Individuals suffering from alcohol abuse and addiction can experience serious mental and health consequences. But beyond just the individuals, alcohol addiction can be painful for the families and friends of those caught in the grips of alcohol.
Thankfully, there are many treatment options available for alcohol abuse and addiction that have been proven effective. With the proper motivation and the right treatment program, sobriety and recovery are possible.
However, these programs do cost money and unfortunately, financial circumstances can sometimes stand in the way of necessary addiction treatment.
One way to deal with the financial hurdle of addiction treatment is to use insurance coverage to pay for all or some of the treatment.
To help you learn if insurance will cover alcohol treatment, we will explain how insurance works when it comes to alcohol addiction treatment and what is usually covered.
Insurance Coverage For Drug Rehab
Alcohol and drug addiction falls under the medical category of Substance Abuse Disorders (SUD).
The Affordable Care Act of 2010 mandated that all new small and group healthcare plans include coverage for a specific list of health conditions, including SUD.
Since SUD includes alcohol abuse or addiction, most new policies will have some degree of coverage for treatment.
Does Insurance Cover Rehab For Alcohol
Policies can differ greatly depending on various factors. Some may provide full coverage for in-patient or outpatient SUD treatment, including alcohol rehab.
Other policies may only provide basic treatment options or only cover outpatient programs.
You’ll need to consult your individual policy or provider to learn the exact terms of your insurance coverage.
But overall, does medical insurance cover alcohol rehab? The answer is yes, although the specific coverage can vary from policy to policy
Types of Insurance Plans for Alcohol Rehab
The specific insurance plan you have can have an impact on what is covered as well as your out-of-pocket expenses. Your insurance plan can also determine whether you will need a referral to see an addiction specialist.
HMOs For Alcohol Rehab
An HMO plan uses a network of contracted healthcare providers. As a member of an HMO, you have to choose providers within the network in order to be covered under the plan.
This includes coverage for SUD or alcohol treatment. If your HMO network contains substance abuse centers, then you may be covered by the plan.
HMOs typically have lower costs than the other major plan type known as a PPO. With an HMO, you will need to receive a referral for alcohol rehabilitation from your primary physician. While this usually isn’t a problem, it can sometimes delay treatment or cause barriers if the patient is hesitant to visit their primary doctor.
PPOs For Alcohol Rehab
PPOs for alcohol rehab are similar to HMOs in that you still have to choose a provider from a list of contracted providers within the network. However, you can see different providers within the network without being referred by your primary care doctors.
Some patients may find this easier than going through the referral process.
PPOs will generally have slightly higher premiums to account for the increase in flexibility.
If you are a member of a PPO, you can check if it has SUD treatment providers and contact one to determine your eligibility for their programs.
Medicare and Medicaid For Alcohol Rehab
For those without private or employer health care, there is the option of Medicare and Medicaid. Both of these government healthcare programs provide options for alcohol treatment programs.
Medicaid For Alcohol Rehab
Medicaid is a federal and state-supported medical insurance program for those with limited income or other resources.
Medicaid does cover many basic alcohol rehab and treatment programs ranging from inpatient to hospitalization, to outpatient care.
Medicaid often has no co-pay, where the patient is required to pay a set amount of money for treatment. However, this can vary from state to state.
To use Medicaid for alcohol addiction treatment, you will need to find a provider who accepts Medicaid insurance.
Medicare For Alcohol Rehab
Medicare is a federally funded program that offers health insurance to those who are 65 years old and older.
Similar to Medicaid, Medicare covers many SUD-related treatment options such as outpatient care for alcohol addiction and abuse.
Medicare coverage is divided into four plans, which are parts A, B, C, and D.
Part D covers medications and will cover most medications necessary for alcohol treatment. Parts A, B, and C cover various inpatient, outpatient, and medical costs related to alcohol rehab.
Just like Medicaid, you will need to find a treatment provider that accepts Medicaid.
What Parts Of Alcohol Treatment Are Not Covered by Insurance?
If you have an HMO or PPO plan, there may be some features of alcohol rehab that are not covered. This varies depending on the plan. However, treatment options or amenities not directly related to the addiction treatment are generally not covered.
For example, amenities at “luxury” treatment centers are usually not covered. This includes meals, recreational activities, or other additional services.
In some cases, certain medications prescribed during your treatment may have an out-of-pocket cost as well.
Drug And Alcohol Rehab Without Insurance
If you don’t have any form of private or government insurance, you still have options to help pay for alcohol treatment.
The first step is to find out if you qualify for Medicare, Medicaid, or a low-cost insurance program through the Affordable Care Act Marketplace. Most everyone who has no access to health insurance will be able to find a coverage plan through one of those options.
If you have existing health insurance but it doesn’t fully cover alcohol rehabilitation, most treatment centers can still work with you.
Treatment centers can work with the insurance coverage you do have and then offer payment plans to fit your budget. They can also tailor the treatment to fit your needs as a patient and your financial situation in most cases.
Find Out If Your Insurance Covers Alcohol Rehab
At Emory Recovery Center, we offer several proven treatment options to help those dealing with alcohol addiction.
We are also experienced in dealing with insurance companies and providers to ensure our patients have the full financial assistance they are eligible for when seeking treatment at our facility.
If you are seeking alcohol treatment and want to know if your insurance can help, contact us today, and one of our intake experts can walk you through the process and explain your payment options.