There are plenty of barriers between people who need addiction treatment and the services that will lead them to meaningful recovery. However, two of the most significant concerns people have are the cost and finding the right addiction treatment program for their individual needs.
Cost shouldn’t stop your path to recovery.
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Addiction doesn’t only affect your health. It affects multiple aspects of your life, including your relationships, finances, and your ability to maintain an income. If you don’t get the help you need to take back your life from the oppression of addiction; it may cost you your health, money, and relationships.
Being free from active addiction is invaluable. It not only means saving your life; in many cases, it also means having the freedom to pursue a productive life free from the burden of chronic substance use.
Throughout the 20th century, we have learned more about addiction and come to understand that it is a complex and chronic disease. Furthermore, it’s a disease that can be treated with a variety of treatment options. With this discovery and America’s current opioid epidemic, insurance companies have also come to consider that addiction is a complicated but treatable disease, and most private insurers cover addiction treatment.
Still, insurance coverage is always difficult to navigate, and insurance for addiction treatment is no exception. But at New Perspectives, we are committed to making the process of financing your recovery as simple as possible.
Continue reading to learn more about financing options, how to get help navigating insurance coverage, and what insurance companies usually cover in addiction treatment.
Substance Abuse Insurance Coverage
Addiction treatment comes in a wide variety of options. With the addiction epidemic continuing on, clinicians, researchers, and other professionals, in the field of addiction treatment, are working to come up with new ways to treat it. Plus, there are also dozens of existing treatment options, all with varying degrees of effectiveness.
While it’s true that most insurance companies cover addiction treatment, they might not cover every type of therapy or every type of treatment center.
Some treatment centers already have relationships with insurance providers, and it will be easier to get treatment at that center rather than a facility that is unknown to your provider.
That doesn’t mean out-of-network facilities are off the table. You still may be able to get coverage at another facility if you believe that it would better fit your needs. Your insurance company will need to evaluate the facility to determine it meets their qualifications.
Your insurance provider will look at a number of factors, including:
- The type of treatments it provides
- Whether it is in-state or out-of-state
- Whether it is privately or publicly funded
- and other factors
Again, you don’t have to navigate insurance coverage on your own. You can find help from your doctor, your insurance provider, and the facility in which you are interested. But it’s important that you also investigate what type of treatment center would be best for your needs. At New Perspectives, we are dedicated to helping you not only navigate your insurance plan and what it covers but also understand the type of treatment that is ideal for you.
What Is Covered?
Different insurance companies may have different policies concerning addiction treatment coverage. Though they often look for similar things, like a reputable treatment center, treatment models grounded in scientific research, and a clear need for treatment, they may cover you at different points in the treatment process.
Generally, insurance companies will cover the complete continuum of care, especially for highly addictive drugs. The continuum of care includes:
- Medical detox, the highest level of care in addiction recovery. This includes 24-7 medically monitored treatment. As the highest level of care, insurance companies look for a clear medical need. Some drugs cause uncomfortable withdrawal symptoms but have a low risk for medical complication, and some insurers will try to avoid covering you for detox.
- Inpatient services and partial hospitalization are the second-highest levels of care. This level also involves a clear medical or psychological need. It will also offer intensive clinical programs designed to help you get to the root of your addiction.
- Intensive outpatient programs offer more than nine hours of clinical services every week but allow clients to live at home. This is an ideal level of care for people who need intensive clinical services, but their medical, psychological, and cognitive needs are manageable on their own.
- Outpatient services are the lowest level of formal treatment. This is ideal as the last stop on the continuum of care after higher levels are completed. It involves less than nine hours of clinical services.
When deciding whether or not they will cover the treatment or clinical service, insurance companies will look for two specific things:
The first is the use of evidence-based treatment modalities. This refers to therapy options that are backed up by research and can be reproduced in a number of clinical settings. Behavioral therapies are generally the most recommended therapy option for addiction treatment.
Second, insurance companies look for progress. They want to see a record of positive progress and success from a treatment center. If you aren’t making any progress in a treatment center, they may try to discontinue covering treatment at that facility.
State-Funded Treatment Centers
Federal and state financing allows states to set up and provide treatment through their own rehab centers. State centers often offer both residential and outpatient treatment. In most cases, they offer follow-up support services or refer individuals to them. While the programs do not provide the same amenities or cutting-edge treatment methods, a majority of their care is detox or outpatient.
Sixty-one percent of admissions at publicly funded centers were geared toward outpatient services, and another 22 percent were for detox. Seventeen percent of the admissions received were for residential care.
State-funded treatment centers have specific criteria for the person to be accepted into a program. While they vary by state, there are general guidelines, which include:
- Proof of residence in the state they are seeking treatment
- Proof that they are unable to afford treatment
- Proof they are citizens and possess a legal residence in the United States
- Information about the severity of their addiction and addiction history
The primary challenge is availability, and there is typically a waiting list to receive treatment. In a majority of cases, certain individuals will be given priority for space, including pregnant women or veterans. Waiting lists should never turn someone away from getting the treatment they need. While the treatment may not be as luxurious as some that cost money, they manage to help people get sober every day. Receiving this type of treatment is better than no treatment at all
In 2016, 1.7 million people over the age of 12 were admitted to publicly funded treatment centers.
Federal Government Assistance
There are several channels where federal support for drug treatment centers is available. The Substance Abuse and Mental Health Services Administration offers information, services, and grants geared toward helping treatment centers and abuse programs provide services to those who need them but can’t afford them.
Other public assistance from the government includes programs like Medicare and Medicaid, Veterans Affairs (VA) benefits, and other provisions under the Affordable Care Act (ACA). These programs often require certain levels of eligibility based on age, income, disability, or other social aspects.
Be the best version of you – start recovery today!
Be the best version of you – start recovery today!
Medicare and Medicaid
Medicare Part A (hospital) and Part B (medical) insurance programs, including the Part D prescription plan, typically provide coverage for addiction treatment. The programs cover both residential and outpatient programs and medicines used to treat substance use disorders, except for methadone. In some cases, it will cover partial hospitalization treatment. If Medicare covers someone, they must be 65 or older, or disabled.
Medicaid coverage for substance abuse will depend on the state. Many states increased their Medicaid through the ACA, which makes it available to families at a higher rate. Medicaid will provide support for low-income families, and eligibility will vary by state based on:
- Specific income level
- Family with young children
Verify Your Insurance Coverage
National Institute on Drug Abuse. (n.d.). 8: Medical detoxification. Retrieved from from https://www.drugabuse.gov/publications/teaching-packets/understanding-drug-abuse-addiction/section-iii/7-medical-detoxification
National Institute on Drug Abuse. (n.d.). What is drug addiction treatment? Retrieved from from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/what-drug-addiction-treatment
National Institute on Drug Abuse. (n.d.). Behavioral Therapies. Retrieved from from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment/evidence-based-approaches-to-drug-addiction-treatment/behavioral-therapies
Substance Abuse and Mental Health Services Administration. (n.d.). Retrieved from from https://www.samhsa.gov/
Cbhsq. (n.d.). Retrieved from from https://www.samhsa.gov/data/sites/default/files/2015_Treatment_Episode_Data_Set_National/2015_Treatment_Episode_Data_Set_National.html