Does Insurance Cover Detox and Drug Rehab?

Does Insurance Cover Detox and Drug Rehab?

Detox is one of the most useful therapy programs to help a person get over their addiction. But one of the problems contributing to why people don’t go is that the programs can be expensive. Not many people are aware that some insurance companies can cover the costs of detox; they’re too afraid to ask. So here’s what you need to know about insurance covering both detox and drug rehab.

Do Insurance Companies Pay for Drug Detox?

Tricare Insurance, for example, is a private insurance company that provides coverage for substance abuse treatment. This is because the Affordable Care Act now requires it for insurance companies to provide this coverage. Most insurers can’t completely deny coverage for substance abuse disorders. What may differ between companies is how much coverage is provided. Insurance companies may require members to choose from a set of approved providers, and may also request members to take on some of those costs through the form of deductibles, copayments, and premiums.

How the ACA Changed Addiction Treatment 

Before the Affordable Care Act was passed, insurance companies would not cover substance abuse treatment of any kind. In turn, this would also have an effect on those with mental health disorders, since they sometimes go hand-in-hand with substance abuse. Many insurance companies sued to deny coverage for addiction treatment since they were considered pre-existing conditions. 

Medicaid, Medicare, and Addiction Treatment 

For those who have Medicaid, they are covered by substance abuse treatment, which has expanded mental health coverage to more people. For those who are under Medicare, however, their treatment falls under a different set of conditions because it is federally-funded health insurance

  • The provider states the services provided are medically necessary.
  • You receive services at a facility in-network and approved by Medicare.
  • Your provider sets up your care plan.

Not every treatment center accepts Medicaid and/or Medicare, so it’s important that you speak to your provider beforehand to see what treatment options are available to you.

How Long Does Insurance Cover Rehab?

Several criteria are used when determining how much coverage should be provided for a patient. Some may only cover a detox stay, while others may provide coverage for the different levels of detox care. Insurance companies will speak to detox and rehab providers to assess what the needs are of the individual, such as whether they are improving in the program or are struggling. It’s really dependent on a case-by-case basis. 

Substance abuse can be a difficult time for an individual to endure alone, but they shouldn’t be stopped from seeking treatment because of the price tag attached to it. Knowing that it will cost a lot of money will convince individuals that it’s not worth getting help. However, with the changes in the law, being able to attend rehab or detox has become more accessible, especially to those who need it the most. If you or someone you know is in need of substance abuse treatment, be sure to speak to a medical provider or your insurance company to see if you or your loved one may be covered.