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Insurance Coverage for Rehab

Becoming aware of an addiction and enrolling into a treatment program can be a difficult first step towards obtaining long-term recovery. Many individuals feel scared making this step due to a fear of the unknown. That is why, the more you learn about rehab before entering a program, including what to expect, the length of time you might spend there, and costs that come with it, the easier your road to recovery will be.

In this article, we’ll answer the most popular questions about insurance coverage, such as “How much does rehab cost with coverage?”, or “What do insurance policies generally cover?”, as well as other financial aspects of rehab.

What are the different types of health plans?

There are four common types of plans that each insurance brand might offer:

  • Health maintenance organizations (HMOs)
  • Preferred provider organizations (PPOs)
  • Exclusive provider organizations (EPOs)
  • Point-of-service (POS) plans

What will the deductible be?

The deductible is the amount you pay out-of-pocket before insurance coverage is issued. The deductible varies depending on your plan, with the least expensive plan carrying the highest deductible.

  • Platinum plan: covers approximately 90% of your medical costs, with a 10% deductible
  • Gold plan: covers approximately 80% of your medical costs, with a 20% deductible
  • Silver plan: covers approximately 70% of your medical costs, with a 30% deductible
  • Bronze plan: covers approximately 60% of your medical costs, with a 40% deductible

What are America’s biggest health insurers?

America has many health insurance companies operating on the market. The biggest health insurers include UnitedHealth Group, Anthem, Aetna, Cigna, Humana, Centene, Health Net, WellCare Health Plans, Molina Healthcare, and Magellan Health.

How much does rehab cost?

The costs of rehab vary from one center to another. The expenses also depend on whether it’s an inpatient or outpatient program, as well as location, length, and what’s included. Some inpatient rehabs may cost $6,000 for a 30-day program, while others cost up to $20,000 for a 30-day program. For those individual who need 60- or 90-day programs, the average costs could range between $12,000 to $60,000.

Regarding outpatient programs, they’re slightly cheaper than inpatient rehab. A 90-day program might cost $5,000. The price depends on how often the patient visits the center each week and for how long.

Detox services range from $1,000 to $1,500. The accurate cost depends on the type of addiction being treated and the type of inpatient program. Health insurance companies won’t usually cover rapid detox. 

Does health insurance cover drug rehab?

Yes it does, if you have an insurance policy your treatment is most likely covered. The American Medical Association recognizes alcoholism and substance addiction as diseases, thus forcing health insurance companies to provide treatment coverage. Moreover, the 2008 Affordable Care Act and Mental Health Parity and Addiction Equity Act require that insurance policies, both public and private, must cover substance abuse treatment to the same extent that they cover other medical conditions. Those who don’t have insurance, can apply for coverage at any time.

What do insurance policies generally cover?

Most insurance policies cover one or more of the following, depending on the insurance company:

  • Assessment – normally fully covered.
  • Detoxification – normally mostly covered.
  • Inpatient treatment – normally partially covered.
  • Outpatient treatment – generally mostly covered.

What is Medicaid and Medicare coverage?

Medicaid and Medicare are government-sponsored insurance plans, created in 1965 in response to the inability of older and low-income Americans to buy private health insurance. Medicaid is not the same as Medicare.

Medicare is for people aged 65 or older with a severe disability, regardless of their income level. It covers up to 190 days of inpatient services during a lifetime, with a $1,260 deductible and variable co-payments. Medicare also covers outpatient counseling and therapy, once screening per year, and medication management.

Medicaid is a joint state and federal program for low-income households. Medicaid has strict eligibility requirements. Since the program is designed to help the poor, many states require Medicaid recipients to have no more than a few thousand dollars in liquid assets to participate in the program. There are also income restrictions. The plan includes coverage for inpatient and outpatient care, as long as the rehab center accepts Medicaid.

If an individual is eligible for both Medicare and Medicaid plans, they can have both.

Is Luxury Rehab covered by insurance?

Many health insurance companies may not consider a luxury rehab program to be essential for recovery. If this is the case, you might be asked to pay a portion of the costs for your treatment at a luxury rehab. Your benefits depend on your specific plan and what state you live in. Private insurance companies can provide you with a wider range of treatment options, some of which might include treatment at a high-end facility.

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