Rehab Insurance Coverage

What is an Insurance Plan?

An insurance plan is a contract that you pay for between you and an insurance company to transfer the risk of financial loss due to certain expenses. In other words, an insurance plan is a deal you make with an insurance company to pay a fee in exchange for that company paying for the majority of the expenses in case certain situations arise. 

Insurance plans come in different forms. For example, there is health insurance that covers basic medical expenses and there is auto insurance that covers any unexpected car expenses due to a car accident. Because insurance plans vary on what expenses they will and will not cover, many people that suffer from addiction ask themselves the question, does insurance cover rehab addiction treatment?

What is Addiction Treatment?

Addiction treatment is rehab used on people that are suffering from addiction to drugs and/or alcohol. The goal of addiction treatment is to help addicts get rid of their addiction and maintain a healthy and sober life. 

What Are the Different Categories of Insurance Plans?

When it comes to insurance plans, there are major categories in which they come in. You should choose an insurance plan for your rehab that is within a category that you qualify for and that tends to provide the level of coverage that you need. You should also make sure that the insurance plan that you choose is within a category that covers addiction treatment, to begin with.

Group Insurance Plans

Group insurance plans are insurance plans that are offered to members of a certain group of people. For example, your place of employment may offer a group insurance plan for all the employees to join in on. Insurance carriers usually offer group insurance plans. 

When it comes to group insurance plans though, employers usually pay for a part, or all, of the insurance coverage. Most major group insurance carriers provide coverage for rehab.

Private Insurance Plans

Like group insurance plans, employers or members associations often provide people with private insurance plans. You can also get a private insurance plan through private purchase independent of any organization. Also, like group insurance plans, private insurance plans provide coverage for rehab treatment. 

Private insurance plans are known to be very flexible as they allow you to choose the level of coverage that you want. In fact, most private insurance plans that provide coverage for rehab tend to allow more rehab treatment options with fewer limitations on whether the treatment that you choose is in their network or not. Despite having more network flexibility on your choice of rehab, the amount of coverage that private insurance often gives to rehab is limited. 

There are three major types of private insurance plans.

1. Private Insurance Plan – Health Maintenance Organization (HMO) Plans

Health maintenance organization (HMO) plans are very specific in that they only allow people to go to rehab centers that are within their network. If you have an HMO private insurance plan and do not attend rehab within their network, you will have to pay a bigger percentage of your rehab costs. 

2. Private Insurance Plan – Preferred Provider Organization (PPO) Plans

Like HMO plans, preferred provider organization (PPO) plans want you to seek rehab treatment within their network. To motivate you to seek treatment within their network, PPO plans provide an even higher level of coverage for treatment than HMO plans. 

PPO differs from HMO though in that you are allowed to receive rehab treatment outside of the network with PPO. If you go to treatment outside of the PPO network, the amount of treatment that your PPO insurance plan will cover is less than if you would have retrieved treatment within the network.

3. Private Insurance Plan – Point-of-Service Plans

Point-of-service plans are the most flexible rehab insurance plans. This is because point-of-service plans allow you to choose between HMO and PPO services for each treatment.

Public Insurance Plans

Insurance plans that the state or government funds are called public insurance plans. Public insurance plans have specific requirements that you have to meet to be eligible for them. There are two major forms of public insurance coverage. 

1. Medicaid

Medicaid is a state-funded, government-regulated public insurance benefit. Individuals that receive social security, have low-income families, and/or are a pregnant woman that meets certain qualifications, you can receive Medicaid benefits. Each state may have its own other requirements to qualify for Medicaid.

2. Medicare

Medicare is a federally funded public insurance program. If you are 65 or older, you qualify for Medicare. Otherwise, you have to have a bad disability and/or a deadly disease to possibly qualify.

Does Insurance Cover Rehab?

When it comes to addiction, there is often a stigma behind it. Part of this stigma is people thinking that you chose to suffer from addiction. As a result of this stigma, it used to be hard to get health insurance to cover rehab. Luckily, now the government sees addiction as a public health issue. As a result, most local, state, and federal government healthcare insurance providers cover rehab. 

*See More Information About Your Specific Coverage*

The Affordable Care Act 

The Affordable Care Act (ACA) is a law that provides the opportunity to purchase health insurance from the government if you do not have it. The government cannot deny treatment for drug addiction treatment under the ACA. In fact, under the ACA, coverage for addiction treatment has to be on par with the level of coverage for any other physical health issue. On top of this fact, the ACA offers drug and alcohol addiction treatment and funding to people that receive healthcare coverage under Medicare and Medicaid. 

The Affordable Care Act (ACA) includes addiction treatment healthcare coverage for:

  • Evaluations
  • Interventions
  • Addiction treatment medications
  • Clinic visits
  • Drug and alcohol testing
  • Home health visits
  • Family counseling

Rehab Treatment Coverage Assistance for People of Low Income/No Insurance

Another law that you can turn to if you lose your job and the healthcare benefits that come with them is the Consolidated Omnibus Budget Reconciliation Act (COBRA). Passed down in 1985, COBRA provides health insurance coverage to those that do not have it due to losing your job. 

There are even some no-fee rehab programs available for people of no or low income and no insurance coverage. 

Unity Behavioral Health Has Got You Covered

If you want to find an addiction treatment center that is accommodating and understanding about your financial situation, receive treatment at Unity Behavioral Health. Not only do we accept many different insurances, but we also offer a variety of individualized addiction treatment programs. These programs include medical detox treatment, substance abuse treatment, neurobehavioral therapy, partial hospitalization treatment, intensive outpatient treatment, residential treatment, and outpatient treatment

To learn more about Unity Behavioral Health and our insurance policies, feel free to contact us 24 hours a day, 7 days a week.