Most insurance plans will cover either all or a portion of the treatment.
- Content Reviewed By:
- Andrew McKenna - JD
- SUD's treatment executive, national news contributor & keynote speaker.
Navigation:
- Overview
- What Types of Treatment Does Private Insurance Cover?
- Private Insurance and Mental Health Coverage
- How Much Does Rehab Cost with Insurance?
- How Much Does Rehab Cost WITHOUT Insurance?
- In-Network Insurance Partnerships
- Will My Insurance Cover Rehab?
- Know Your Rights and Responsibilities
- Insurance Coverage after Treatment
- Additional Resources
Overview
Private health insurance has emerged as a viable and popular means of paying for alcohol and drug rehab. More often than not, this insurance is provided by your employer or that of a loved one. At a time when over 49 percent of workers are struggling with some level of alcohol or drug abuse, and over 18 percent of employed adults are illicit drug users, it’s critical that employers take an active role in getting their employees help for their substance use and associated mental health issues. Private health insurance can make addiction care more affordable and accessible to patients with limited means.
What Types of Treatment Does Private Insurance Cover?
Private insurance will cover virtually every type of medically approved, evidence-based care, either partially or entirely, according to your plan type and tier of coverage. Some of the more common types of treatment that insurance covers include, but are not limited to:
- Medical Detoxification and Withdrawal Management – Safe and effective withdrawal management from alcohol and drug use disorder is, by all accounts, a medical procedure and should be treated as such. Most insurance companies offer coverage for this critical phase of the treatment process. Detox usually lasts an average of three to seven days, depending on patients’ progress and ongoing care needs. Insurance companies often cover up to a week.
- Inpatient or Residential Care – Programs that last an average of 28-30 days, in which patients stay at their facility to get the help they need for substance use disorder. These programs provide evidence-based behavioral techniques, such as cognitive behavioral therapy, dialectical behavioral therapy, and more. Some programs also offer access to medical detox and withdrawal management. Many insurance companies cover partial inpatient treatment after an out-of-pocket payment for a certain number of days.
- Outpatient Treatment – Daily programs that allow patients to return home after their program to attend to their daily lives. Outpatient programs offer targeted and intense daily behavioral therapy using evidence-based practices. In some cases, insurance companies may more readily cover outpatient programs for a patient’s first time in treatment.
- Medication-Assisted Therapy (MAT) – Nearly all private insurers cover MAT for opioid use disorder. This includes the use of FDA-approved medications, such as Suboxone®, methadone, and Vivitrol®. The policies governing the administration method and duration of these drugs vary between providers, but all use of medications must occur under the supervision and approval of a licensed provider.
Your insurance may also cover partial hospitalization programs (PHPs), which are structured daily programs that offer a higher level of guidance and supervision than traditional outpatient programs, but still allow patients to return home each day. Online behavioral rehab is now also covered by most private insurance companies.
Private Insurance and Mental Health Coverage
The Affordable Care Act also mandates that insurance companies provide a baseline of coverage for mental health treatment. This is important because more than half of the people who struggle with addiction also struggle with underlying mental health issues like depression, anxiety, bipolar disorder, and others. This combination is what is known as a co-occurring disorder or dual-diagnosis disorder, requiring treatment for the immediate impact of addiction, as well as the mental health issues associated with it.
How Much Does Rehab Cost with Insurance?
The cost of your treatment with your insurance will vary according to your provider and the scope of coverage. Each provider uses its own formula and calculations to determine how much your plan will cover. In many cases, however, private insurance will cover all, if not most, of your treatment, leaving you with little to no out-of-pocket obligation. Cost may also vary, based on the type of program you’re considering, the state in which you or your loved one resides, clinical modalities offered at your respective program, amenities, staff, and other factors. Your insurance company will be able to give you a complete, detailed breakdown of your coverage allotment versus your out-of-pocket responsibilities.
How Much Does Rehab Cost WITHOUT Insurance?
Again, the cost of addiction treatment without insurance will vary based on the factors above. Rehab centers with more basic programming and fewer amenities will generally be more affordable. Detox programs can cost up to $800-$1000 per day before insurance, while outpatient treatment often costs between $2500-$10,000, while inpatient programs are far more expensive, usually ranging between $25,000-$60,000 without insurance. These numbers are just estimates. Each facility’s costs will vary, and it’s important to get a detailed understanding of the cost of your program before making a decision about your treatment program.
It’s also important to remember that many facilities can offer additional financial flexibility for the portion of your program (if any) that is not covered by insurance. These options may include financing, sliding scale arrangements, scholarships, and more. Sliding scale arrangements are income-based agreements that allow you to pay what you can for the remaining portion of your care, while scholarships often factor in extraordinary circumstances in order to cover your treatment. Talk to the staff at your prospective facility to learn about your options and how to proceed with your care.
In-Network Insurance Partnerships
When you’re looking for a drug or alcohol rehab center that accepts private insurance, it’s a good idea to ask about their potential in-network partnerships with insurance companies. In-network partnerships are pre-determined agreements that offer treatment at a fixed lower rate for members who are covered by the provider. This means, for example, that if you’re working for an automotive company and are covered by a particular insurance company, there are facilities that work directly with these providers to offer lower-cost care.
Some of the companies with whom rehab centers may have in-network partnerships include:
- Aetna
- Amerigroup
- AmeriHealth
- Ambetter
- Anthem
- (BCBS) Blue Cross Blue Shield
- Beacon Health Options
- Carelon
- Cigna
- ComPsych
- First Choice Health Insurance
- First Health Network Insurance
- GEHA Health
- Halcyon
- Health Net
- Harvard Pilgrim
- Highmark Health
- HMC Healthworks
- Humana
- Kaiser Permanente
- Johns Hopkins Medicine
- Magellan Health
- Meritain
- Molina Healthcare
- MultiPlan (Claritev)
- Mutual of Omaha
- New York State Health
- Optum
- Oscar
- Priority Health
- TRICARE Military Insurance
- TriWest Healthcare
- UMR Insurance
- United American Insurance Company
- UnitedHealthcare
- ValueOptions
- Zelis Health Insurance
Will My Insurance Cover Rehab?
Your private insurance will cover at least some type of drug or alcohol rehab. Newer legislation requires this as an Essential Health Benefit. The best way to find out the scope of coverage provided by your healthcare provider for rehab is to call the representatives of the facility so they can provide a full verification of your benefits and place you at a facility that will offer affordable care.
Use our directory of rehabs that take private health insurance to start your treatment and recovery. You don’t have to let cost get in the way of your recovery or your future. There are many more private insurance companies that cover Substance Use Disorders (SUDs).
There are many more private insurance companies that cover Substance Use Disorders (SUDs). To find out if your private insurance covers SUDs, you can check the back of your insurance card where a phone number is usually listed. Some insurance companies may have a specific number for mental health and SUDs.
Know Your Rights and Responsibilities
The plain truth is that navigating insurance coverage for any medical condition can be challenging, and the impact of addiction on your mind and body can make it even more difficult to advocate for yourself. Here are some steps you can take to ensure you’re getting the most accurate and reliable information.
- Get someone from your insurance company on the phone for direct answers to your questions
- Get a copy of your insurance company’s provider directory to see the in-network addiction specialists.
- Coordinate with your human resources specialists to fully understand your coverage options.
- Prepare a list of questions for the facility you’re considering.
Don’t be afraid to ask questions. It’s also important not to get discouraged if you find yourself getting frustrated by the research process. If you’re seeking treatment for yourself, it may help to have a loved one assist you with finding a program that can suit your clinical and financial needs.
Insurance Coverage after Treatment
Those who struggle with addiction know that treatment is only the first step in the recovery process. Substance use disorder is an ongoing disease that requires consistent care beyond the initial rehab process. The good news is that most private insurers continue to fund mental health treatment, such as psychotherapy and medications, after you or your loved one completes your program. Your aftercare plan will more than likely include referrals to mental health specialists in your area. Be sure to verify that these specialists are in your insurance provider’s network.
