Topic: Does Health Insurance Cover Drug Rehab?
Does your health insurance cover drug addiction treatment?
Health insurance plans will cover treatment for drug addiction, addiction, and mental health disorders. With the passage of the Affordable Care Act, more Americans now have access to these forms of treatment. Plans can vary depending on the type of insurance coverage they provide or how long they will cover alcohol or drug addiction rehab, so it’s best to check with your provider or the treatment center you’re interested in.
What types of drug treatment programs are covered?
About 91% of Americans had health insurance in 2014. According to the details of the plan, those with insurance can use this coverage to:
Health insurance was once considered a luxury. People with tight budgets and low-paying jobs may not have had the extra money they needed to buy expensive health care plans, so they tried to save enough money to afford them. To seek treatment for problems considered potentially fatal. Everything else has not been resolved. Often this meant that the addictions were not being addressed. For people without health insurance, getting drug addiction care was too expensive to consider.
Much of that changed with the passage of the Affordable Care Act. Today, more people than ever have health insurance. According to the Kaiser Family Foundation, only 13% of Americans did not have health insurance in 2014.
Everyone else had the coverage they needed to deal with health issues. These plans typically include coverage for mental illness and addiction. However, some limits and specifications must be met for families to get the real benefits they need at the right time.
The two most common health care plans are HMO and PPO. Your insurance provider may cover drug addiction treatment and recovery. Learn more about which plan, HMO or PPO, offers the best coverage:
Health Maintenance Organization (HMO) plans allow patients to choose their primary care physician and see that physician for most of their medical needs. This allows them to establish a relationship with a doctor who knows all of their medical histories.
When looking for an out-of-network specialist or doctor, your primary care physician needs a referral.1 HMOs have lower or no deductibles, and general coverage often costs less than PPO. The benefits of HMO coverage are for those who are not looking for a specialist and healthcare providers outside of their network and paying lower premiums.
Preferred Provider Organization (PPO) plans allow patients to see healthcare providers in and out of their network without a referral. PPOs may have higher deductibles than those with an HMO scheme. Off-network providers without a referral from your primary care physician.
Does Health Insurance Cover Drug Rehab?
What addictions does the insurance cover?
HealthCare.gov advises that plans participating in the marketplace must provide care in 10 essential health categories, one of which is addiction care. Many private health insurance plans also follow these same rules, so they could be sold on the market later. Most insurance policies do not divide drugs into “covered” and “not covered” categories.
If addiction treatment is considered a covered benefit, then care is provided to anyone with an addiction, regardless of the cause of the addiction. It is the same model that health insurance programs use to treat other medical conditions.
For example, some people develop obesity from overeating, while others develop weight problems due to hormonal or gland abnormalities. Health insurance programs that provide a weight loss benefit do not cover one type of weight loss and eliminate the other.
This would make plans much more expensive, as insurers would have to dig into the medical history of each person in need of care, and the plans would have to cover sophisticated tests to determine how obesity arose. Simply by covering all obesity treatments, the plan can save money.
The same goes for dependencies. Plan administrators don’t want to cover in-depth tests and interviews about the drugs used, how the drugs were developed, where they came from, and what they are mixed with. Plans can keep things simple by covering all drugs if they provide an addiction care benefit.
Under the Affordable Care Act, insurance plans must provide a one-page summary of benefits and therapies, along with their fees, according to the U.S. Department of Health and Human Services.
Supporting addictions can also help states cut costs. For example, a PBS report suggests that jailing an adult for a year can cost up to $ 37,000, while residential drug addiction care costs just $ 14,600. State-run plans could provide robust all-drug addiction care simply because they would keep other costs in check.
Private plans can pay off if addicts don’t end up in expensive emergency rooms due to addictions or overdoses. By providing care for addictions, they could also reduce the number of organ transplants they might need. When it comes to savings, rigorous care of all medications may be the best solution, and that is exactly what many insurance plans do.
This means that anyone who has questions about what medications are and are not covered by insurance can simply go to this page and get clear answers in minutes. This page is a good first stop for anyone with questions about drug treatment.
What types of rehab centers are covered?
A summary sheet can help families, and loved ones understand what types of drugs are covered and what is not, but it may not provide all the addiction care families need to understand before enrolling. For example, this sheet may not provide details on the names of the treatment providers’ facilities and the features that families can use.
The National Institute on Drug Abuse reports that there are more than 14,500 specialty drug treatment centers in the United States alone. Although a health plan may provide coverage for drug addiction, not all facilities may be covered by the plan.
Some insurance programs have special agreements with vital service providers. With these agreements in place, providers agree to offer a specific type of care at a specific price, and in return, the insurance plan agrees to provide referrals to that facility. Mental Health America suggests that people with plans like this can ask their doctors for the names of facilities or professionals that the insurer considers network providers, but many drug addiction facilities are happy to answer questions about coverage. A quick call to a provider may be enough for families to answer this question. In addition to concerns about network coverage, there are issues related to the types of addiction care.
Substance abuse treatment facilities can provide different types of care, including:
- Inpatient Detox
- Outpatient Detox
- Partial Hospitalization
- Residential Rehab
- Outpatient Rehab
Some plans cover all the types of approaches on this list. KPCC in California, for example, suggests that Medi-Cal provide inpatient detoxification care, residential treatment services, and outpatient visits. It’s the entire spectrum of addiction care, all under one plan. But some programs offer payments for only one type of care and can limit the time a person can access that care.
This is a great question to ask a health plan administrator, or families can ask the intake coordinator of a drug treatment center to do this research on her behalf.
What mental health problems does the insurance cover?
Legislation passed under the Affordable Care Act was not limited to drug addiction care. The law also required plans to provide the same level of care for mental health problems as for physical health problems. This means plans that offer doctor visits for a foot problem for $ 20 must also include doctor visits for depression for $ 20. The care and cost must be the same. The American Psychological Association says these parity laws apply to all types of programs, including those provided by employers, those that go through health care exchanges, and those that go through Medicaid and CHIP.
Parity laws do not explicitly state the types of mental health problems for which mental health plans must provide care, but the rules are similar to those observed in the field of addiction. While plans provide care for mental illness, they generally do not specify that some illnesses are covered, and others are not. It would take a lot of paperwork and time, and most plan administrators don’t have much to lose, so the plans just cover everything. Again, this is a matter that should best be discussed with a plan administrator. But in general, fears that mental health problems are not covered because they are “bad” are often unfounded. Health insurance just doesn’t work that way.
The law also required plans to provide the same level of care for mental health problems as for physical health problems.
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Are treatment medications covered?
Maintenance programs, which are part of follow-up treatment, are designed for people who cannot reach a normal level of function without medication, even if they have undergone a rehabilitation program at a treatment center. The chemical disturbances caused by drugs are too severe in these people, and they need medications to correct these imbalances in order to live a life free from the influence of drugs.
Maintenance treatment helps many people recover from certain substance use disorders, often long after the initial rehabilitation stay. For example, opioid maintenance treatment with an opioid agonist drug such as methadone or buprenorphine can help prevent withdrawal, minimize cravings, and, in the long run, deter relapse and allow the person to recover.
Maintenance medications like Suboxone, Buprenorphine, and Antabuse are made for people with these types of problems, but they can be expensive. Fortunately, most experts suggest that insurance plans generally cover these drugs.
The National Alliance of Buprenorphine Advocates says, for example, that most health insurance plans cover maintenance medications for people recovering from addiction to heroin and other similar drugs. The organization does not specify how many plans offer this coverage or what the typical copays might be, but the group seems to be convinced that most plans offer this benefit.
The Substance Abuse and Mental Health Services Administration says, on the other hand, that Medicare and Medicaid plans will only cover these drugs if their use is deemed vital to the continuing health of the person in recovery. If it is determined that the person can recover in some way without the drugs, these plans will not provide coverage. These two opposing views make it clear that diets can manage addiction maintenance care in very different ways. That is why it is beneficial for families who need this care to know the coverage, copayments, and therapies before starting to receive it. Some programs may have broad coverage, while others may not.
