Insurance Coverage For Addiction Treatment

Medical insurance covers the treatment of addiction and mental illness. By passing the Affordable Care Act, more Americans now have access to these types of treatment. Plans may vary in the type of coverage they provide or for how long they will cover the treatment, therefore it is better to check with your insurance or the rehabilitation program you are interested in attending.

What type of health insurance coverage is available for addiction treatment?

Nearly 91 percent of Americans had health insurance in 2014. Depending on the specific details of the plan, those with insurance can use coverage to:

  • Internal care in an approved center
  • Outpatient care with an approved provider
  • Medical detoxification, including medicines
  • Concurrent Mental Health Conditions
  • Follow-up counseling
  • Addiction maintenance medications

Medical insurance was previously considered a luxury. People with tight budgets and low paid jobs did not have the cash needed to buy expensive insurance plans. Therefore, they tried to save money for serious situations. Everything else was not about. Many times, that meant that addictions were not treated. For people without medical insurance, getting medical care for addiction was too expensive.

Much has changed as the Affordable Care Act passed. Now more people who never have health insurance. In fact, according to the Kaiser Family Foundation, only 13 percent of Americans had no insurance in 2014. All others had the necessary coverage to deal with their health problems. These plans typically include coverage for mental illness and addiction, although there are limits and specifications to which they should pay attention so that families get the real benefits they need at the right time.


The amount of coverage or acceptance of insurance is based on each client’s insurance plan. This means that out-of-pocket expenses will vary. Please contact Z Rehab Centers to help you determine what your plan covers.

What Drug Addictions Does Medical Insurance Cover?

HealthCare reports that plans that participate in the Insurance Marketplace must provide care in 10 essential health categories. One of them is the care of addiction.

Many private plans also take these rules to participate in the Market at a future date. Most insurance policies do not separate drugs into “covered” and “non-covered” categories. If addiction treatment is considered a covered benefit, care is provided to anyone who has an addiction, regardless of what caused the addiction. This is the same model that medical insurance programs use to treat other medical conditions.

For example, some people develop obesity through overeating, and others develop weight difficulties due to abnormalities of glands and hormones. Insurance programs that provide a weight loss benefit do not cover one type of weight loss while eliminating the other. This would make the plans much more expensive because insurers would have to investigate the medical history of each person in need of care, and the plans would have to cover sophisticated evidence to determine the origin of obesity. By covering all obesity treatments, the plan saves money. The same is true for addictions.

The administrators of the plans do not want to cover deep evidence or interviews about what type of drugs were used, how the drugs were developed, where they came from, or with which they were mixed. Plans can keep everything simple by covering all drugs, if they offer addiction care benefit.

Covering addiction care also helps states keep costs down. For example, a PBS report suggests that jailing an adult for one year can cost up to $ 37,000, while providing residential care for addiction costs only $ 14,600. State-managed plans could provide well-developed addiction care for all drugs simply because doing so could keep other costs online.

Private plans can benefit if addicted people do not fall into emergency rooms due to addiction and overdose. By providing addiction care, they can also reduce the number of organ transplants that they may have to cover. When it comes to savings, robust care for all drugs may be the best way, and some insurance plans do just that.

This means that anyone who has questions about which drugs are covered or not covered can look at this page and get clear answers in just minutes. That page is a good beginning for anyone with questions about addiction treatment.

What types of rehabilitation centers are covered?

A summary sheet can help families understand what type of drugs are covered or not, but it will not provide the full extent of addiction care that families need to understand before enrolling. For example, the sheet may not provide details about the names of the centers and other characteristics that families use.

The National Institute of Drug Abuse reports that, in the United States alone, there are more than 14,500 specialized treatment facilities for drug abuse. Even if an insurance plan has coverage for addiction, it may be that not all facilities are covered in the plan.

Some insurance programs have special agreements with vital service providers. With these agreements in force, providers agree to offer a specific type of care at a specific price, and in return, the insurance plan agrees to send referrals to that center. Mental Health America He suggests that people with these types of plans may ask their doctors for the names of the centers or professionals that the insurance considers a network provider, although many centers that specialize in addiction would answer your coverage questions with pleasure. It may be that a short call to the provider is all that families need to answer this question. In addition to concerns about network coverage, there are also issues about the types of addiction care. Addiction treatment facilities may offer different types of care, including:

  • Inpatient Detoxification
  • Outpatient detoxification
  • Partial hospitalization
  • Residential rehabilitation
  • Outpatient rehabilitation

Some plans provide coverage for each type of approach on this list. KPCC in California suggests, for example, that Medi-Cal provides inpatient detoxification, residential treatment, and outpatient counseling. That is the full spectrum of addiction care, all under one plan. But some programs offer coverage for only one type of care, and may limit the time someone can access that care.

This is a great question for insurance plan administrators, or families can ask the addiction center admission coordinator to investigate on their behalf.

What Mental Health Matters Does Insurance Cover?

The legislation that passed as part of the Affordable Health Care Act does not stop with addiction care. As part of the law, plans also have to provide the same level of care for mental health issues that they provide for physical health conditions. That means that plans that provide medical visits for $ 20 for a foot problem also have to offer medical visits for depression for $ 20. The care and cost have to be the same. The American Psychological Association says that these parity laws apply to all types of programs, including those provided by employers, those that come from the swap, and those that come from Medicaid or CHIP.

Parity laws do not explicitly say what types of mental health conditions the plans should cover, but the laws are similar to those seen with addiction. If a plan covers the care of mental illnesses, they usually do not specify that some diseases are covered and others are not. This would require a lot of paperwork and time, and most administrators don’t have much of either, so the plans simply cover everything. Again, this is an issue that is best discussed with a plan administrator. But in general, fears that mental health issues are not covered because they are “bad” are typically unfounded. This is not how medical insurance works.

Are Maintenance Programs Covered?

Maintenance programs are designed for people who cannot function at a normal level without drugs, even if they have gone through a rehabilitation program. The chemical imbalances caused by drugs are too severe in these people, and they need medications to correct those imbalances and to be able to live a life free from the influence of drugs. Maintenance medications such as Suboxone, buprenorphine, and Antabuse are made for these types of problems, but they can be expensive. Fortunately, most experts say that insurance plans typically cover these medicines.

The National Alliance of Buprenorphine Treatment Advocates says, for example, that most health insurance plans cover maintenance medications for people recovering from addiction to heroin and other similar drugs. The organization does not specify how many plans offer this coverage or what would be the typical co-payments, but the group is confident that most of the plans provide this benefit.The Substance Abuse and Mental Health Services Administration says, on the other hand, that Medicaid and Medicare plans only cover these medications if their use is considered vital for the continued health of the person in recovery. If they believe that the person is able to heal without medication, coverage will not be provided under these plans.

These opposing views clarify that plans can treat addiction maintenance care in different ways. Therefore, it is worthwhile for families in need of this care to ask about coverage, co-payments, and therapies before starting them. Some programs may have extensive coverage while others do not.

Using Insurance

Health insurance benefits are designed to make health care affordable and accessible. People with addictions and with insurance should use their coverage to the fullest to obtain the necessary care to leave addictions behind.

A good start is to talk with the plan administrators, but remember that the team at the treatment centers can also offer essential help.

In some cases, they can smooth the path to payment so that families have less to worry about recovering.

Useful Health Insurance Resources

  • Department of Health and Human Services : Read precisely what is in the Affordable Care Act.
  • HelathCare: The official ACA website. Find out if you can qualify, enroll, or make changes to your insurance.
  • Medicaid: See how the ACA works for those who receive Medicaid.
  • Internal Revenue Service : Educate yourself about the tax provisions of the ACA and how they could affect the way you file your return.
  • State Health Insurance Assistance Program : SHIP provides free insurance, counseling, and assistance information for Medicare beneficiaries and their families, friends, or caregiver.
  • Help Selecting a Plan : HealthCare.Gov also offers a concise online guide to understand insurance plans.
  • National Committee for Quality Assurance : NCQA 2015-2016 Insurance Plan Classifications – Summary Report


  • Aetna
  • Anthem
  • Centene Corporation
  • Cigna
  • Magellan Health
  • Molina
  • United Healthcare
  • Wellcare

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