Rehab Payment Cost & Options | How to Pay for Residential Treatment?

Paying for Drug & Alcohol Addiction Treatment

If you or your loved one are struggling with addiction and have decided to undergo professional treatment, it’s important to find a program that meets your specific needs. The cost of treatment may be an important factor for some individuals, especially for those wondering how to pay for rehab treatment without insurance.

Therefore, in addition to researching available programs and facilities, individuals battling addiction should also learn more about their options when it comes to paying for rehab.

How Insurance Works

Typically, the way insurance works is that a person signs up for a healthcare plan and pays a monthly premium. Insurance can be bought on the federal Marketplace or from insurance companies directly during an open enrollment period.1 Different providers may be available, depending on where a person resides.

Most insurance plans have deductibles or amounts that a person must reach before insurance coverage kicks in. Insurance will then pay a percentage of the services rendered while the individual is responsible for the remaining amount. For example, if someone has a deductible of $500 and insurance pays out at 80 percent over that, after $500 is paid out of pocket for medical expenses, the insurance company will pay 80 percent of the remaining balance while the individual is responsible for 20 percent of the costs. This is called coinsurance.

Policies will also generally have an annual out-of-pocket limit, or maximum, after which the insurer will pay 100 percent of all covered medical costs. At the time services are provided, individuals may also be required to pay a copay, which is separate from deductible and coinsurance amounts. Copays are typically low in dollar amount.2

paying for rehab without insurance: grants, loans, scholarships & private pay

Types of Insurance Plans

Insurance plans often come in differing levels of coverage, such as Bronze, Silver, Gold, and sometimes Platinum. Generally speaking, Bronze-level plans have the lowest monthly premiums, highest deductible, and potential out-of-pocket costs while Platinum plans offer the reverse.

Within each specific plan, the type of coverage and services that are covered can vary. Different plans may require individuals to receive care at specific treatment facilities or obtain a referral before specialty services (like those related to addiction or mental health concerns) can be rendered.

Insurance plans may only cover services performed by an “in-network” provider as well. Healthcare providers often work directly with insurance providers to offer discounted rates on services provided to members. These providers are then considered to be in-network for these insurance policies. Other plans may allow their members to obtain services from providers that are considered “out-of-network.” However, these services generally cost more and may be covered at a lower percentage.

PPO, HMO & POS

When it comes to types of insurance plans, the following distinction can also be made:

  • A PPO(Preferred Provider Organization) plan allows individuals to receive care from out-of-network providers without a referral for a higher cost while providing lower costs for services obtained from in-network providers.
  • An HMO (Health Maintenance Organization) requires individuals to remain in-network for medical services (except in the case of emergencies) and often requires members to work or live within a specific services area.
  • POS (Point of Service) insurance plans provide discounted rates for in-network providers and require a referral for specialty services.

Different states and insurance companies will have different policies, coverage types, and plans available to members.

Available Insurance Providers

Click below to learn about some of the major insurance providers with policies that may cover drug treatment or ancillary services:

Insurance Companies Explained

There are hundreds of different health insurance providers offering coverage within the United States, and each has a variety of plans and options to choose from. Below are some of the most common providers and general information on them:

Individuals who require subsidization, or who cannot afford health insurance and meet specific criteria, may be eligible for federal Medicare coverage offered in partnership with one of the above insurance providers. If you need help paying for drug and alcohol rehab without insurance, be sure to check with the health insurance provider directly for more information on Medicare coverage, local healthcare plans, covered services, and any restrictions or limitations that may exist.

Unsure where to start? Take Our Substance Abuse Self-Assessment

Take our free, 5-minute substance abuse self-assessment below if you think you or someone you love might be struggling with substance abuse. This evaluation consists of 11 yes or no questions that are designed to be used as an informational tool to assess the severity and probability of a substance use disorder. The test is free, confidential, and no personal information is needed to receive the result. Please be aware that this evaluation is not a substitute for advice from a medical doctor.

 

Insurance for Behavioral Health Services

The Affordable Care Act (ACA) ensures that behavioral health services are covered under any health insurance plan sold on the federal Marketplace.13 Mental health and addiction issues are included as “essential health benefits” that are required to be covered by insurance the same way that other medical and surgical procedures are. Covered services can include:

  • Detox services
  • Crisis services
  • Inpatient treatment
  • Outpatient treatment
  • Residential treatment
  • Therapy and counseling
  • Prescription medications
  • Community-based programs
  • Co-occurring disorders treatment

To be able to use insurance to help pay for addiction or mental health treatment, a person may be required to prove medical necessity. This means that coverage is only offered if it is deemed medically necessary. Individuals may need to visit their primary care provider (PCP) in order to obtain a referral for these specialty services.

Some plans may require that a person first attempt an outpatient addiction treatment program before the insurer will provide coverage for a more comprehensive inpatient program. Insurance plans may provide coverage for a preset amount of time in a treatment program, for a certain number of therapy or counseling sessions in a calendar year, or up to a certain monetary amount annually. Plans vary on what is covered, how much is covered, and what restrictions and exclusions may apply.

People may be required to receive treatment services at specific facilities and treatment centers in order for coverage to apply. Different states have variable rules regarding insurance policies and coverage for behavioral health services as well.

Addiction treatment facilities may have trained staff on-site to help individuals navigate and maximize their insurance coverage.

 

 

Frequently Asked Questions