Substance use disorder (SUD) remains a major public health issue, affecting over 40 million people aged 12 and above in the US. Unfortunately, only 1 in 6 of these individuals who need proper care and support receive it.
In 2025, provisional data from the Centers for Disease Control and Prevention reported nearly 70,000 overdose deaths.
The cost of rehab is a major obstacle for many people struggling with addiction. It’s not uncommon for those living with SUD to refrain from receiving treatment because they can’t afford the expenses.
The good news is that, under the Mental Health Parity and Addiction Equity Act (MHPAEA) and Affordable Health Care Act, insurance providers are now required to cover substance abuse treatment.
If you live in New York and have health insurance through the New York State Health Insurance Program (NYSHIP), you may wonder whether your plan can help with your or a loved one’s substance abuse treatment.
Here’s everything you should know.
Does the Empire Plan Cover Addiction Treatment Services?
Yes, the New York State Health Insurance Program does include comprehensive benefits for addiction care and treatment. This applies to New York State employees, retirees, and their dependents.
You can be eligible for NYSHIP insurance if you are:
- Actively working a state government job in New York for 20 or more hours weekly
- Earning at least $2,000 annually
- Working for three consecutive months (may vary based on employer)
- Completed a standard 28-day waiting period
- A retiree who meets the service credit and enrolled as an employee or dependent before your retirement date
The Empire Plan, NYSHIP’s primary health plan, usually covers 100% of the cost for outpatient care for members who meet the deductibles. The insurance can be used wherever and isn’t limited to New York State.
Carelon Behavioral Health administers the Empire Plan’s Mental Health and Substance Use Program. UnitedHealthcare is responsible for NYSHIP’s Medical/Surgical program.
It’s worth noting that the Empire Plan may not provide the same behavioral health benefits to everyone.
There may be out-of-pocket costs to consider (copayments, deductibles, coinsurance limits, etc.). Requirements may also vary if you’re receiving care from a participating or non-participating provider, outpatient or residential treatment.
Moreover, some services may require prior authorization before they’re eligible for the benefits.
Before committing to a rehab center, it’s best to confirm that you’re enrolled in the Empire Plan through NYSHIP and learn about the levels of care that can be covered.
What Types of Treatment Does the NYSHIP Cover?
The Empire Plan covers a whole range of substance use disorder treatment and interventions that may help you or a loved one overcome addiction.
However, treatment can wildly vary from one recovering individual to another. Depending on the level of care you need, healthcare providers may recommend the following services.
Medical Detox
NYSHIP’s Empire Plan may cover medical detox as a key part of its substance use disorder benefits to manage acute dependence.
Detoxification is the usual first step to alcohol and drug addiction rehab. This is the process where the patient abstains or cuts back drinking to rid the body of the substance.
However, when someone becomes physically dependent on drugs or alcohol, detoxifying can lead to a string of uncomfortable and sometimes life-threatening symptoms. This is why opioids and benzodiazepines may require tapering.
Medical supervision during detox can significantly reduce the risk of withdrawal. Physicians may also use prescription drugs to alleviate symptoms and manage pain.
Outpatient Treatment Programs
Outpatient care, also called day programs, is a rehabilitation arrangement in which patients can continue living at home while receiving support.
This can be ideal for those who can’t afford to pause their lives to recover from an SUD.
There are different levels of outpatient care depending on the person’s circumstances. There are standard outpatient care, intensive outpatient programs (IOP), and partial hospitalization programs (PHP).
A PHP is the most intensive type of outpatient treatment, involving 5 to 6 hours of daily therapy and medication. NYSHIP insurance may cover both IOP and PHP.
The overall duration of outpatient support is typically based on clinical need.
Inpatient Rehabilitation
Inpatient rehab is a supportive environment for individuals living with moderate to chronic addiction and those requiring trauma-informed care. This allows patients to focus on recovery away from everyday triggers.
NYSHIP lists inpatient treatment and residential rehab for drug and alcohol addiction treatment as part of its benefits.
During inpatient care, patients receive 24/7 medical and emotional support. Its duration can range from 30 to 90 days, or longer, depending on the severity of SUD.
NYSHIP may require pre-authorization before an inpatient admission.
Medication-Assisted Treatment (MAT)
MAT is an evidence-based approach to rehab and a core component of many dual-diagnosis treatment programs for co-occurring ailments.
The goal of MAT is to stabilize the individual and reduce painful and uncomfortable withdrawal symptoms while recovering. It combines FDA-approved medications, behavioral therapies, and counseling.
NYSHIP may cover prescription medications, including naltrexone, buprenorphine, acamprosate, and disulfiram, as part of medication-assisted treatment.
If your physician recommends MAT, check your health insurance benefits and which prescription drugs are included.
Family Therapy
While addiction is often considered a personal struggle, its causes and consequences rarely only affect the individual. The condition can impact relationships with friends and family members.
Family counseling can decrease stress, teach coping skills, promote family cooperation during rehab, and is included under the Empire Plan’s benefits.
Based on medical necessity, NYSHIP may also cover the costs of other types of therapies, including those for couples, individual, and group therapy.
Aftercare and Relapse Prevention
Aftercare refers to services provided by addiction treatment centers and clinics after a patient finishes residential rehab. They help the individual transition back into their regular life without returning to old patterns.
Stepdown outpatient services like home-based counseling, IOP, and PHP are examples of this and are covered by NYSHIP.
Other examples of useful relapse-prevention initiatives rehab centers may provide are sober living homes, alumni programs, 12-step groups, and practical online support. Most of these aim to provide continuous guidance to reduce the likelihood of relapse.
Does the Empire Plan Only Cover In-Network Providers?
The Empire Plan can cover both in-network and out-of-network providers. However, the specific health benefits and reimbursement structures may differ.
Using the facilities and healthcare professionals of a participating provider typically gives you the highest level of coverage. This means less out-of-pocket expenses, though it generally comes with a fixed copay.
Opting for a non-participating provider can mean potentially facing higher deductibles and coinsurance.
That said, an out-of-network center can still be worth considering for several reasons.
For instance, in-network treatment providers often have a waiting list. In situations where immediate admission is necessary, a non-participating rehab center may offer intervention more promptly.
This can be important, as fast access to addiction treatment can significantly reduce the risk of overdose. Timely interventions also improve long-term recovery outcomes.
Another reason is if you’re looking for specific amenities or specialized care a participating provider doesn’t have. This can be private accommodations or a program designed around specific substances.
To ensure high-quality treatment that meets clinical and safety standards, you can refer to the Office of Addiction Services and Support’s (OASAS) official list of accredited providers.
What Are Other Ways to Pay For SUD Treatment?
There are other ways you can pay for your or a loved one’s rehab besides NYSHIP. Here are some ways you can look into:
- Sliding Scale and Income-Based Pricing: People with lower income can qualify and have their rehab cost adjusted based on their earnings. It’s usually available in non-profit rehab centers and community programs.
- SAMHSA Grants and Scholarships: The Substance Abuse and Mental Health Services Administration offers grants that allow those who struggle with substance abuse to get help regardless of their capacity to pay. Some facilities also have scholarship programs.
- Employee Assistance Programs (EAPs): While they don’t usually pay for rehab, EAPs can provide short-term support, free SUD evaluations, and professional referrals.
- Medicare and Medicaid: Seniors (people over 65) who have paid Medicare taxes for at least 10 years and are struggling with addiction can use it to pay for therapy and MAT. Those who meet low-income thresholds can apply for state-funded Medicaid.
Compassionate Drug Rehab in Hudson Valley, New York
Fighting addiction can feel like an uphill battle. But with proper care and professional support, you can overcome this chronic condition for good.
For those enrolled in NYSHIP and ready to proceed to the next step, Mid Hudson Addiction Recovery centers offer a wide range of treatment, from medical detox to inpatient rehab and outpatient services.
We understand how SUD can be different for everyone. That’s why our focus is providing personalized interventions to match your unique needs. Our healthcare providers also specialize in gender-informed care.
We’re here to support you every step of the way. Speak with our compassionate advocates and rebuild your life with Mid Hudson Addiction Recovery!