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January 14, 2022

How To Find Out If Your Insurance Covers Rehab

If you suffer from substance abuse and have reached the point where you are ready to make a change in your life, navigating the world of insurance is the last thing you want to do. Luckily, most insurance covers some, if not all of rehab costs.


The first step to addiction recovery is recognizing that you need help. From there, it’s all about putting the miles in to overcome the addiction and take control of your life back. When you make the decision to begin a treatment plan, you need to be able to make a lot of changes in your life. For starters, the way you cope with stressful situations, your hobbies, the way you see yourself, and possibly even your friend group, all might need to change or be adjusted. Before committing to the step of treatment, check out this article about overcoming drug addiction.

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Once you have made your decision to start treatment, handling the payment of the program is the next biggest hurdle. How you will pay for the treatment will determine some of what options you have. If you plan on paying out of pocket, you can determine the best treatment plan based on your needs and your budget. But most people will need some assistance in paying for their treatment plans.


Affordable Health Care Act and Substance Abuse Treatment

When the Affordable Health Care Act (or ACA) was passed in 2010, it put into place many reforms that made healthcare more obtainable and affordable for everyone. The ACA listed substance abuse treatment as an essential health benefit. For more information about the ACA and how it has affected the coverage of treatment, visit https://obamawhitehouse.archives.gov/ondcp/healthcare. Now that treatment is a part of most health care packages, it is easy to find at least partial coverage with your insurance provider.

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Starting in 2014, private and employer-sponsored insurance companies were required to include the coverage of mental health treatments, such as substance abuse. After this change, coverage of these types of treatments increased to 100 percent. There are some exceptions to this law, with some plans being grandfathered in, but most new plans are required to offer treatment for substance abuse in some way. Also increasing since the introduction of the ACA, is the percentage of people using this coverage on their plans.


In 2008, another health act was enacted to ensure that insurance offering coverage for mental health and substance abuse make their benefits comparable to general coverage. This means that all copays and deductibles for substance abuse are under the same guidelines as other benefits offered by the insurance company. This ensures that insurance companies see substance abuse as what it is, a medical disease, and treat it as such.

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Finding Coverage

Finding the coverage you need is easy. The majority of all medicaid and medicare plans will offer coverage for treatments. Private insurance companies, as well as employer-sponsored insurances will most likely offer coverage as well. For example, here are some blue cross blue shield rehab facilities if you have coverage with them. Due to the ACA, failure to offer coverage could result in a penalty for the company, so it is likely most providers will offer some coverage.


Some plans might not offer complete coverage, so if your policy is only partially covering the costs, additional funds will need to be found. Personal bank loans can be taken out to help cover additional medical costs if needed.

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What To Ask Your Provider

Once you have a provider, here are a few questions that will help get you started on your path to recovery.


  1. Make sure you find out what the copay and deductible of your treatment will be. A copay is a fixed fee you pay every time you visit a doctor or pick up prescriptions. Your individual coverage will have a set amount for your substance abuse treatment plan, whether in an in-patient facility, or out-patient care. The deductible is the out-of-pocket amount you must pay before insurance takes over the payment. Again, each of these amounts is based on your individual plan so finding out from your provider will help you make your decisions.
  2. Ask your provider what type of treatment programs your policy covers. There are in-patient rehabs, out-patient care, and medical detoxification. Your particular policy might also cover medications and on-going treatments, such as therapy.
  3. Another important question to ask is how many days of treatment are covered under your plan. Especially for those deciding to do an in-patient program, the length of time covered by your plan will determine your program. Recovery is a long process, so it is important to get the maximum coverage you can for your treatment.
  4. Last, find out from your provider what rehab facilities and treatment centers are covered under your insurance’s network. Finding a facility within your network will ensure that you are getting the most out of your insurance coverage.
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Other Options

If you don’t have insurance coverage and you can’t obtain any through work or a spouse, there are other options. Some state-run facilities have government grants intended to help those without coverage get the help they need. These facilities can still provide care, based on the individual’s need and income. The downside to these facilities is the grants can only be given when there is money available, and the choices for treatment centers and programs will be limited.


Don’t let the anxiety of dealing with finding funding get in the way of your individual treatment. Addiction is a disease and must be treated as such. Finding the right treatment and care is the only way to get your disease under control. Partial or full coverage should be a part of your insurance plan. If you need assistance with finances, government grants, or individual loans can cover the discrepancies.

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Now that you are ready to take this step, and make positive changes in your life, don’t waste any time. Call your provider, ask your questions, and make a plan to improve your health, and overall life.





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