Navigating Insurance Coverage for Addiction Treatment

Ready to get drug or alcohol addiction treatment but scared about the bill? Don’t worry, chances are your insurance will fully cover it. Don’t have insurance? Not a problem, we will look into what you can do if that’s the case too.

Does Insurance Cover Addiction Treatment?

The short answer is yes, health insurance does cover substance abuse treatment. But there might be some nuances that come with it. 


Many health insurance plans offer coverage for substance abuse treatment, although the extent of coverage and out-of-pocket expenses may differ. 


The policy and insurance provider are the key factors that determine the application of addiction treatment coverage. 


Typically, insurance covers a range of 30% to 100% of substance abuse treatment costs following the fulfillment of the deductible.

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

Substance abuse treatment is one of the essential categories of coverage under the Affordable Care Act (ACA).  This means that insurance coverage for addiction treatment is mandatory in the United States. 


In America, substance abuse treatment must be provided to the same extent as other medical and surgical treatments. Despite not having a policy at the time of addiction, it is still possible to receive insurance coverage for substance abuse treatment. 


The Affordable Care Act safeguards addicts seeking treatment by covering pre-existing conditions. As a result, addicts can apply for insurance and access healthcare services, regardless of their stage of recovery. 


Therefore, even without insurance, individuals can still explore the marketplace, obtain a policy, fulfill any deductible requirements, and access the necessary treatment.

Does Medicare and Medicaid Cover Addiction Treatment??

In the United States, Medicare and Medicaid are government-sponsored health insurance programs. It is common for these plans to cover screening for substance abuse, but not always treatment. 


Medicaid is a government-sponsored plan that provides assistance to low-income individuals and households. The terms of Medicaid may vary by state, but it does cover inpatient and outpatient care in centers that accept it.

Which Types of Substance Abuse Treatment Does My Health Insurance Cover?

When it comes to health insurance for addiction treatment, not all plans are the same. The treatment you receive will depend on the facility’s costs.


With premium plans, they’ll likely cover most of the bill but be prepared for higher costs with policies and deductibles. They might even include luxury facilities. On the flip side, basic plans might have fewer benefits.


To figure out what your insurance covers, reach out directly to them or chat with an admission counselor at a rehab facility. Changing your insurance plan is also an option under the Affordable Care Act, although it might take a bit longer.


At a minimum, you could expect policies to cover some or most of the following treatments


  • Behavioral health treatments such as counseling and psychotherapy
  • Mental and behavioral health inpatient services
  • Substance abuse treatment such as detox and outpatient care

Insurance Companies That Cover Substance Abuse Treatment

Finding out if substance abuse coverage is included can be challenging as it’s not commonly advertised by most providers. 


However, there are companies that have previously offered health insurance for addiction treatment


  • Blue Cross Blue Shield
  • Humana
  • Aetna
  • UMR
  • Vela Point
  • Beacon Health
  • United Healthcare
  • Multiplan
  • Geha
  • Cigna
  • CoreSource
  • Gilsbar
  • Anthem
  • Value options

What if Your Claim Is Denied?

In some cases, you could be denied coverage from your health insurance for addiction treatment. If so, you can always appeal their decision.


Typically, you’ll need an official denial before you can file an appeal. It’s important to keep all your coverage information, call notes, insurance provider correspondence, and the names of representatives handy to support your claim. 


The time for the appeal process can vary, ranging from 30 to 60 days with some expedited cases being resolved in just a day.

Financing Addiction Treatment

Don’t let financial barriers stop you from seeking recovery. There are countless ways for addicts seeking recovery to secure funding for their treatment journey. 


Many treatment facilities offer flexible payment plans tailored to individual financial situations. Private funding opportunities may also be within reach for some.


Don’t forget about government programs like Medicaid or Medicare, specifically designed to support treatment initiatives. 


Additionally, certain states provide grants or scholarships to help cover treatment costs. To navigate these options, consider reaching out to an admissions counselor who can guide you through the process.


At Veritas Detox, our admission counselors are well-versed in dealing with insurance providers and can offer invaluable expertise. 


Unsure if your insurance policy covers the treatment you need?  Reach out to Veritas Detox  today and let our dedicated counselors assist you on your recovery journey.

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