Everything You Need to Know About Insurance and Addiction

It used to be difficult to get a health insurance company to pay for addiction treatment services, dual diagnosis treatment, and even outpatient treatment programs. Fortunately, things have changed, and most insurance companies are now required to offer coverage for addiction treatment the same way they cover surgery, primary care, and other medical services.

If you’re struggling with drug and alcohol use in the Carolinas, it’s important to enroll at a treatment facility that is willing to work with your insurance to minimalize the out-of-pocket expenses and design an individual program for your drug or alcohol addiction.

Insurance Coverage for Substance Abuse Treatment

Each year, federal agencies survey thousands of Americans to identify trends related to alcohol and drug use. In a 2021 survey published by the CDC, nearly 12% of Americans aged 12 and older reported they had used at least one illicit substance within the past month. Alcohol treatment for alcohol abuse is also a concern, as nearly 15 million Americans aged 12 and older had alcohol use disorders in 2021.

Depending on the terms of your plan, you may be covered for the following types of services:

• Individualized Treatment Programs
• Day Treatment/Partial Hospitalization Programs
• Intensive Outpatient Services (IOP) or Generalized Outpatient Services (GOP)
• Treatment for Co-Occurring Disorders
• Counseling for Substance Use Treatment
• Medication-Assisted Treatment
• Detox Services
• and many more substance addiction programs…

The Affordable Care Act

In 2010, Congress passed the Patient Protection and Affordable Care Act, which eliminated some of the barriers to accessing care at addiction treatment centers around the United States, such as care for pre-existing conditions — like substance abuse coverage. It also created a list of 10 essential health benefits that all traditional health insurance companies must cover. This list of benefits includes mental health services and treatment for drug and alcohol addiction.

Under the ACA, plans sold via the Health Insurance Marketplace must also follow certain parity guidelines. This means an insurance plan must treat behavioral health care and medical/surgical care the same when it comes to deductibles, co-pays, authorization requirements, and the number of treatments covered by each plan.

Insurance Verification for Addiction Treatment

When it comes to treatment for drug and alcohol addictions, many people ask the same question: Does insurance cover rehab? Thanks to the ACA, traditional insurance programs cover at least some of the services provided by a sober living treatment center or outpatient treatment rehab. However, what they cover varies from one plan to another.

Several factors affect how much your insurance provider pays for alcohol addiction treatment or drug addiction treatment:

• What type of health insurance coverage do you have (health maintenance organization, preferred provider organization, etc.)
• Which treatment options do you choose?
• Whether you select an inpatient or outpatient program
• Additional services recommended by your treatment provider

Because insurance plans vary so much from one company to the next, it’s important to have your benefits verified before you enter treatment. Verification can help you understand how much your insurance covers and how much you can expect to pay out of pocket. It will also help you find out if you need prior authorization for any behavioral health treatment you’ll receive.

Out-of-Pocket Expenses With Health Insurance

Most insurance plans don’t cover addiction treatment at 100%, so it’s important to find out what your out-of-pocket costs will be before you start getting drug abuse treatment or alcohol abuse treatment. If you have a marketplace insurance plan, the amount you pay depends on your metal tier.

Every insurer is different and we recommend you learn about your specific policy coverage for services. For instance, if you are part of the government’s healthcare plan, your policy typically covers rehab treatment at the following levels:

• Bronze: Bronze plans usually have a 60/40 split, meaning the insurance company pays 60% of your drug rehab costs.
• Silver: If you have a silver plan, you may have to pay 30% of the cost of drug rehab after your insurance company pays 70%.
• Gold: Gold plans have higher premiums, but they also cover more of your costs. Most gold plans cover 80% of the cost of alcohol rehab and drug rehab.
• Platinum: Platinum plans have some of the highest monthly premiums, but they also provide the highest level of coverage. In many cases, a platinum plan covers 90% of the cost of behavioral health services, leaving you to pay the remaining 10%.

Does Changing Tides Accept Health Insurance?

Changing Tides works with several national insurance plans to ensure people with substance use disorders can get the care they need.

• Aetna: Aetna works with its plan members to determine if each service is covered.
• Anthem: All marketplace Anthem plans cover some type of addiction treatment. You may also qualify for coverage if you have Anthem coverage through your employer.

• Beacon Health Options: This Boston-based insurance company has more than 40 million subscribers throughout the United States. Most of its plans are group plans offered by employers.
• Blue Cross and Blue Shield: The Blue Cross Blue Shield System is made up of 35 independent and locally operated companies. To access your member services, please visit your BCBS company.

• Cigna: Cigna has group plans and marketplace plans that cover addiction treatment. The level of coverage provided depends on which plan you have.

• Optima: Virginia-based Optima offers, PPO, and point-of-service (POS) plans. If you need treatment at an out-of-network facility, the POS plan may cover some of the cost, but your out-of-pocket costs will be a little higher than they would be for an in-network provider.
• UnitedHealthcare: UnitedHealthcare operates United Behavioral Health, a service for members who need support for addiction and other mental health issues. Your UHC plan may also include a Maximum Non-Network Reimbursement Program (MNRP). If it does, you may have to pay more for drug and alcohol rehab than you would with another type pf plan.

If your plan doesn’t cover 100% of your costs, there are several ways to cover the remaining balance.

• Credit cards: Substance abuse issues can have life-threatening consequences. Using a credit card to cover some of the costs can help you avoid some of the harmful effects of long-term substance use.
• Medical loans: Several companies make loans specifically for people in need of medical or mental health treatment. If you qualify for a loan, you can use the funds to pay for treatment.
• Family loans: Your family members want you to get well. If they have the funds available, you may be able to borrow money, ensuring you can get treatment as soon as possible.

Changing Tides Accepts Health Insurance to Cover Substance Abuse Treatment

If you’re seeking addiction treatment, Changing Tides is ready to help you determine how much your insurance covers and explore your options for covering any remaining balance. Call (252) 715-3905 to request verification of your insurance benefits and start the admissions process. Just one phone call could change your life.