Certain institutions such as the American Medical Association consider alcohol or drug addiction to be a disease, which means that insurance firms must cover it. This is included in provisions such as the Mental Health Parity and Addiction Equity Act as well as the Affordable Care Act. Whether your policy is private or public rehab insurance must be offered in the same manner that coverage is available for other health problems.
Things That Insurance Typically Covers
In the past, insurance providers were able to deny individuals who had preexisting conditions which included drug addiction. Today, drug addicts who desire to enter rehab, but who do not have the funds to pay the full cost out of pocket can obtain insurance, which means that their out of pocket expenses will be much lower.
However, it is important to remember that insurance policies will vary from one provider to another. Services which are commonly provided by most policies include detoxification, assessment, and inpatient and outpatient treatment. These services are fully covered, mostly covered or partially covered. It is important to do your research and read insurance policies carefully to determine exactly how much you will be expected to pay. The good news is that insurance coverage for rehab will be equal to what you would expect for other health issues, but it must be considered a medical necessity.
The term “medical necessity” is defined by the government as medical services or products which are a necessity for detecting and treating an injury or disease in a manner that is acceptable by current medical standards.
Figuring Out Your Coverage
You will first need to contact the member services of the insurance company that provides your coverage. When talking to the representatives, be sure to have a pen and paper handy so you can jot down important information. Ask them which “levels of care” are provided for substance addiction. Ask about inpatient/outpatient care, detox and assessment. Find out the specific percentages which are covered for these services, as well as the deductible and co-pay. One of the most important things to determine is your maximum out of pocket costs, as this can help you establish a budget for rehab. Most insurance companies will have criteria, so find out what this entails.
Medicaid and Medicare
While both Medicaid and Medicare are insurance plans which are sponsored by the government, they may only cover screening for substance addiction, as opposed to actual treatment. Medicare applies to individuals who are over the age of 65 or who have a serious disability. Medicaid, by contrast, is designed for households which are low income. Medicaid will vary from state to state but will cover inpatient and outpatient care provided the rehab center accepts it.
The health insurance marketplace is another popular option. It offers insurance plans which are provided by state governments. These plans will cover substance addiction to a certain extent, which will vary from state to state. Typical things that will be covered under these plans include assessment, outpatient care and detox.