Understanding the nitty-gritty of health insurance can be a very daunting task. For different issues and claims, you need to understand the complete procedure in order to determine, if you are cover under a certain medical condition.
Addiction is a common case found with people in America and going into rehab is its ultimate treatment. It is a legitimate question to ask or think whether health insurance covers for addicted, who goes under rehabilitation.
As compared to the usual medical conditions, addiction is catered differently under insurance. The dynamics of health insurance needs to be checked to determine the eligibility of drug rehab to be covered under health insurance.
How Insurance Works? #
The short and straight answer to the subject question is “Yes”. Health insurance covers drug rehab, but different conditions may be involved. It mainly depends upon the source of your health insurance and then the government policies and the act protecting the rights of those having an addiction, mental issues, and other behavioral health conditions. We will discuss this all in detail in the next sections.
Health insurance needs to be purchased, where you need to sign up for a specific plan that suits your needs.
A premium, mostly on a monthly basis needs to be paid for the insurance. In USA, you have the option to buy insurance from the federal marketplace or otherwise from the different authorized health insurance companies.
The majority of insurance plans have a certain deductible amount or a specific amount that the person should reach before the subject coverage is applicable. The insurance service provider then pays specific percentage of the rendered service and the individual has to take care of the remaining cost.
Affordable Care Act (ACA): #
Affordable Care Act ascertains that all the behavioral health services are essentially covered under all the different types of health insurance plans. Addiction issues are covered under the scope, which the insurance companies must adhere to. The covered services for addiction treatment may include the following:
- Inpatient treatment
- Residential treatment
- Outpatient treatment
- Crisis services
- Prescription medications
- Co-occurring disorders treatment
- Community-based programs for drug rehab
Common Healthcare Plans: #
The substance abuse including alcohol or drug treatment and recovery could be covered by your insurance provider. The following are the two common types of health insurance plans and you can choose, which better suit your needs:
Health Maintenance Organization (HMO) #
This plan enables patients to select their primary care doctor. If you are looking for a medical specialist outside the network, then a referral should be provided by your primary care physician. These plans have lower or sometimes no deductibles at all. This plan is suitable for those who are not looking for any specialist physician or a doctor outside their network. It also works for those paying lower insurance premiums.
Preferred Provider Organization (PPO) #
These plans enable patients to get treated by healthcare providers either in or outside their network. No referral from your primary care physician is required. In comparison with HMO, patients having PPO plans could have much higher deductibles.
The insurance acceptance or the amount of health insurance coverage is dependent on the insurance policy under which the patient is covered. It means that out of the pocket cost will vary. American Addiction Centers should be contacted to know about what the policy includes.
Your Health Insurance Plan: #
No matter, you choose the federal marketplace or other private insurance companies for your health insurance, the services you get varies, based on your plan. Plans are categorized into different categories. The rule is simple. Plans with more premiums will have more services and those with lesser premiums will cover less. It is always advised to shop smartly for your health insurance plans, which should be chosen based on your potential health conditions and of course your budget as well.
The cost of drug rehab treatment varies big time on the type of treatment center or are you preferring outpatient or inpatient programs. The non-profit healthcare centers provide free of cost services, while luxury healthcare providers can be very expensive. However, as a rough estimate, drug rehab treatment could cost you anywhere between $2000 – $25000 per month. Therefore, you need to be very smart about choosing your health insurance plan.
The rehab cost varies based on the length of the treatment, your location, treatment center and what services are included in it. For example, a drug rehab center with a beach view would be more expensive than one in a suburb town with only basic facilities. Outpatient option id always cheaper than inpatient, and works in most of the cases.
It usually is a basic concern regarding the drug rehab insurance that most patients have because when it comes to cost, everyone needs to be sure about the budget and the overall coverage for the situation.
Usually, the insurance providers make sure to offer all the desired details before everything is finalized so that no ambiguity is there for both parties.
It is always better to select the health insurance plan that actually covers the options you need so that if you have selected the plan for your overall coverage, it will provide the support that is needed.
Addiction or drug abuse is covered by health insurance plans. The best thing is that insurance is provided without making any categories based on type of addiction or drug abuse.
Your type of insurance plan determines what type of drug rehab services you get and how much deductibles or premium you have to pay. It is better to understand things for all the various expenses and how the condition is going to get compensated by the insurance provider. It may not be simple or straight forward for those who are looking for such an insurance plan for the first time, but still enough help is expected through then plan if it’s the right package for your coverage.
Insurance plans cover many different types of services, where outpatient is much more affordable as compared to inpatient treatment.