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The journey toward recovery can feel both uncertain and hopeful. Trying to understand your insurance coverage for addiction treatment can further add to any overwhelm—creating another barrier to getting the help you need. At Freedom Recovery Centers (FRC), our team is here to help. We accept Medicaid and most insurances, and can help verify your insurance, making it easier for you to take that first step toward recovery. Call us at 804-635-3746, or continue reading below for more information about insurance coverage for addiction rehab.
The Affordable Care Act (ACA)
In recent decades, insurance providers have faced major legislation changes—requiring them to offer more comprehensive coverage for addiction treatment. The Affordable Care Act (ACA), also known as Obamacare, was created in 2010.
This law required insurance plans to cover rehab and addiction treatment in some shape or form. For instance, most plans cover detox as it’s often deemed medically necessary to receive effective addiction treatment. In other words, treatment for substance use disorder (SUD) became an essential health benefit.
Before the ACA, many insurance plans didn’t offer coverage for addiction treatment or solely provided very limited coverage. This made it difficult for those struggling with substance abuse and addiction to get the help and care they need. Additionally, insurances could previously deny coverage to addicts or charge much higher rates. The ACA changed all of this.
On top of the above, the ACA also made it necessary for insurances to cover mental illness. This can also make it easier for individuals struggling with co-occurring substance abuse disorders and mental health issues to get proper treatment. In turn, addiction treatment can be more effective, tackling addiction from the ground up.
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Using Medicaid for Addiction Treatment
Medicaid is a federal and state government-funded health insurance program that provides coverage for millions of Americans. It helps cover the cost of healthcare for eligible individuals, such as those with low incomes.
Thanks to the ACA, Medicaid covers addiction treatments. But it’s important to note that exact coverage specifics vary by state.
In Virginia, the Addiction and Recovery Treatment Services (ARTS) program was introduced in 2017. This is a Virginia Medicaid benefit that improves access to treatment for substance use disorders. It helps cover a wide range of addiction treatment services, such as inpatient detoxification, residential treatment, outpatient services, and more.
At the same time, government budget cuts and more can impact Medicaid coverage. If you’re relying on this for addiction treatment, make sure you stay up-to-date on the latest coverage options. If you’re unsure where to start with this, contact the FRC team at 804-635-3746. We can help you navigate the complex landscape of insurance.
Learn more about Virginia Medicaid addiction treatment coverage
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What Does Insurance Cover?
Beyond Medicaid, most major insurance providers offer coverage for addiction treatment. While specifics vary based on your individual plan, your insurance may cover partial or total costs associated with:
- Detoxification
- Inpatient rehab
- Outpatient rehab
- Behavioral therapy
- Medication-assisted treatment (MAT)
- Support groups
- Aftercare
Often, you must meet your deductible before your insurance plan will pay for treatment. This means paying a certain amount, then your insurance pays the rest. For instance, you may need to pay $2000 out-of-pocket, but your insurance covers the remaining $8000 on a $10,000 healthcare or rehab bill.
Other Out-of-Pocket Costs
Out-of-pocket costs are the expenses you must pay, such as your deductible. Other out-of-pocket expenses may further include:
- Copayments: This is a fixed amount paid for a specific service. For example, your insurance may require $50 per counseling session. However, without insurance, this would cost much more.
- Coinsurance: For some plans, you may be required to pay a percentage of the costs after meeting your deductible. For instance, your insurance may cover 80% of the cost, meaning you’ll need to cover 20% of the cost.
- Out-of-Pocket Maximum: This refers to the most you’d have to pay annually. Once this amount is met, your insurance covers 100% of the costs.
- Non-Covered Treatments & Services: Depending on your plan, specific treatments or services may not be covered. This means that you will need to pay for them out-of-pocket.
Discussing finances for addiction treatment can bring about stress and worry. However, understanding your specific insurance plan can ensure less stress and fewer headaches down the road. It’s essential to verify your insurance before entering rehab. At FRC, we recommend getting preauthorization (or preapproval) for the services you need. This means your insurance pre-approves your treatments. But you don’t need to do this alone. Our team is here to help.
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Verify Your Insurance Today
The road toward recovery can be paved with obstacles. Yet, our team is ready to help you overcome whatever stands in your way. Whether this is your first or last time in rehab, we are committed to helping you achieve lasting sobriety. Reach out to us today to verify your insurance and begin your journey toward a healthier and more meaningful life.
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FAQs
What insurance providers cover detox?
Most major private insurance companies cover detox, since it’s medically necessary for treating addiction. However, it’s always good to double-check your plan. Under the ACA, detox should be partially or fully covered.
What do most treatment plans for addiction include?
Most treatment plans for addiction include detox, individual therapy, behavioral therapy, relapse prevention, group therapy, and aftercare. At FRC, our programs are unique to each individual. This means that your exact treatments depend on your specific situation.
What types of addiction treatment are typically covered?
Typically, insurance will help cover detox, medication, therapy, and some support services.
Does my insurance plan cover addiction rehab?
This depends on your individual plan. Before entering rehab, it’s important to determine what’s included in your coverage. Our team can help verify your insurance and help you get pre-approval.
What if my insurance doesn’t cover rehab?
Thanks to the ACA, insurance providers, by law, must cover some rehab services. If you don’t have insurance, there are other financial options available. Call us at 804-635-3746 or fill out our form to learn more.
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