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Guide to Addiction Treatment Health Insurance

Addiction Treatment Health InsuranceTreatment for substance use disorder comes in many forms. Generally the most effective course starts with detox (7-10 days), inpatient residential care (30-90 days), and then outpatient care. All of these levels of care include some combination of behavioral and medical treatment modalities. More than 14,500 treatment centers offer help for addiction within the United States. Care teams at these centers typically include some combination of counselors, physicians, psychiatrists, psychologists, nurses, and social workers. Drug abuse and addiction represent major public health problems, so most insurance plans offer comprehensive coverage. However, this varies by the type of plan. Insurance policies offer various levels of addiction treatment health insurance coverage depending on how the person qualifies based on:

  • Drug/alcohol use history
  • Amount of times the person went to treatment previously
  • Level of care needed
  • Frequency of outpatient visits
  • Services provided by the treatment center

Do All Health Insurance Plans Cover Treatment?

Care centers offer help with the many aspects of life affected by addiction. Private insurance plans, such as those provided by an employer or purchased through a state exchange, offer the most comprehensive coverage for treatment. Treatment centers that take private insurance also tend to have much lower waiting times than publicly funded institutions. Unfortunately, long wait times often translate to not getting treatment as the “window of willingness” to get help may not stay open for long enough. But treatment saves lives. In fact, insurance plans cover addiction treatment for a more cost-effective approach.

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Active drug or alcohol addiction incurs many ancillary long term healthcare costs. Obvious examples include trips to the ER or ambulance rides from an overdose event. But due to the nature of addiction, individuals suffering with the disease also symptomatically neglect their own health and wellbeing. By skipping preemptive care and overlooking early symptoms of issues like infections or diseases, healthcare costs go up exponentially. Self care represents a large tenet of addiction treatment, so it naturally helps lower lifetime health insurance costs. Comprehensive addiction treatment health insurance plans will cover more treatment services.

Does State Insurance Cover Rehab?

Although low income insurance plans such as Medicare and Medicaid do not cover treatment at many centers, individuals and families do have additional options. California in particular offers many excellent plans on its state exchange. Thankfully, the ACA declared into law that addiction cannot be defined as a pre-existing condition. So most insurance plans will cover detox, residential, and outpatient. These insurance plans offer coverage for individuals or families seeking treatment for substance use disorder.

What Do ACA Insurance Plans Cover in Treatment?

ACA (Affordable Care Act) insurance plans typically offer comprehensive coverage for substance use disorder treatment. The ACA classifies mental health like any other physical condition and mental illnesses/behavioral disorders receive coverage accordingly. ACA plans have parity and cover all of the following:

  • Outpatient care
  • Inpatient care (coverage varies by individual plan)
  • Treatment medications
  • Family therapy
  • Individual therapy
  • Medication-assisted treatment

Due to its high cost, the coverage for detox depends on the level of plan. California offers excellent ACA-compliant plans on the state insurance exchange. These plans will vary in how long they cover various levels of care. Treatment centers can run benefit plans to determine what length of stay any individual plan covers. Costs for plans offered through state exchanges typically vary by an individual’s income, age, and household size.

What Do Private Insurance Plans Cover?

Addiction treatment health insurance plans issued by employers or purchased through a state exchange will offer various levels of coverage. Detox represents one area of care that is particularly high cost, so not all insurance plans cover it fully. Plans will also vary in how long they will cover various levels of care. For example, they may only cover the first 30 days of inpatient care. Reputable treatment centers will relay coverage information after running benefit plans, or individuals can contact their insurance companies directly to check. Previous stays in treatment may also impact levels of coverage. In general, insurance companies will not cover treatment indefinitely if the individual repeatedly relapses or drops out of a program.

Generally, treatment facilities keep professionals on site who can determine the level of coverage offered by your or your loved one’s insurance policy. Blue Coast Behavioral Health runs confidential verification of benefits at any time for those seeking help: 855-997-4702

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What if I Don’t Have Addiction Treatment Health Insurance?

Treatment centers operate either through taking insurance plans or through state funding. Individual who do not have health insurance may pay out of pocket for treatment at these facilities. Alternately, programs such as the Salvation Army offer free rehab services. These programs typically maintain waiting lists due to demand. They provide counseling, assessments, and transitional living arrangements to low- and no-income families.

If you or a loved one is seeking help for a substance abuse problem, fill out our contact form today to get help.