Addiction Treatment Insurance
Addiction to drugs or alcohol can be an isolating experience, but what few struggling with substance abuse don’t know is that it’s far more prevalent than one might expect. While available data isn’t quite recent, data from 2017 reveals that over 19.7 million Americans over the age of 12 struggled with substance use disorder (SUD). Addiction not only affects you physically, emotionally, and financially, but it has an impact on the family unit, the community, and all the systems nearby that you touch. The longer addiction is allowed to persist, the more damage it does.
This is why the focus on comprehensive care and the need to get it immediately is emphasized heavily for those battling addiction. But if you’ve sought help, you may have one major concern: affordability. Care costs, and not everyone has access to the funds they need to afford drug or alcohol rehab. But what you might not be able to cover completely, addiction treatment insurance can help with. In this guide, we’ll walk through what addiction treatment insurance is, some of the things that you should know in order to take advantage of it, and how it can help you make treatment more accessible.
Understanding Addiction Treatment Insurance
Addiction treatment insurance isn’t its own type of coverage, but rather a form of care covered by various insurance policies. Most insurance providers, due to legislation, are required to offer coverage for mental health care and rehabilitation services. Addiction treatment insurance is often designed to support you through various steps of the process, including medical detox, rehabilitation programs, and even continued mental health support as you navigate recovery post-rehab.
This ensures you’re able to get treatment without worrying about having to cover the full amount on your own. With the financial support offered by insurance, affording rehab becomes much less of a challenge and much more of a reality.
- GHI / EmblemHealth
- Empire Plan Drug Reha Centers
- Empire Plan Drug Detox Centers
- Oxford Health Plans
Types of Treatments Covered by Insurance
It’s important to preface this section and the following sections by stating that how much coverage and the services covered by insurance will vary. Current laws can help you make sure you have access to coverage, but not all plans will offer the same thing.
With that in mind, what might you expect to be covered by insurance? Some of the essential treatment services that could be covered by your insurance plan include:
- Medical detoxification programs
- Residential treatment or inpatient treatment
- Outpatient treatment
- Counseling, therapy, and related mental health (MH) services
- Medication-assisted treatment
- Aftercare and sober living homes
Factors Influencing Coverage
How much coverage you receive is ultimately dependent upon the type of insurance that you choose. There are multiple factors that will impact your coverage for better or for worse. Here are some of the things you need to know before you begin evaluating your insurance options.
- HMOs vs. PPOs: It’s important to know that you have choices when it comes to your insurance, including the choice between an HMO and a PPO. HMOs cost less but require you to get referrals for doctors in-network. Meanwhile, PPOs cost more but offer greater flexibility, allowing you to visit any specialist without requiring you to reach out for a referral and covering you for in-network and out-of-network visits.
- Insurance Providers and Policy Terms: Even if plans may seem similar in nature, the insurance provider behind said plans and the policy terms they lay out can be vastly different. Make sure you understand what your policy offers before you sign up for it.
- Federal and State Laws: Federal and state laws will dictate what needs to be offered to you in terms of substance use disorder and mental health treatment. We’ll touch on this more below.
- Type and Severity of Addiction: The type of addiction you have and the severity of it will naturally impact what type of coverage you receive. This ties into the next point.
- Duration and Type of Treatment: Some policies may only cover 30 days of rehab. Others may only offer support for certain forms of treatment. If you require a longer treatment plan or several types of treatment, you may not always be covered.
The Role of the Affordable Care Act and MHPAEA
The ACA, or Affordable Care Act, and the MHPAEA are two federal laws that greatly benefit those struggling with addiction.
The ACA essentially ensures that all plans being sold through Health Insurance Exchanges and Medicaid plans offer coverage for SUD services. Previously, substance abuse may not have been treated the same as other essential healthcare services. Through the ACA, substance use disorders are now treated as one of ten parts of essential health benefits. This reduces discrimination those struggling with addiction might otherwise face.
The MHPAEA plays a crucial role in reducing discrimination and improving access to SUD services as well. Under this law, large group health plans, as well as some health insurance issuers, are not allowed to impose limitations that make receiving mental health care or substance use disorder care less favorable than the benefits offered for medical or surgical benefits. Parity Laws are crucial because they limit some insurance providers’ ability to try to reduce your benefits for these essential services.
Individual states may also expand upon these laws, requiring other health insurance providers to fall in line with these requirements or requiring them to offer a minimum form of coverage for those needing MH and SUD services.
Tips for Navigating Insurance for Addiction Treatment
Navigating insurance treatment doesn’t have to be difficult or complex. If you’re ready to work toward recovery, here are a few helpful tips that will allow you to find the right insurance for your needs.
- Reach Out to Learn More About Your Coverage: If you currently have insurance, contact your provider to learn more about the details of your policy and what type of coverage is currently being extended to you. If you don’t have insurance, take care to understand all of the details of your desired policy before purchasing it.
- Consult Nearby Treatment Centers: It’s not only important to understand what your insurance covers but also what treatment centers will accept. Consulting nearby treatment centers about insurance can help you determine which options are the right fit for you. You can also ask them about billing and negotiating costs to see how you can make treatment more affordable.
- Take Time to Understand Insurance Costs: While insurance helps you afford necessary treatment services, you’re still expected to cover a certain amount of your care. Conduct further research into any out-of-pocket costs you will be required to pay, what co-pays are required that you’ll need to consistently pay, and what your deductible is so you know how much of your care you will need to cover before your insurance kicks in.
- Explore Alternative Options for Additional Support: Even with insurance, you might not have all the resources you need to comfortably afford care. Explore various opportunities made available to you, including state-offered grants and scholarships that you can use to get treatment.
Proper planning can help you seek treatment with confidence. Using the above tips and reaching out for help when you need it will make it so that you know everything you need to know to get the care you deserve.
The Bigger Picture: Socio-economic Implications
As we discussed above, addiction impacts much more than the individual dealing with it. While the impact is often harmful during the addiction, it can instead be beneficial when care is made more affordable and accessible to those who need it.
Addiction treatment insurance provides prompt and effective care, reducing overall healthcare costs and burdens that would be placed upon the system by those who frequently need care because of their substance abuse. Those who struggle with addiction would be allowed to return to the workforce as well, benefiting the local economy and contributing positively to the community.
Most importantly, it would reduce the negative impact the community faces, including overall crime rates, family issues that perpetuate harmful behaviors and affect multiple generations, and so much more. In many cases, addiction treatment insurance can make all the difference.
Accessible addiction treatment can mean the difference between a healthier individual and community and a lifetime characterized by struggling with the individual and systemic symptoms of addiction. While those with the resources to pay for treatment in full have no issue accessing care, addiction treatment insurance helps to bridge the gap for those who are not so easily able to manage care costs. All in all, it’s important to continue advocating for affordable care, comprehensive insurance coverage, and reduced stigma surrounding those who are battling addiction.
Are you ready to learn more about treatment or take the next steps? Contact us today so we can help you understand the rehabilitation process and give you the support you need to begin your journey.