Does Insurance Cover Rehab?

What Types of Insurance Cover Residential Rehab?

Insurance companies regularly update their policies. Talk to your insurer, rehab center, doctor, or someone else on your care team to ensure you have the most recent information before you commit to a particular rehab program.

Most types of insurance cover some amount of addiction and mental health treatment, including but not limited to the following:

• Medicaid
• Medicare
• Marketplace insurance plans,¹ through the Affordable Care Act
• Blue Cross Blue Shield
• Aetna
• Cigna Healthcare
• United Healthcare
• Tricare
• Optum

With any insurance, it’s important to check what coverage your specific plan can offer. For example, some plans might require a referral from your doctor. Others may cover medical detox but not longer-term care.

Out-of-Network vs. In-Network Treatment Centers

A network is a list of providers who accept a particular insurance plan. In-network healthcare providers² can easily bill your care to your insurance company. You may still need to go over some details to make sure your treatment is covered by insurance. But in most cases, attending an in-network treatment facility is the most straightforward option.

Simple isn’t always better. You might need a type of care that’s only available at an out-of-network facility. In that case, you’ll probably have higher out-of-pocket costs than you would at an in-network rehab. You might even have to pay the full amount. But that’s not always the case. You can still ask your provider to get in touch with your insurance company to learn more about your options.

Going to Rehab Without Insurance

If you’re paying out of pocket, or your care plan won’t cover rehab for drugs or alcohol, you can still find ways to get the treatment you need:

• • Some rehab centers offer scholarships,³ grants, or financial assistance. Ask your center’s admissions team to learn how you can apply. You may be eligible for funding through a public aid program or directly through your rehab facility.
  • Consider outpatient treatment. These programs are usually much less expensive than residential rehab. You might attend an intensive outpatient program (IOP) or partial hospitalization program (PHP). Either one will allow you to live at home while attending therapy like a part-time or full-time job.
  • Find a more affordable rehab program. According to the National Center for Drug Abuse Statistics, the least expensive inpatient rehabs in the U.S. cost approximately $6,000/month.

((“Average Cost of Drug Rehab [2023]: By Type, State & More.” NCDAS, https://drugabusestatistics.org/cost-of-rehab/. Accessed 31 May 2023.))

How to Get Insurance to Pay for Rehab

Walter Baker, insurance expert with Sandstone Care, says that “The #2 barrier to treatment and the #2 cause of relapse is money.” Many people delay getting the care they need because they’re afraid they won’t be able to afford it. And what’s more, worrying about money can directly affect your mental health.⁴ You can put your mind at ease by getting clear answers before treatment. Use these strategies to plan for your long-term recovery.

Build Personal Relationships

Some rehabs and insurance companies may hesitate to tell you how much treatment will cost. If you can appeal to them on a personal level, you can break through this barrier. Reach out to the admissions team at a rehab and ask them for help. They may know someone who works at your insurance company. If not, they can help you plan to contact them yourself. Knowing who to ask can make all the difference.

Document Your Process

Insurance companies use a lot of specialized terminology. That can make it hard to understand your own bills, much less negotiate their terms. Plan around this by keeping clear records of all your correspondence with your rehab and your insurance company. You can also request a copy of your medical records from your doctor, therapist, and other providers. If you get a surprising bill, ask an expert about it instead of paying immediately. Your rehab’s staff might be able to help you, or your insurer might be willing to make adjustments if you can give them enough information.

Get Medically Necessary Care

Most of the time, insurance only covers medically necessary treatments.⁵ In other words, you or your care team will need to prove that you need a specific type of care. This practice prevents people from abusing their insurance to get treatment they don’t really need. When you’re healing from substance use disorders, this can be especially important. The downside is that it can limit what types of treatment are available to you.

When you’re choosing a rehab, broaden your search to include several different levels of care. Your insurance may be willing to pay for an IOP or PHP, even if they deny coverage for residential rehab.

Choosing the Best Rehab for You

While insurance can be confusing, it’s there to help you recover. Your care team can advocate for you while you research different options. Don’t be afraid to comparison shop between various rehab programs. Consider their types of treatment, insurance coverage, and how much support you get from the admissions team.

Throughout this process, you’ll also learn to be your own greatest ally. “Just because an insurance company says one thing and a provider says another thing, the truth is probably somewhere in the middle,” Walter Baker explains. If you can find that truth before you commit to a rehab program, you’ll set yourself up for long-term success.

Search rehabs by insurance coverage to find a program that meets your unique needs.

1. “Mental Health and Substance Abuse Health Coverage Options.” HealthCare.Gov, https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage/. Accessed 31 May 2023. [↩]
2. “What You Should Know About Provider Networks.” Health Insurance Marketplace. https://marketplace.cms.gov/outreach-and-education/what-you-should-know-provider-networks.pdf [↩]
3. Welcome to Benefits.Gov | Benefits.Gov. https://www.benefits.gov/benefit/871. Accessed 31 May 2023. [↩]
4. Ryu S, Fan L. The Relationship Between Financial Worries and Psychological Distress Among U.S. Adults. J Fam Econ Issues. 2023;44(1):16-33. doi: 10.1007/s10834-022-09820-9. Epub 2022 Feb 1. PMID: 35125855; PMCID: PMC8806009. [↩]
5. “Understanding Health Care Bills: What Is Medical Necessity?” National Association of Insurance Commissioners. https://content.naic.org/sites/default/files/consumer-health-insurance-what-is-medical-necessity.pdf [↩]