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
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:
- Aetna Insurance: Covering over 23 million members in 2016, Aetna offers an array of insurance plans and coverage types provided by a wide range of treatment providers and innovative services.2
- Anthem: In partnership with Blue Cross Blue Shield, Anthem Insurance is the second biggest health-plan-owned behavioral health company, providing its more than 13 million members with access to a large network of behavioral health providers.3
- Blue Cross Blue Shield (BCBS): With over 100 million members and the highest rate of specialists, hospitals, and doctors contracted by a health insurance company in the United States (over 90 percent), BCBS provides insurance coverage for members in all 50 states.4
- Cigna: A health services company with a global reach, Cigna has relationships with over 1 million service providers, clinics, facilities, and healthcare professionals around the world to provide its members with comprehensive medical care and highly rated insurance coverage.5
- Healthnet: With comprehensive coverage provided in all 50 states, Healthnet offers a ProviderSearch tool to help members find contracted specialists, hospitals, and doctors in their local area. The company strives to enhance the well-being of its members.6
- Humana: Offering a wide range of health insurance plans for families, individuals, and employers, Humana provides budget-friendly plans for people from all walks of life with innovative services and a commitment to overall health and wellness for those it serves.7
- Kaiser Permanente: Through personalized care and dedication to its members, Kaiser Permanente provides quality healthcare services and insurance coverage as one of the biggest not-for-profit health plans in the United States.8
- Molina Healthcare: A multi-state healthcare organization, Molina Healthcare is a Fortune 500 company offering health management solutions to its millions of members with a strong focus on preventative medicine.9
- Asuris Northwest Health: A not-for–profit healthcare company, Asuris Northwest Health offers strong leadership and community roots as well as many insurance plans to choose from to improve the overall health and wellness of its members.10
- Tricare: Serving United States active-duty military members, their families, and retirees, Tricare provides healthcare and comprehensive coverage that includes all of the essential health benefits and specialty services, and offers 11 different plan options to choose from.11
- UnitedHealth: A comprehensive and diversified health company, UnitedHealth Group prides itself on innovation, adaptation to an ever-changing market, and helping people to live healthy lives. The company serves people’s healthcare needs in all 50 states with over 30,000 nurses and doctors within the workforce.12
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.
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
- Under the Affordable Care Act, all market plans consider substance abuse an important health issue. At least a portion of substance abuse treatment is covered by most private health plans and some cover it entirely. 13 Group insurance plans provided by employers vary and may cover these facilities to a degree. However, since each plan is different it would be best to check with your carrier. To find out what is covered by your carrier’s benefit coverage for residential treatment, call them or visit their website.In case you’re not sure what to ask, some drug treatment centers can provide you with assistance on this matter. They can find out if they are part of your provider’s network and what services are covered by your particular insurance plan.
- Each state takes part in benefit programs such as Medicare and Medicaid. They are federal and state partnerships that provide healthcare for individuals with certain requirements. Coverage restrictions and conditions for treatment differ between states. Additionally, Medicare or Medicaid are not approved by all substance abuse treatment providers.Medicare is accessible to U.S. citizens who are 65 years old or older, who have paid Medicare taxes for at least 10 years. It is also provided for people under the age of 65 who have been eligible for Social Security disability insurance for 24 months or who qualify for other disability-related requirements. Substance abuse treatment coverage from Medicare is divided into three parts:14
- Medicare Part A includes hospital stays and inpatient facilities such as residential drug and alcohol treatment for up to 60 days.
- Part B of Medicare includes rehabilitation facilities such as outpatient drug treatment, which are medically required.
- Part D of Medicare includes prescriptions used in the treatment of substance abuse, such as those used in medication-assisted treatment plans.
Assistance centers for the State Health Insurance Plan offer state-specific Medicare details which can be obtained at SHIP National Technical Assistance Center. Medicaid provides low-income households with health care coverage, as well as pregnant women and others who receive Supplemental Security Income. Copayments for recovery facilities vary from state to state. Find out more at Medicaid.gov.15
Veterans may get coverage for addiction treatment through the Veterans Health Administration.
The VA offers evening and weekend hours for veterans. For those who live far away from a VA facility or have unstable housing, residential (live-in) options are available. For patients with specific needs, such as women, OEF/OIF veterans, and also homeless patients, special services are also offered. Some types of care include:5
- Initial screening for substance abuse.
- Short-term outpatient therapy and counseling.
- Intensive outpatient treatment for substance abuse.
- Residential treatment programs for substance abuse.
- Medically managed detox if needed.
- Ongoing care, post-treatment support, and relapse prevention.
- Family therapy and marriage counseling.
The Veterans Health Administration provides all eligible veterans with compensation for substance abuse disorders and medication-assisted recovery services. This healthcare is accessed free of charge by most veterans, although some need to pay copays.16
- There are several ways to get help with rehab costs. Some of your options to pay for residential treatment may include:
- Private financing
- Sliding scale options
Also, there are public substance abuse treatment programs such as non-profits. In case you cannot afford care or don’t have insurance to cover any of the expenses, these offer free or low-cost facilities.
- The cost of rehab should not stop you or your loved one from getting the care and assistance you need, even without health insurance. It is possible to pay for the treatment with a credit card or on a sliding scale.Some credit card companies specialize in medical expenses.6 However, there may be limitations on credit cards. The limit may not be high enough in order to fund the cost of treatment.Some treatment facilities will take your income and financial condition into account when charging for treatment, in case you opt for sliding-scale fees. Based on what you earn in a year, they can help reduce the cost of care.
How to Get Help for Addiction Without Insurance?
State-funded recovery facilities may be an affordable choice for individuals without insurance. While they may not be the most advanced, any treatment is better than no treatment at all.
Advantages of state-funded programs:
- Treatment costs little to nothing.
- Substance abuse treatment from qualified specialists.
- Patients are offered community support from other patients and staff.
However, state-funded programs may also bring some disadvantages:
- Due to their affordability, many state-funded facilities have long waitlists for patients.
- Some patients may be released before a comprehensive recovery program has been completed because of the long waiting list.
- State-funded facilities have limited budgets, so they might not be able to offer the most up-to-date services for patients.
- In case you can not afford rehab for yourself or your loved one, there are a few options available:
- Substance abuse treatment scholarships: There are many substance abuse treatment grants and/or scholarships. SAMHSA directory is available to individuals seeking more information.
- Asking friends or family for help
- Getting a loan: If an individual needs assistance to pay for substance abuse treatment without insurance, medical loans, medical credit cards, and personal loans are available to those who qualify via banking institutions.
- Crowdfunding: Creating a public fundraiser initiative where friends and family can contribute can raise a large sum of money for treatment.
- If you are interested in getting into rehab, but cannot afford it in any way, you can:
- Find free addiction support groups.
- Use other addiction resources.
There are support groups for any type of addiction. You will most likely find a support group based on your needs if you live in or near a major city. Also, there are several online support groups that could assist you on your path to sobriety if you do not attend meetings in person.
Additionally, there are many addiction and treatment resources that can help you learn about your addiction and getting help. Valuable advice can be also found in self-help books. However, it is important to stress that individuals struggling with substance abuse should consider finding a way to undergo professional treatment to enhance their health and achieve recovery.
- U.S. Centers for Medicare & Medicaid Services. HealthCare.gov.
- Aetna Insurance.
- Anthem Blue Cross Blue Shield.
- Blue Cross Blue Shield.
- Cigna. Company Profile.
- Healthnet. Provider Search.
- Humana. Company Profile.
- Kaiser Permanente. Fast Facts About Kaiser Permanente.
- Molina Healthcare. Company Info.
- Asuris. About Us.
- Tricare. Plans.
- UnitedHealth Group. About Us.
- HealthCare.gov. Mental health & substance abuse coverage.
- Department of Health and Human Services. (2019). Medicare Coverage of Substance Abuse Services.
- HealthCare.gov. Medicaid & CHIP coverage.
- U.S.Department of Veterans Affairs. Treatment Programs for Substance Use Problems.
- United States Government Accountability Office. (2014). Consumer finance: Credit Cards Designed for Medical Services Not Covered by Insurance.