Does Insurance Cover Rehab?

Addiction treatment is just like getting treatment for any other chronic illness—cancer, heart disease, diabetes, arthritis, etc. And like with all treatment plans, one of the big questions is: How much is this going to cost me?
Like choosing a cardiac specialist for cardiac rehab or a physical therapist for physical rehab, addiction treatment costs are complex but a necessary and real part of choosing a center. For addiction rehab, we’re here to be transparent about the reality.
Can Insurance Cover Rehab?
Well, that depends.
Rehab costs depend on 2 major factors: facility type and your specific insurance plan. As a refresher, there are 2 types of rehab facilities:
- Inpatient rehab: Also known as residential, these are 30-, 60-, and 90-day programs where the person lives at the facility and undergoes treatment.
- Outpatient rehab: The person undergoes treatment in an ambulatory (or outpatient) setting, where they can detox, attend therapy, or participate in any other recovery program while still going through their daily lives.
The second factor, insurance type and plan, is more complicated, and requires individual research and insurance provider consultation. Like rehab facilities, they generally fall into 2 categories:
- Medicare/Medicaid/Tricare: These are federally funded health insurance plans based on age, income, veteran status, and disability status, and are received through an individual application process.
- Commercial: This insurance is through private companies and is usually tied to the individual’s employment. There are dozens of different companies (Anthem, Cigna, Molina, etc.), and each company offers a variety of plans that either the person or their employer selects.
Now that we’ve established this, let’s dive into inpatient versus outpatient insurance coverage.
Inpatient Rehab Insurance Coverage
Inpatient facilities are more likely not to accept insurance, and many centers require out-of-pocket or strictly cash payments. Inpatient centers can typically cost between $10,000-$30,000 with costs varying depending on the duration of treatment (1–3-month programs), services offered (detox, therapies, etc.), amenities (like spas, gyms, etc.), and location (city v. suburbs).
It’s really important to ask your insurance carrier to help you find in-network resources that meet your needs. For instance, full Medicaid offers extensive coverage for addiction rehab, so your treatment will likely cost you nothing with this insurance type. On the other side, commercial insurance and Medicare can cover some costs at some facilities. Your insurance company should be able to find you an inpatient facility in network AND confirm your coverage. They may offer alternatives to changing what you pay, so be sure to ask. But your coverage is your coverage.
You can learn more about the cost of inpatient rehab and other options in our alternatives to inpatient rehab article.
Outpatient Rehab Insurance Coverage
Outpatient facilities are significantly more likely to allow insurance coverage, and some even offer flexible payment plans for un- or underinsured patients. With outpatient facilities, be mindful of 2 different factors:
- Facility Policies: Each rehab center has its own list of insurances accepted, so be sure to research on a case-by-case basis (center website, phone call, etc.). Master Center accepts Medicare, Medicaid, Tricare, and almost all commercial insurance with special payment plans as well.
- Rehab Services: Outpatient centers offer a variety of services, and different ones accept different plans or have different copay/coinsurance costs. Some plans cover Intensive Outpatient Programs, some may cover a certain number of therapy appointments, or others may only cover medication costs. Talk to your insurance provider specifically about what services they can cover.
Read our cost of rehab article to learn more about outpatient rehab costs. You can also compare different rehab types in our treatment types pros and cons article.
Important Insurance Terms to Know
The health insurance industry can be confusing, so here are some important terms to know when researching rehab centers:
- Deductible: The amount you must pay out-of-pocket for medical expenses before the insurance company will cover any costs for the year. Some plans offer high deductibles in exchange for more coverage or lower costs, and these vary on a plan-by-plan basis.
- Premium: The base amount you pay every month through a payroll deduction for health care coverage, whether or not you use the insurance.
- Out-of-pocket maximum: The most you would pay out-of-pocket for covered services in a year. Once you reach this amount, your plan covers all eligible expenses.
- Copay: A flat fee you pay to your provider at the time of service. This includes medications, labs, additional tests, general consultation appointments, etc.
- Coinsurance: The cost between you and the insurance company that totals 100%; for instance, if the plan pays 80%, you’re responsible for 20% of the service cost.
- Claim: A medical IOU sent from the provider to the insurance company. Once your insurance pays its share, you’ll receive a bill for the remainder.
Each component depends on the different companies and plans, so it’s crucial to understand these terms when exploring rehab options. Always contact your insurance company if you’re confused about anything or need clarification on these amounts.
How to Find Insurance Coverage
Step one is to research and call different rehab facilities. Figure out what insurance they accept, what estimated costs are for your plan, and coverage for the services you’re interested in. Some questions we recommend asking:
- Do you accept [insurance company]?
- Are any medications covered by my insurance plan?
- Do you take copays/co-insurances per appointment?
- Do you accept un/underinsured patients?
- Do you offer payment plans for [insert insurance]?
Step two is to call/contact your insurance company to find out the extent of your coverage and what your plan offers. We recommend asking these questions:
- Does my plan cover addiction rehab?
- How much is my yearly deductible, and will it cover rehab once met?
- What are my out-of-pocket expenses for addiction rehab?
- Do I have to pay copays or coinsurances per appointment?
Knowledge and preparation are key, so be ready when reaching out.
Resources to Help Pay for Rehab
We know that understanding healthcare and insurance is tricky and confusing, but resources are available to help you determine costs and navigate the insurance world.
Master Center has specialized Healthcare Navigators to help with Medicare and Medicaid applications, find government-funded programs, and offer other ways to assist with financial barriers. They are fantastic resources for finding additional services outside of rehab to prevent as many obstacles as possible.
The cost of rehab is a big factor, and we aim to make understanding the process as easy and transparent as possible. So, no matter where you go, just do your research and be prepared, and lifelong sobriety awaits you.
About Master Center for Addiction Medicine
Master Center for Addiction Medicine is a groundbreaking addiction treatment program headquartered in Glen Allen, Va. Based on a vision of comprehensive outpatient care, Master Center was launched in 2016 and now includes locations throughout the Commonwealth.
Master Center offers a coordinated, multidisciplinary approach rarely seen in the outpatient setting, staffed by experienced addiction physicians, psychiatrists, counselors, therapists, and peer recovery coaches. This evidence-based approach, both reliable and flexible, is meant to provide a physician-oriented response to addiction that can work seamlessly in the mainstream system of healthcare.
Give us a call today at 804.332.5950 to schedule an appointment or learn more about us.