How Is Addiction Recovery Covered Under Insurance?

Getting Help For Addiction

If you or someone you love is struggling with an addiction, you might be concerned about how addiction recovery services will be paid for. In fact, worrying about how much these services cost and whether they are affordable is one reason that some people don’t get help for their addictions. The good news is that in many cases, health insurance will cover at least some of the treatment. When a person is uninsured or underinsured, there are other programs available to help. Read on to find out how various programs make it possible for people to get the care they need.

 

How Much Addiction Recovery Costs

It might be helpful to know that there are many different options when it comes to choosing the recovery program that is right for your particular situation. Your budget and the type of financial help available can factor into that. Not having the funds for an expensive program does not mean that you simply do not get the care you need.

Outpatient care is, of course, less expensive than inpatient care, and not everyone with an addiction requires an intensive program. Talk to your addiction specialist about what type of program is right for your type of addiction. You might be referred to a program that is doable with your budget, particularly if your health insurance is paying some of the bills.

 

The Affordable Care Act

In 2014, the healthcare laws in the United States changed thanks to the Affordable Care Act, which is sometimes called “Obamacare.” The ACA compels health insurance policies to cover certain basic services, and one of those services drug addiction and substance abuse recovery programs. This includes counseling, rehabilitation, and prescription medications that are needed to help a person recover from their addiction.

If you have an ACA-compliant plan, you might have a deductible that needs to be met before the plan will pay for the rest of your care. If you have met the deductible (or part of the deductible) by paying for health services, that will reduce the amount you have to pay. You also might have a copayment or coinsurance amount that you need to pay. A copayment is a set dollar amount that you have to pay each time you see your counselor or specialist. For example, you might pay $20 or $35 for each appointment. Coinsurance is a percentage of treatment costs that you must pay if you are in an intensive outpatient program or a residential (inpatient) program.

The staff at your recovery center will be able to work with you to tell you what is covered and what is not covered under your ACA-compliant plan. Remember that with ACA plans, there is no waiting period or exclusion for pre-existing conditions, so even if you have gone to recovery in the past, it will still be covered. Unless you have recently had a life-changing event (the loss of a job, a new pregnancy or new baby, a move to a different area), you will need to apply for ACA insurance during the open enrollment period, which is currently in late November and December. You can review the different ways to apply at HealthCare.gov.

 

Medicaid and Medicare

If you are 65 or over or if you have certain disabilities, you likely qualify for Medicare, which is government-subsidized health coverage for senior citizens and some others. Medicare will cover most costs associated with rehabilitation for addiction, including counseling, inpatient care, outpatient care, and the medications required during an inpatient stay. Medicare will not cover methadone and similar drugs that are prescribed for drug addiction, however.

Medicaid is a type of government-funded health coverage that is for low-income individuals and families. The income requirements are higher for children and teens under the age of 19, so if you have a teenager who needs addiction recovery treatment, he or she might qualify for Medicaid. Medicaid will cover addiction recovery services and the medication required for treatment, but not every provider accepts Medicaid.

 

Other Programs That Can Help

What can you do if you don’t have an ACA-compliant plan or if your deductible and copayments or coinsurance payments are too much for you to pay? It might help to look into free clinics in your area. Those that provide mental health services often also provide addiction recovery services. These will usually be on an outpatient basis or, in some cases, a very short-term inpatient program, such as three or five days. They can help you get sober and start you off on the right foot toward permanent sobriety.

You might also be able to find a provider who will accept payment on a sliding scale. That means that they will look at your financial information and determine what their formula says you should be able to pay. If your income is low, your payment will be low.

State-funded agencies are another option. These are funded by each state or by grants from the Substance Abuse and Mental Health Services Administration (SAMHSA), which is a federal agency. You will need to have proof of residence, proof of income, and meet some additional qualifications. You can find a list of agencies to contact here.

Getting help for an addiction can seem like an overwhelming obstacle. Take it one step at a time and don’t worry about the total price tag of the treatment, because chances are very good that there will be one or more programs or health coverage options that can help you. Talk to your addiction specialist, mental health counselor, or primary care physician. They will be able to direct you toward national, statewide, and local programs that can help you afford the care that you need.