What Will Insurance Cover for Addiction Treatment?

What Will Insurance Cover for Addiction Treatment?

Anyone struggling with an addiction is likely to have countless questions about detox, rehab – and how to pay for both. Thanks to the Federal Parity Law enacted in 2008, large employers with more than 50 employees who purchase group healthcare plans must secure coverage for employee mental health and drug and alcohol rehabilitation. Additionally, a plan that offers such coverage cannot restrict it any more than coverage for other medical issues like surgeries and emergency care. “Parity” implies that coverage for mental health services and substance abuse treatment is equal to more “traditional” medical coverage.

While the Federal Parity Law ensures large employer coverage for mental health and substance abuse treatment, smaller employers with fewer than 50 employees do not need to meet this requirement. However, many states have enacted their own parity laws concerning mental health and substance abuse coverage for employee insurance plans. Roughly 96% of American employers report that their insurance coverage applies to mental health and substance abuse. When an insurance plan falls under the jurisdiction of both federal and state-level parity laws, whichever one provides the greater benefits applies.

Depending on your health insurance coverage, your plan may cover all or part of your substance abuse rehabilitation. However, it’s vital to carefully review your policy to look for disclaimers or network restrictions. You may need to attend a rehabilitation center from a specified list provided by your insurance carrier or within a certain radius of your primary residence. Some insurance plans will require a referral before coverage applies, and some plans may not cover your type of addiction.

What Does Insurance Cover For Drug Rehab?

If you want to get the most out of your existing insurance coverage, you should first look at the differences in benefit allowance for in-network versus out-of-network care. For example, your plan may cover 100% of the cost of visiting an in-network provider, but only cover 60% of the cost of an out-of-network provider.

You should also investigate your deductible obligation to find out how much you’ll have to spend out of pocket before your insurance coverage takes over. Your plan may also include an out-of-pocket limit. Once you reach this limit, all of your remaining medical expenses for the year receive 100% coverage. Your insurer will also want proof of good faith that you are taking rehab seriously, so you should expect some type of monitoring during your recovery.

There’s no solid answer to what your insurance will cover for drug rehab. Coverage will vary based on insurance carrier, employer, location, state parity laws, and individual details. Some of the largest medical insurers in the country offer drug rehab coverage under certain conditions.

Aetna Drug And Alcohol Insurance Coverage

Aetna offers a variety of drug rehab coverage, and plan details vary by plan option as well as by state. Aetna plans offer coverage for inpatient and outpatient rehab services as well as behavioral health services, so it’s up to you to find a plan that works for you. Some Aetna plans will cover a portion of inpatient substance abuse treatment, outpatient rehabilitation services, and behavioral health counseling. The covered portion of the cost can sometimes exceed $9,000 per individual per the calendar year, depending on the plan. As a baseline, most Aetna plans will offer up to $1,500 toward detox and withdrawal treatment and another $2,500 per year for additional services.

Anthem Drug And Alcohol Insurance Coverage

Anthem is part of the Blue Cross Blue Shield insurance network and upholds the belief that behavioral health is integral to overall health. Anthem plans can include 100% coverage or partial coverage for substance abuse treatment, psychological counseling, and behavioral health services. Policyholders will also have the option of purchasing partial coverage for lower premiums or participating in a health savings account. The exact details of Anthem’s coverage vary from plan to plan.

Assurant Drug and Alcohol Insurance Coverage

Assurant provides a wide variety of mental health and substance abuse coverage options in their insurance plans. Most Assurant plans will cover most inpatient and outpatient treatment services, typically requiring a $30 copay per calendar day. Some plans limit the number of service days you can have in one year while others have no limits. This is especially valuable for intensive treatment programs like inpatient substance abuse rehabilitation.

Blue Cross Blue Shield Drug And Alcohol Insurance Coverage

Blue Cross Blue Shield is one of the largest medical insurance carriers in the country, and the details of a Blue Cross Blue Shield insurance plan will vary on an individual basis. Coverage options vary between states, so it’s vital for policyholders to understand the coverage they have in their state.

While there are limits to certain types of coverage, most Blue Cross Blue Shield plans include coverage for family counseling, cognitive behavioral therapy, medication coverage, and psychotherapy. A distinct benefit to Blue Cross Blue Shield coverage is that there are no dollar limits you will need to meet throughout the year that affects your ability to receive treatment.

Cigna Drug And Alcohol Insurance Coverage

Cigna coverage can include outpatient rehabilitation services, intensive inpatient rehabilitation, and some residential treatments. Like all other insurance carriers, it’s important for policyholders to carefully review the terms of their coverage to confirm in-network and out-of-network rates, disclaimers, and restrictions for coverage. Cigna also has a unique Alcohol Specialty Care Management Team including licensed professionals with training in alcohol abuse disorders. This team helps connect policyholders to providers in their area.

Coventry Health Care Drug and Alcohol Insurance Coverage

Coventry is part of the Aetna insurance network and offers access to the First Health Network, one of the largest and most reputable Preferred Provider Organizations in the country. Coventry also offers Medicare Advantage plans that may cover both inpatient and outpatient substance abuse treatment services.

Harvard Pilgrim Health Drug And Alcohol Insurance Coverage

Harvard Pilgrim offers coverage through United Behavioral Health, a network of specialists and professionals including medical doctors, detox experts, psychologists, psychiatrists, and holistic therapy experts. Harvard Pilgrim also offers family counseling, marriage counseling, and even access to social workers and individual counselors.

Health Alliance Plan (HAP) Drug And Alcohol Insurance Coverage

Based in Michigan, the HAP is part of the Henry Ford Health System and assigns a unique service coordinator to every policyholder. HAP also covers emergency services and urgent care anywhere, even outside of Michigan, and detox and rehab programs throughout Michigan fall under HAP coverage as well.

Humana Drug And Alcohol Insurance Coverage

Humana is one of the largest insurance carriers in the country and offers both individual and group healthcare plans. Every plan is different, and there are several options for coverage for inpatient services, intensive outpatient services, and behavioral health counseling.

Medical Mutual Drug And Alcohol Insurance Coverage

Medical Mutual offers coverage for substance abuse, dependency, individualized therapies, and both inpatient and outpatient addiction care. This insurance carrier also sets itself apart by guaranteeing at least partial coverage for all the typical expenses associated with a rehabilitation program. A Medical Mutual plan may also cover alternative, faith-based, or holistic therapies.

Oxford Health Plans Drug And Alcohol Insurance Coverage

Oxford Health Plans operate under the umbrella of United Healthcare in New Jersey, New York, and Connecticut, but coverage often extends outside of these states as well. As a branch of United Healthcare, Oxford offers a wide variety of individual plan options for policyholders in many states, and plans can cover inpatient, outpatient, and mental health services.

United Healthcare Drug And Alcohol Insurance Coverage

United Healthcare offers nationwide coverage, so you won’t have to worry about traveling out of state for substance abuse treatment. United offers several plans that cover a wide range of treatment options for substance abuse and rehabilitation programs in every state. Coverage can extend from detox through inpatient and outpatient intensive care and behavioral health counseling.

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About James Haggerty

Experienced Chief Executive Addiction Recovery and Mental Health Professional Business professional in the Addiction Recovery and Mental Health industry for the past 26 years. Caring, compassionate and strongly motivated to make a difference in the organizations I am affiliated with and welfare of the population we serve. Currently focused on advocating, educating and developing projects leveraging evidence based, real time technology to support individuals in recovery.