Originally written on: Thursday, 07 June 2018 Last edited on: Wednesday, 31 July 2019

Drug & Alcohol Rehabilitation Services covered by Private Health Insurance in the U.S.

Health insurance companies cover certain costs of health care, and this does include substance abuse addiction and recovery, and mental health services. Within the United States, there are government-funded health insurance, private health insurance, and private group health care plans. Health insurance often becomes a useful tool to help pay for some of the cost of drug treatment. Everyone who is struggling with drug and alcohol addiction will not always be able to afford treatment, and they will sometimes turn to their health insurance providers to help pay for rehab or cover some of the cost.

Drug and alcohol addiction impacts millions of Americans, and with the current opioid epidemic with drugs such as fentanyl, heroin, and prescription opioids; more people are searching for the help they need. Substance abuse can impact anyone at any point in life, whether someone is an adolescent or in their fifties. Different types of illicit street drugs are available in the United States, and there is also a market for prescription narcotics. Rehabilitation and treatment services will either be private facilities or organizations or will be state-funded through local health services. Health insurance providers can cover both, but this will depend on the type of health insurance, and who is providing it.

Private health insurance is available through companies such as Cigna, Aetna, Humana, United Healthcare, United Behavioral Health, and many others. Private health insurance in the United States can be more expensive than government health insurance, but they will provide more health care options, especially those surrounding the treatment of substance abuse. What is covered by private health insurance companies does differ from company to company and plan to plan, but it is important to always check with what is covered for substance abuse treatment. Group health insurance plans are a type of commercial health insurance, and are often offered by employers, and each plan differs from company to company. The Affordable Care Act has also ensured that government-funded insurance, workplace healthcare plans, or private health insurances are required to give the same level of treatment benefits for substance abuse and addiction. Anyone who may not be enrolled in a government health insurance plan, can purchase health insurance in the market place, which is a collection of insurance plan options with some tax credits available. The premium tax credit is a refundable tax credit that will help eligible individuals and families with low or moderate income afford health insurance, which is purchased through the health insurance market place.

Government health insurance programs will include Medicaid, Medicare, and CHIP or the Children’s Health Insurance Program. Medicare is a health insurance provider for the elderly, the disabled, and people receiving long-term treatment with dialysis. Medicare can help cover certain costs for state funded drug treatment for elderly, or those with a disability who are suffering from a drug addiction. Medicaid, which does fund health care for certain people who live below the poverty line or with a disability, will also help cover some costs with drug and alcohol treatment. CHIP is a program that coordinates funding and resources to provide care to people with special health needs, and because this is primarily for children, there may be special circumstances if some type of drug intervention is needed. There are many other government insurance programs such as Tricare, which the largest health insurance provider for active-duty service members in the United States, along with covering retired military personnel and their families. Many of the drug and alcohol treatment facilities in the country will accept Tricare health insurance.

There is also the Veterans Health Administration, which is a government operated health care system, which provides comprehensive health services to eligible military veterans. Substance abuse is often a problem among veterans, and many drug rehab programs in the country will work with veteran’s health insurance. The Indian Health Services, which is a system of government hospitals and clinics providing health services to about 2 million American Indians and Alaskan Natives living on or near a reservation. Most Indian American and Native Alaskan cultures treat drug addiction or substance abuse within their culture, but some drug rehab programs in the country do provide specific programs for this demographic. The Federal Employee Health Benefits Programs allows private insurers to offer insurance plans with guidelines set by the government, for the benefit of active and retired federal workers and their survivors. Federal works that may be struggling with substance abuse issues, can access services and receive treatment, which can be covered by their health insurance. Roughly 30 to 35% of Americans are covered by government insurance or government provided care.

Private health insurance or other types can help cover different things when it comes to the treatment of a substance abuse disorder or addiction. For example, it may help pay for inpatient care in an approved facility, or outpatient care, with an approved provider. Medical detox, including medications may be covered, along with the treatment of co-occurring mental health conditions. Some health insurance providers may cover follow-up counseling, or the prescription of maintenance addiction medication. The best way to find out what will be covered is to contact the insurance provider directly and ask what services may be covered. Another option includes visiting healtcare.gov, which does report the plans participating in the insurance marketplace, for anyone who may be utilizing this option. Insurance providers within the insurance marketplace must provide care in 10 essential health categories, one of those being addiction care. Many private health insurance plans do follow these same rules, and if addiction is considered a covered benefit, then care is provided to anyone who has an addiction. However, under the affordable care act, insurance plans are required to provide a one-page summary of benefits and therapies, along with their feed, per the U.S. Department of Health and Human Services. The National Institute on Drug Abuse does report there are more than 14,500 different treatment facilities for drug addiction in the United States. Not every program will take insurance, or when they do, it may be unlike than what the patient has, it is important to check with the insurance provider and the drug rehab center.