Insurance coverage is available for detox and rehab. Under the Affordable Care Act (ACA) and Mental Health Parity and Addiction Equity Act (MHPAE), rehab should be covered equally to any other mental health condition. This article explains how insurance makes care more affordable.
Table of Contents
- Why Insurance Is Required to Cover Detox and Mental Health Services
- What Types of SUD and Mental Health Treatments Are Covered By Insurance?
- What Insurance May Not Cover in Addiction Treatment
- How to Verify Your Insurance Coverage
- What If You’re Uninsured or Underinsured?
- Find Affordable Care at BlueCrest Recovery
- FAQs
Key Takeaways
- Many people who require substance use disorder services don’t get the help they need, and cost is often a factor.
- Fortunately, the Affordable Care Act and Mental Health Parity and Addiction Equity Act require insurers to cover substance abuse and mental illness services, comparable to any other medical need.
- Getting the care you require means understanding what services are covered and not covered, and verifying your insurance with your provider or preferred facilities.
- If you are unable to attain insurance, there are other affordable options to consider.
Introduction
2024 SAMHSA research shows 80% of people who require substance abuse treatment don’t get it. Various factors can be at play, but cost is often the biggest one. Many people just can’t afford the care they need.
Individuals who show signs they need detox may wonder, ” Is detox covered by insurance?” The answer is yes. The Affordable Care Act (ACA) and Mental Health Parity and Addiction Equity Act (MHPAE) ensure coverage is provided without restrictive limits.
Why Insurance Is Required to Cover Detox and Mental Health Services
People now have greater access to the care they need through the ACA and MHPAE. An ASPE report shows the ACA helped 32.1 million Americans gain access to coverage, including care for mental health conditions and substance use disorders.
- MHPAE: Passed in 2008, this act ensures federal and state laws prevent insurers from imposing stricter limitations on addiction treatment compared to other medical services due to mental health parity requirements. In other words, the co-pays you pay for mental health and rehab services should be equal to what you might pay for other medical procedures.
- ACA: Passed in 2010, this act requires most insurance providers to provide coverage for mental health and substance abuse treatment, recognizing them as one of the 10 essential health benefits. Under the ACA, private insurance companies are required to provide some form of substance abuse treatment coverage, making it more difficult for insurers to deny coverage for addiction treatment based on pre-existing conditions.
What Types of SUD and Mental Health Treatments Are Covered By Insurance?
The types of services covered vary by provider, but may include:
- Detox Process: The initial phase focuses on breaking the physical bonds of recovery and managing withdrawal symptoms.
- Therapy: Behavioral health services that address the underlying cause of addiction.
- Medications: Prescription drugs used to manage symptoms.
- Programs may be covered for all populations, including detox programs for older adults and detox programs for teenagers.
What Insurance May Not Cover in Addiction Treatment
Insurance may not cover:
- Out-of-Network Providers: Using in-network providers generally reduces patients’ out-of-pocket costs during detox.
- Luxury or Holistic Rehab Centers: While core services may be covered, you may have to pay out of pocket for additional amenities.
- Extended Stays Beyond the Medical Necessity: Most insurance coverage will cover treatment, depending on medical necessity, which is typically determined by factors including the severity of the addiction and the risk of withdrawal complications. If you choose to stay longer, you may need to use a private payment plan.
- Deductibles, Copays, and Coinsurance: Insurance coverage for rehab often requires patients to pay copayments, deductibles, or premiums, and the extent of coverage can vary by health care plan and state regulations.
How to Verify Your Insurance Coverage
Most rehab centers offer a free verification process. You can simply call the facility and ask which insurance companies they accept. They should be able to walk you through, telling you exactly what’s covered and what you can expect to pay out of pocket.
You may also call the number on your card for similar information. When calling, be sure to ask about in-network detox facilities, prior authorization requirements, levels of care covered, and out-of-pocket costs.
What If You’re Uninsured or Underinsured?
Of course, some people can’t afford insurance or don’t have enough coverage to make drug rehab affordable. Here are some options to consider.
- Medicaid Services: This insurance is available to low-income individuals.
- State-Funded Detox: These programs are typically more affordable, and many offer sliding-scale payment options.
- SAMHSA’s Helpline: This helpline provides resources to help you find affordable care in your area.
Find Affordable Care at BlueCrest Recovery
BlueCrest Detox will help you get the care you need. We perform no-obligation insurance verifications over the phone so you know exactly what you’ll pay before you commit. Our facility works with most major providers, including Cigna, Aetna, and United.
Beyond that, we are dedicated to helping people find affordable treatment, even if it’s not with our clinic. We will review your options and match you with a disorder treatment that suits your needs. Call us to learn more about our detox recovery program.
FAQs
Do I need prior authorization for substance use disorder treatment?
Yes, most insurance plans will require prior authorization for disorder coverage. Insurers usually require a physician’s evaluation to prove that professional detox is medically necessary for health and safety. Contact your insurer before starting a treatment plan to learn what’s required and avoid unexpected costs.
How long will insurance cover rehab?
In New Jersey, insurers are mandated to cover the first 28 days of inpatient care, intensive outpatient care, and partial hospitalization without prior authorization under the New Jersey Substance Use Disorder Law.
Does insurance cover alcohol rehab?
Yes, alcohol detox is covered under the same mental health and substance use disorder benefits that apply to drug detox, as it is considered medically necessary due to the dangers of alcohol withdrawal.
Sources
- Centers for Medicare & Medicaid Services. “The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).” https://www.cms.gov/marketplace/private-health-insurance/mental-health-parity-addiction-equity
- Centers for Medicare & Medicaid Services. “Information on Essential Health Benefits (EHB) Benchmark Plans.” https://www.cms.gov/marketplace/resources/data/essential-health-benefits
- U.S. Department of Health & Human Services. “Affordable Care Act Expands Mental Health and Substance Use Disorder Benefits and Federal Parity Protections.” https://aspe.hhs.gov/reports/affordable-care-act-expands-mental-health-substance-use-disorder-benefits-federal-parity-protections-0
- HealthCare.gov. “Mental Health and Substance Abuse Health Coverage Options.” https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage/
- Substance Abuse and Mental Health Services Administration (SAMHSA). “Release of the 2024 National Survey on Drug Use and Health.” https://www.samhsa.gov/blog/release-2024-nsduh-leveraging-latest-substance-use-mental-health-data-make-america-healthy-again
- National Association of Counties. “SAMHSA Releases New 2024 Data on Rates of Mental Illness and Substance Use Disorder in the U.S.” https://www.naco.org/news/samhsa-releases-new-2024-data-rates-mental-illness-and-substance-use-disorder-us
- Medicaid.gov. “Substance Use Disorders Resources.” https://www.medicaid.gov/medicaid/benefits/behavioral-health-services/substance-use-disorders
- Medicare.gov. “Mental Health & Substance Use Disorders.” https://www.medicare.gov/coverage/mental-health-substance-use-disorder
