Trusted Content

Insurance Coverage

Isaac Alexis, M.D., AAMA, AMP-BC

Medically reviewed by

Isaac Alexis, M.D., AAMA, AMP-BC

March 12, 2019

Ultimately, the question of whether or not insurance will cover one’s rehab treatment comes down to the specifics of the health insurance plan and the type of rehab one is seeking. Of course, the best course of action is to speak to your insurance provider directly. That said, there are some broader pieces of insurance-related advice you can keep in mind as you begin looking at treatment options.

Type Of Insurance Plan

One factor to consider is the type of health insurance plan you have. Is it a group plan provided by your employer? Is it a private individual or family plan purchased through the marketplace? Or, perhaps you have a government-funded plan through Medicaid? The availability of insurance coverage for substance abuse rehab, along with the amount of coverage you can get, varies greatly depending on which one of these insurance types you have.

Group Plans

Currently, 43 states (Arizona, Georgia, Idaho, Indiana, Iowa, Oklahoma, and Wyoming being the exceptions) require all commercial group or employer-sponsored plans to cover substance abuse treatment to some extent. Meanwhile, on the federal level, more support has come from the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). This act requires that for employers offering health insurance to 50 or more employees at a time, the coverage offered for substance abuse treatment must be as generous and as affordable as coverage for other medical procedures, specifically when it comes to things like out-of-pocket costs and permitted number of visits.

That’s for group plans offered through an employer. What about people that suffer from substance abuse without employer-provided insurance?

Individual And Family Plans

Until just recently, people with private, individually purchased health insurance plans had relatively fewer options than those with employer-sponsored group plans. The Affordable Care Act has tried to fix this, extending similar provisions to the individual insurance marketplace as those found in the MHPAEA. All individual and family plans marketed to consumers on the exchange must cover “10 essential health benefits”, one of which is treatment for mental health and substance abuse disorders.

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Copays And Deductibles

Whether one has employer-provided insurance or an individually purchased plan, one important thing to remember is that even if rehab is covered under your plan, you still might have to pay a portion of the treatment cost. The precise percentage varies, as different plans have different copays and deductibles.

The amount of money you may owe also depends heavily on the kind of treatment you receive. Inpatient rehab, for example, tends to be significantly more expensive than outpatient rehab, and thus often requires a heftier monetary contribution from the patient in the eyes of the insurance company.

Find The Rehab That Suits Your Finances

Health insurance can be a complicated, confusing process. Don’t let it get in the way of treatment, however; contact us at, and we’ll help you find a quality treatment center that suits the specifics of your health plan and won’t break the bank.

Commonly Used Insurance Providers That Cover Drug And Alcohol Treatment

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