One of the common barriers for people with substance use disorders is they are not financially able to afford the cost of addiction treatment. Even when they have health insurance, they often question is addiction treatment covered by insurance.
What is Addiction?
Addiction is a disease that affects an individual and their body and brain. It often involves using substances compulsively without regard to the consequences of continued use of the substance. Addiction can be caused by a variety of factors, including environmental, social, psychological, and family history.
Is Addiction Treatment Covered by Insurance?
When the Affordable Care Act (ACA) went into effect in 2014, it included a list of ten essential health benefits. Among those was mental and behavioral health services coverage, including substance use disorders.
So, if someone has Marketplace health insurance coverage, their plan will include addiction treatment. According to Healthcare.gov, all plans must cover substance use disorder treatment. However, the extent of that coverage will depend on the health insurance plan one has selected and the state where one resides.
What if I Have Employer-Sponsored Insurance?
Most employer-sponsored insurance plans are also required to provide the same essential health benefits as plans available through the Marketplace. Each employer-sponsored plan and coverage will vary from one company to the next. Just like Marketplace plans, the extent of substance use addiction treatment coverage can differ but should be available.
What if I Have Medicaid or Medicare?
The ACA also applies to state and federal insurance plans, including Medicaid and Medicare. There is funding available under these plans for addiction treatment. However, one may need to obtain treatment at a specific facility.
What if I am a Veteran?
The U.S. The Department of Veterans Affairs provides several different covered options for veterans with substance use disorders. Veterans with VA health care program coverage can often choose the substance use disorder facility where they want to be treated.
In addition, if a veteran does not have Va health care coverage, they can still qualify for addiction treatment through various VA programs. Furthermore, if the veteran is considering self-harm and suicide, with or without an addiction, they can admit themself to any treatment facility, and their treatment is covered under TRICARE.
What if I Don’t Have Insurance?
There are several different options for people who do not have insurance coverage or whose insurance coverage does not include addiction treatment. Most addiction treatment centers have a list of resources, including state-funded, scholarships, and grants for people without insurance that provides no-fee or minimum-fee treatment costs.
Will Insurance Fully Cover Addiction Treatment?
Full coverage for addiction treatment programs is not always guaranteed, even with the ACA. Marketplace and employer-sponsored plans can have different coverage limits and requirements based on the particular plan as follows:
- Some plans will cover detox, while others do not.
- Some plans will require the person to use an in-network treatment center.
- Coverage might be limited to a specific type of program, such as inpatient or outpatient.
- There may be a specific coverage time for treatment, such as up to 90 days.
- Coverage limits might vary depending on the type of substance.
What Insurance Providers Offer Plans that Cover Addiction Treatment?
The following is a list of the more common insurance providers that offer Marketplace and employer-sponsored insurance plans that cover addiction treatment:
- Aetna
- Ambetter
- Blue Cross Blue Shield
- BCBS of California
- Cigna
- Humana
- Kaiser Permanente
- Sierra Health
- Triwest
- United Healthcare
- VA Insurance
- VA TRICARE
How Can I Find Out if Addiction Treatment is Covered by Insurance?
There are several options to determine whether your insurance covers addiction treatment. First, you can call your insurance provider using the phone number found on your health insurance card.
When you speak to your insurance provider, if they say your insurance carrier covers treatment, you will want to ask them the following:
- What type of addiction treatment is covered?
- How long is treatment covered?
- Does treatment include detox?
- Does treatment include medication-assisted treatment?
- Are all treatment programs covered or only specific ones?
- Can I go to any treatment center, or are there specific in-network ones I have to use?
Your next option to find out whether your insurance covers addiction treatment is to call the treatment facility directly. They have insurance coordinators who can verify your insurance coverage and find out precisely what addiction treatment services you have available.
Do I Need a Referral to Obtain Addiction Treatment?
Some insurance plans will require you to obtain a referral from your primary care physician (PCP) before you can start an addiction treatment program. If they do, simply ask your PCP for a referral for addiction treatment. Another option is to have the treatment center request the referral on your behalf from your PCP.
Verify Your Addiction Treatment Coverage in Orange County, CA
It is easy to verify your addiction treatment coverage at Pacific Sands Recovery Center in Orange County, California. We are happy to assist you and answer any questions you have about insurance coverage, admissions, and our treatment programs. Contact us today to verify your addiction treatment coverage.
