What You Should Know About Alcohol Rehab Insurance Coverage
The opportunity to recover from alcohol addiction sometimes depends on a person’s financial capabilities. That’s why understanding how insurance covers rehab can help make treatment more accessible.
The cost of alcohol addiction treatment varies by center and the treatment type. Other factors that affect the cost of rehab include medical care and amenities.
Some programs are free, while others may cost thousands of dollars daily. Each program varies based on location, available resources, and demand. It’s essential to thoroughly research your options to find a program that suits your needs and financial situation.
In 2021, an estimated 28.6 million adults aged 18 and older (11.3% of this age group) were reported to have alcohol use disorder (AUD).- National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Cost of Alcohol Rehab (By Type)
The type of care a drug and alcohol rehab facility provides affects the cost of becoming sober. Treatment options are also different for certain addictions.
Some inpatient rehab facilities cost around $6,000 for a 30-day treatment program. More renowned centers often charge between $20,000 and $50,000 for a 30-day program.
Extended programs of 60 to 90 days may have to pay anywhere between $12,000 to $60,000.
Typically, outpatient programs cost around $5,000 for a three-month schedule. Outpatient programs for mild to moderate alcohol use disorders are more affordable than inpatient rehab centers.
However, costs can vary based on factors such as the frequency of visits and treatment duration. Some treatment facilities, like Hazelden Betty Ford, charge $10,000.
Partial Hospitalization Programs
People in a partial hospitalization program (PHPs) typically pay around $350 to $450 daily. Their ability to live in their own homes makes care costs less expensive than those associated with residential care.
Behavioral therapies can be expensive, often costing $100 or more per hour. Some therapists or clinics offer treatment on a sliding scale, which means that costs fluctuate based on income.
Ask about a sliding scale or other payment options when visiting a therapist or clinic for a consultation.
Medication-Assisted Treatment (MAT)
Treatments requiring medication can cost several thousands of dollars annually. These most often address alcohol and opioid addiction.
The medications necessary for alcohol addiction treatment are primarily what affect the rehab costs. Some people don’t require medication for their addiction, while others need a significant amount.
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Does Insurance Cover Alcohol Rehab?
Insurance is one of the most common ways of covering rehab costs. The amount insurance covers depends on the insurance company and what the healthcare provider accepts.
Insurance providers that provide alcohol rehab coverage include, but are not limited to:
Outpatient and inpatient alcohol rehab insurance coverage aren't all the same. Coverage differs by individual insurance plans and the treatment.
Typically, insurance covers the medically necessary aspects of treatment, including:
- Screening and intervention services
- Detoxification from alcohol use
- Medication for detox or recovery maintenance
- Inpatient services at a hospital or specialty facility
- Outpatient rehab or treatment services
- Individual or group counseling
Alcohol rehab insurance is less likely to cover anything that’s not medically necessary. Coverage exclusions typically include luxury services at high-end treatment centers, including:
- Gourmet food
- Recreation programs
- Some holistic care services
- Other non-medical additions
Out-of-Pocket Fees of Medication-Assisted Treatment (MAT)
The out-of-pocket fees of medication-assisted treatment (MAT) programs can vary depending on the insurance provider. For example, the medication naltrexone’s insurance fees may differ based on what your insurance plan covers and the provider prescribing and distributing it.
Some states also mandate laws that enable private insurers to deny coverage to intoxicated persons when they request service. This is mainly if emergency care is necessary for an injury or illness resulting from actions taken while drunk.
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Other Ways to Pay for Rehab
There are other ways to pay for substance abuse treatment aside from using health insurance companies.
Medicare Parts A and B provide coverage for substance abuse treatment, including alcohol rehab.
- Medicare Part A: Covers inpatient hospital stays, detoxification services, and other medically necessary inpatient services
- Medicare Part B: Covers outpatient services, outpatient mental health services, partial hospitalization programs (PHPs), or intensive outpatient programs (IOPs)
- Medicare Part C: Plans are offered by private insurance companies approved by Medicare; an alternative way to receive Medicare benefits, combining coverage for hospital (Part A), medical (Part B), and often prescription drugs (Part D) into a single plan
- Medicare Part D: Provides prescription drug coverage depending on the specific drug and insurance plan
People with low-income levels or with disabilities may be eligible for Medicaid. Additionally, people's healthcare policies through the Affordable Care Act marketplace or state exchanges must include this coverage.
At the same time the ACA was introduced, the United States government required that specific medical insurance plans include substance abuse treatments as part of each plan. As a result, Medicaid programs running under the ACA must provide coverage for alcohol rehab.
Who Can Benefit from Marketplace or Exchange Plans?
For those whose workplaces don’t provide insurance, are self-employed, or don’t have insurance, the Marketplace or exchange plans are great ways to get coverage for alcohol addiction treatment.
3. Private Financing or Financing Plans
If you’re uninsured or don’t qualify for state or federal assistance, private financing can help cover the cost of treatment. There are also addiction treatment centers that offer scholarships.
As such, talking to the admissions office of a rehab center of your choice is best. However, if scholarships are unavailable, financing plans are another option.
These plans allow you to pay after discharge. Some third-party lenders offer a loan package where you can arrange financing options according to your financial capabilities.
4. Crowdfunding or Fundraising
Other family members can extend help for your rehab treatment. To ensure proper usage of the money, suggest that they directly make payments to the facility. Your friends can also help fund your rehab treatments using GoFundMe and other crowdfunding sites.
Tips For Finding Rehabs That Accept Health Insurance
Consider these tips when finding a rehab center that accepts insurance:
1. Check Your Private Insurance Policy
Review your policy to understand what types of alcohol addiction treatments it covers. Note that health insurance plans with higher coverage typically have higher costs.
2. Understand Premium Costs And Coverage
Insurance plans with excellent rehab coverage often come with high premium costs. This is especially true for group insurance plans that employers provide.
In employer-offered plans, the employer's choice determines coverage. You only receive the coverage that your employers select.
3. Be Aware of Potential Exclusions
Some plans may include exclusions. For example, a policy might cover alcohol rehab treatment for the first time. However, it may not cover additional therapy in the event of a relapse.
4. Impact of The Affordable Care Act (ACA)
The ACA mandates that insurance plans offering drug and alcohol addiction coverage provide benefits equal to the plan’s surgical and medical benefits. This applies to employers with over 50 employees.
However, the ACA doesn’t require all insurance plans to include coverage for substance use disorders. This stipulation only applies to programs that already have such coverage.
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Comparative Analysis of Public vs. Private Rehab Centers
When it comes to seeking treatment for alcohol addiction, there are two main options: public and private rehab centers. Both offer similar services, such as individual or group counseling, but there are significant differences in cost and potential benefits or drawbacks.
The cost is one of the most significant differences between public and private rehab centers. Public facilities are generally more affordable than private ones as they're government or donation-funded.
These centers offer low-cost or even free treatment options for those who can't afford expensive rehab programs. On the other hand, private facilities can be costly due to additional amenities and individualized treatment plans.
Private facilities tend to have more luxurious accommodations and additional mental health services such as yoga, meditation, or equine therapy.
Due to budget constraints, public rehab centers may have limited resources and fewer amenities. However, they still offer essential services such as detoxification, counseling, and aftercare programs.
3. Potential Benefits or Drawbacks
Public and private rehab facilities have potential benefits and drawbacks. In public centers, the main benefit is affordability. For those with low income levels, public rehab centers may be the only option available for treatment.
On the other hand, private facilities offer more personalized treatment plans and several amenities that can make your stay more comfortable. However, their main drawback is the high cost, which may not be accessible to everyone.
It's essential to consider both options carefully and what will work best for you when seeking treatment for alcohol addiction.
|Public Rehab Centers
|Private Rehab Centers
|Generally less expensive or free
|Typically more expensive
|Funded by government or public resources
|Funded by private entities or out-of-pocket payments
|May have longer waiting lists due to high demand
|Usually have shorter waiting lists
|Often have more luxurious amenities
|Wide range of customized programs
|Standard privacy protocols
|Often offer enhanced privacy options
|May have lower staff-to-patient ratios
|Typically have higher staff-to-patient ratios
|Limited choices based on availability in public systems
|Broader range of locations, often in more desirable areas
|Traditional treatment methods
|Access to a variety of treatment methods, including alternative therapies
|Basic aftercare support
|Comprehensive aftercare and follow-up programs
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Does Your Medical Insurance Cover Alcohol Detox & Treatment?
Various options are available to cover the costs of alcohol rehab. Private and public facilities offer different services at varying costs, making it essential to research and understand your insurance policy coverages before seeking treatment.
Other ways to pay for rehab include Medicare, Medicaid, private financing, financing plans, and crowdfunding or fundraising methods. Exploring all options and choosing the best fit for your financial situation is crucial.
Contact health insurance providers or rehab admissions offices for more information on coverage and payment options. Recovery from alcohol addiction is possible, so don't hesitate to seek help and take the necessary steps towards a healthier, sober life.
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- "Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition)." National Institute on Drug Abuse, 2014.
- Huey Dye et al. "The Availability of Integrated Care in a National Sample of Therapeutic Communities." The Journal of Behavioral Health Services & Research, 2014.
- "Treatment for Alcohol Problems: Finding and Getting Help" National Institute on Drug Abuse, 2014.
- Breithaupt, D. “Why health insurers should pay for addiction treatment.” The Western Journal of Medicine, 2001.
- French et al. “The Economic Costs of Substance Abuse Treatment: Updated Estimates and Cost Bands for Program Assessment and Reimbursement,” Journal of Substance Abuse Treatment, 2008.
- "Substance Abuse: Facing the Costs." Georgetown University Health Policy Institute.