Does Insurance Cover Rehab Costs? Yes They Do!
*Insurance Disclaimer: Greenbranch Recovery will attempt to verify your health insurance benefits and/or necessary authorizations on your behalf. Please note, this is only a quote of benefits and/or authorization. We cannot guarantee payment or verification eligibility as conveyed by your health insurance provider will be accurate and complete. Payment of benefits are subject to all terms, conditions, limitations, and exclusions of the member’s contract at time of service. Your health insurance company will only pay for services that it determines to be “reasonable and necessary.” Greenbranch Recovery will make every effort to have all services preauthorized by your health insurance company. If your health insurance company determines that a particular service is not reasonable and necessary, or that a particular service is not covered under your plan, your insurer will deny payment for that service and it will become your responsibility.
Many people choosing to enter rehab for addiction may have wondered whether or not certain services are covered by health insurance, and in general, the answer is yes — many health insurance plans cover treatment and rehab services for alcohol and drug addiction.
Impact of the Affordable Care Act
The Affordable Care Act, a health care system law passed in 2010, ensured addiction treatment would be covered by insurance. Within its language, the bill states that addiction is no longer considered a preexisting condition, which means treatment for addiction would qualify for insurance coverage.
When you shop for a health care plan on the HealthCare.gov Marketplace, you’ll find specific plans that cover mental health and substance abuse services. According to Healthcare.gov, these plans must cover:
Specific coverage benefits vary by specific health care plans.
Examples of some possible addiction treatment services you might be able to benefit from within these plans include:
Parity Protections for Substance Abuse Services
Health insurance companies often place limits on how much they’ll cover — sometimes these limits are financial and have to do with co-pays, deductibles or coverage limits; other times, these limits relate to time, such as dictating the number of days your plan covers you for, such as during a hospital stay.
Marketplace plans generally can’t be more restrictive for mental health and substance abuse services than they are for medical and surgical services.
Addiction Expenses Covered by ACA
Marketplace health insurance plans are divided into several tiers, and percentage of coverage varies depending on the type of plan you select. Reference the table below for a general idea of the percentages an ACA health plan covers for mental health and substance abuse services.
|Plan Type||Percentage of Coverage|
Find Out the Details of Your Health Insurance Plan
The information provided here applies to Marketplace health plans, but if you have a different health insurance plan, such as through your job or your spouse’s employer, details on coverage limits, co-pays and percentage of coverage for certain services may be different.
You can always call your health insurance company to find out details about what rehab services it will cover. That way, you can anticipate costs and make decisions based on what you’re able to pay and what’s best for your health.
The ‘No Surprise Act’ has gone into effect as of January 1st, 2022. It prevents out-of-network care providers from billing clients more than the specified in-network cost-sharing amounts, which are based on a ‘recognized amount’ (specified by state law, or for those that have an all-payer model agreement, approved by the state). You can learn more about the law at cms.gov/nosurprises.