Does Insurance Cover Addiction Treatment?

Seeking out treatment and asking for help can be daunting. On top of that, there’s a cost to figure out. At Gratitude Lodge, we will help you determine if your insurance covers the cost of addiction treatment. Insurance policies differ when it comes to the cost of inpatient rehab, outpatient rehab, prescription medications received during detox, dual diagnosis conditions, follow-up counseling, and anti-craving medication.

Some insurance policies may cover treatment entirely. Some may limit your care providers or require you to contribute to the cost. The cost depends on your insurance policy deductible and your policy co-pay. Most treatment facilities can help determine if your insurance is eligible. We’re happy to check your insurance and find out what would be covered before you begin treatment. The good news is, we accept most PPO health insurance! And if you’re not covered by a PPO plan, don’t worry! There are other financing options available to you.

WE ACCEPT MOST PPO INSURANCE
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cigna
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PRIVATE HEALTH INSURANCE

Private health insurance is partially or entirely paid by you or your employer. You can browse and purchase health insurance directly by visiting the website of a health insurance company. You may also find private health insurance through your employer or on a website that compares insurance benefits and costs.

Private health insurance plans may be offered by the same companies that also offer public health insurance that you find on the ACA marketplace. If you’re able to plan ahead before you go to rehab, you may want to consider choosing insurance with a lower deductible, so you will have to pay less out of pocket.

BENEFITS

With private insurance, you may have to choose a plan provided by your employer, or you may be able to pick a company and plan of your preference. You’re able to choose a plan for seeing the doctor less with a higher monthly premium. While that may not be the best plan to choose for rehab, here are some benefits when using private insurance.

  • 01 More plans to choose from
  • 02 Greater facility selection
  • 03 Greater provider selection
  • 04 Coinsurance may cover some cost
  • 05 Fitness center may be covered
  • 06 Massage therapy may be covered

LIMITATIONS

While having private insurance may come with a lot of benefits in terms of freedom and ability to use it with more facilities, there are some downsides including higher costs for premiums or deductibles. You may also have to wait a certain period of time after starting with a new employer for benefits to start. Here are some limitations you may encounter.

  • 01 Not eligible at low-income facilities
  • 02 Not all providers may accept it
  • 03 Higher monthly premiums
  • 01 Waiting period after employment
  • 02 Higher out-of-pocket maximum
  • 03 Can’t join after open enrollment

PUBLIC HEALTH INSURANCE

Public health insurance can be subsidized depending on your tax bracket, or paid entirely by public government funds. You can find out if you’re eligible for subsidized health insurance by going to healthcare.gov. Public health insurance may be paid for by the state, city or county.

Unfortunately, at Gratitude Lodge, we are not able to offer treatment services to people on Medicare. However, if you have a PPO insurance plan purchased through healthcare.gov, our treatment may be covered by your provider. Be sure to speak to our team to find out more. If you are not covered, there are other recovery treatment payment options available to you.

BENEFITS

Public health insurance may cover rehab or cover a significant portion of it. The ACA also requires public insurance to cover pre-existing conditions, such as a mental illness that you have had before receiving treatment for substance abuse. You may also benefit from:

  • 01 Completely covered costs
  • 02 Greatly reduced costs
  • 03 Option if your employer doesn’t offer insurance
  • 04 Credits based on household income
  • 05 Lower out-of-pocket maximum
  • 06 Lower monthly premiums

LIMITATIONS

Though public health insurance offers a lot of help, there may be limitations on coverage. This could include the facilities you are able to use your insurance, which providers will take your insurance, and how much is covered by the government or public funding. Here are some limitations you may encounter.

  • 01 Limited provider selection
  • 02 Limited facility selection
  • 03 Amount covered by public funding
    • 04 Can’t join after open enrollment
    • 05 No massage therapy or acupuncture
    • 06 Fitness classes or gym not covered

QUESTIONS TO ASK YOUR PROVIDER

It’s important to check with your insurance provider when looking into rehab to see if they cover evaluation, medication, inpatient stays or outpatient visits, and aftercare. You can check coverage on your provider’s website or app, and you can call the rehab facility of your choice to make sure they take your insurance.

There may be exceptions to some coverage, such as pre-existing conditions, which are conditions you have had before your coverage began. Plans in the ACA marketplace are required to cover pre-existing conditions. Here are more questions you’ll want to clarify when talking with your insurance provider over the phone.

  • 01 What is the cost of inpatient treatment and outpatient treatment?
  • 02 Are my co-occurring disorders (mental health and addiction) eligible for coverage?
  • 03 Does my plan cover aftercare, such as maintenance medication and therapy?
  • 04 How much do name-brand and generic medications cost under my insurance?
  • 05 How much should I expect to pay out-of-pocket before, during and after rehab?
  • 06 Do I need to call and confirm my admission into the facility before receiving treatment to ensure coverage from my plan?

WHAT IF I’M NOT COVERED?

If you’re not covered by health insurance, or your current healthcare provider won’t cover the costs of rehab, there are still options available to you. You may be eligible for a personal loan, or a health care credit card, to cover the remaining costs that you or your insurance can’t cover. Money should never get in the way of your sobriety. Speak to our team to learn more about alternative financing options.

  • 01 Financing options, such as a loan
  • 02 Credit card
  • 03 Support from friends or family
  • 04 Direct payment
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Don't Let Addiction Control You

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NEWPORT BEACH & LONG BEACH, CA