you.

How do I pay for addiction treatment?

You shouldn’t let financial concerns derail your plans for addiction treatment. Most treatment providers accept insurance coverage as well as private out-of-pocket pay. You may also be able to ask family members and friends to contribute financially to cover any expenses not covered by insurance. Some treatment providers also offer a sliding scale or installment payment plans to help ease the burden. Make sure you ask your preferred provider directly about their payment options.

If a reputable treatment provider feels that you’re not financially qualified for their program, they should refer you to a program that you may be able to afford.

Will my insurance coverage cover addiction treatment?

man discussing insurance coverage for rehabUnder the 2008 Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, or MHPAEA, the federal government requires private insurers including those who provide both individual and group policies, to offer equal coverage for mental health and addiction treatment as they do to other medical conditions if they offer such benefits. This means that insurers who provide mental health and substance use benefits must ensure those benefits are equivalent to other medical coverage.

Under the MHPAEA, insurers who provide coverage for substance use and mental health treatment must make sure that their coverage:

  • Has the same level of payment required and amount of coverage as the medical benefits that they offer
  • Must be governed by the same rules and regulations as other medical benefits (in other words, no special burdens can be placed on substance use and mental health treatment)
  • Provide out-of-network benefits for mental health and substance use care if the plan offers out-of-network benefits for other medical care

While the MHPAEA does not require insurers to provide coverage, it does require that existing coverage be fair and equitable between mental health and addiction care and other medical care.

Insurance plans sold on the Affordable Care Act Marketplace are required to provide mental health and substance use coverage, however, and can’t put a financial limit on the amount of coverage provided in a given year.

Can I confirm my coverage before I enroll in treatment?

Yes, and you should. Not every insurance plan covers every treatment program, so it’s wise to confirm that your insurance will cover your preferred provider before enrolling. Luckily, this process is quick and easy. Just ask your provider of choice to verify your insurance benefits. During this process, they may ask for some details from you, including:

  • Your name and address
  • Your insurance provider
  • Number and details of your insurance policy

It’s important to provide accurate details during this process. If you’re not sure about the details of your policy, contact your employer or your insurance company directly. Once benefits are verified, you can be more confident that insurance will cover the provider of your choice.

How do I know what my insurance is actually covering during treatment?

addiction treatment insurance formOne of the easiest ways to verify what your insurance coverage is actually paying for during addiction treatment is to review the documentation that your insurance provider is required to send to you. Some providers will call these documents a statement of benefits, while others may use different terminology.

After your insurance provider has covered a particular aspect of your treatment, they should send you a breakdown in writing of what they have paid, as well as how much is still left for you to cover. This amount will vary depending on factors like the size of your deductible, as well as the type of insurance plan you have.

When you receive your statement, review it carefully for a few important details. These include:

  • What aspects of your treatment your insurance provider covered
  • What aspects of your treatment your insurance provider did not cover
  • How much you owe after your insurance payment
  • Whether you have met your deductible or still owe an additional amount

It’s also wise to look for any unexpected charges or lapses in coverage. This commonly happens in two ways. Your insurer could mistakenly miss a payment that you are owed, or your provider could mistakenly charge for a service. It’s important to be an educated consumer and make sure your benefits are being applied where they should.

Does government-run health insurance provide addiction treatment services?

Yes. The government-run health insurance program Medicare provides addiction treatment benefits for certain needs. These include:

  • Psychotherapy
  • Medication-assisted treatment for opioid addiction
  • Substance use therapy and counseling
  • Drug testing
  • Screening and intervention for addiction in a hospital setting
  • Inpatient addiction treatment
  • Outpatient addiction treatment

However, it’s important to note that not every addiction treatment provider accepts Medicare and other government-run insurance programs. If you are relying on this coverage for your treatment, make sure to ask upfront about whether or not your chosen provider has such coverage. It’s important that you work with a Medicare-certified provider if you want to be covered under the insurance program.

Where can I get my questions answered about addiction treatment and insurance coverage?

Both addiction treatment and insurance coverage can be confusing and daunting. But don’t let that intimidate you. Don’t be afraid to ask questions of both your treatment provider and insurer to better understand your options. We’ve put together a list of suggested questions below to help you get started.

Treatment Provider Questions

  • Which insurances do you accept?
  • Are your services in or out of network for most insurers?
  • Can you verify my insurance benefits?
  • What are my payment options for any amounts not covered by insurance?
  • Do you have any other payment-related policies I should understand?

Insurer Questions

  • Do you offer mental health and substance use treatment benefits?
  • Are there any limitations on those benefits?
  • How does coverage typically work with addiction treatment providers?
  • How much is my deductible for mental health and substance use treatment?
  • Do you have a point of contact for further questions, particularly about benefits?

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