Alcohol is a widely used addictive substance. It is legal in most countries, and anyone over a certain age can drink alcoholic beverages. These drinks also come in different forms and are sold everywhere, so they’re easily accessible.
Drinking alcohol once in a while does not cause problems. But if people drink too much, they can become dependent on alcohol. Worse, they may develop alcohol use disorder, or AUD. People with AUD cannot control their drinking habits, and their lives would revolve around alcohol.
Those who have AUD and want to live sober again may go through alcohol rehab. Depending on how severe their addiction is, alcohol rehab can take anywhere from 90 days to half a year. Most rehab programs also involve aftercare, which are follow-up therapies done after patients have completed their alcohol rehab programs.
Alcohol rehab can cost a lot of money. People may hesitate going through rehab because of the cost. Even if they have health insurance, the rules on mental health coverage are not always clear cut.
So, is alcohol rehab covered by health insurance? Read on to find out.
What is involved in alcohol rehab?
Alcohol rehab is a process that uses multiple treatments. These include:
- Medically assisted detox, including medications
- Inpatient rehab services
- Outpatient rehab services
With that, alcohol rehab as a whole is an expensive undertaking. Not many people with AUD can afford to pay for everything out of their own pockets. For that reason, many people with AUD opt out of treatment in the first place.
Alcohol rehab is particularly costly if patients require inpatient rehab. That’s when they have to stay inside a rehab center for several months, depending on how serious their AUD is. The price includes accommodation, board, and amenities on top of the costs of the therapies themselves.
Outpatient rehab is less costly, as patients only have to go to the rehab center during scheduled sessions. However, outpatient rehab is only effective for milder cases of AUD. More severe ones definitely need inpatient treatments.
Does private insurance cover the entire cost of alcohol rehab?
The good news is most private insurers cover treatments for addictions. The challenging part is each insurer has a different set of rules. Some insurance policies have complete rehab coverage, while others only cover part of the cost. Those with more comprehensive rehab coverage often charge higher premiums, though.
For individuals with AUD seeking treatment, they must check with their insurance providers first before enrolling in any alcohol rehab program. In most cases, there are costs that they have to pay out of pocket.
People who are under group health plans provided by their employers face similar challenges. There may also be exclusions under these plans, so it’s best to check with the insurer first.
Often, most insurers cover rehab only for the first time. Those who have to go to rehab again may not be covered anymore. This includes relapse.
Even if the National Institute of Alcohol Abuse and Addiction says that relapse can be part of the recovery process, insurers can exclude any treatments after relapse because patients have already gone through treatment before.
The Affordable Care Act of 2008 also set a new standard for the coverage requirement. If an insurance provider has plans that cover alcohol rehab, the law states that it must provide benefits equal to the plan’s surgical and medical benefits.
Take note, though, that the Affordable Care Act did not require insurers to provide coverage for AUD and other substance use disorders. Thus, this law only applies to insurance plans that already cover these cases.
Does Medicaid or Medicare cover alcohol rehab?
For individuals who don’t have private health insurance, Medicare and Medicaid can help them.
Medicare Parts A and B provide coverage for alcohol rehab. Part A can help with hospitalization for AUD treatment, while Part B can help pay for outpatient therapies and partial hospitalizations.
For patients needing medications like naltrexone, Medicare Part D covers this. Naltrexone is often used in detox processes for alcohol rehab. This drug reverses the harmful effects of alcohol on patients’ bodies.
Medicaid programs under the Affordable Care Act are required to provide coverage for alcohol rehab. This is another option, especially for people with disabilities or those with low income.
The US government’s Health Insurance Marketplace is a good place to scout for insurance plans that have alcohol rehab coverage. Visit healthcare.gov to see the different choices.
Which parts of alcohol rehab are not covered by insurance?
Most medically necessary aspects of alcohol rehab are covered. These include detox, detox medications, and behavioral therapies.
Those that are not quite necessary, though, are not covered. For example, luxury amenities like gourmet food, swimming pools, spas, and recreational activities are usually excluded from insurance coverage. So-called holistic therapies may also be excluded.
In some US states, their policies state that private insurance providers may deny coverage to people seeking treatment while they are intoxicated. This is especially applicable if the intoxication leads to injuries or illnesses that require emergency medical attention.
What out of pocket expenses are there for alcohol rehab?
Even if insurance providers cover most of the cost, there are some things the policyholder must shoulder aside from the premiums. These include:
- Copays required to get a service or a doctor
- Deductibles, which policyholders must pay before coverage begins
- Lifetime limitations, which include any cost incurred after the duration of the coverage has ended
Do all rehab centers accept insurance?
Most rehab providers accept insurance, but each center may allow certain insurers only, or certain insurance plans only. It’s important to check with the rehab center first.
If the center approves, they must work with the patients’ insurers to find out how much of the rehab is covered. If there are exclusions, the center should be able to help patients find ways to pay for any out of pocket expenses. In some centers, they offer financing options as well.
In short, discuss with the rehab center about any insurance and financial concerns before enrolling in a program.