Alcohol Rehab Insurance: What’s Covered?
According to the 2019 National Survey on Drug Use and Health, 14.5 million Americans ages 12 and older met the clinical criteria for alcohol use disorder (AUD).1 Unfortunately, only 7.2% of these people received any professional treatment within the previous year.1 Many barriers exist that may prevent someone from seeking treatment, including the financial burden of treatment and not having quality alcohol rehab insurance to help cover the costs.
In this article:
- Does Insurance Cover Alcohol Rehab?
- How Do I Know if My Insurance Covers Alcohol Rehab?
- Can I Get Alcohol Rehab Insurance Coverage?
- Does Medicaid/Medicare Cover Alcohol Rehab?
- Can I Go to Alcohol Rehab with No Insurance?
Does Insurance Cover Alcohol Rehab?
The Affordable Care Act of 2010 (ACA) established some vital health insurance reforms, including listing substance use disorders as one of the ten elements of essential health benefits. Beginning in 2014, all health insurance plans sold on Health Insurance Exchanges or provided by Medicaid must include services for substance use disorders.2
The ACA ensures that all health insurance plans must cover the following:3
- Substance use disorder treatment
- Psychotherapy and counseling
- Mental and behavioral inpatient services
It is critical to understand which services are included under the substance use treatment umbrella and which are not. For example, detox services are considered part of the treatment process, so some coverage is required, but sober living communities are a form of aftercare and residential service, so insurance companies do not have to provide coverage for them.
The government has also put certain parity protections for mental healthcare, including substance use treatment. Healthcare marketplace plans cannot deny coverage for a pre-existing condition, including substance use. Because substance use treatment is considered an essential benefit, insurance policies cannot place annual or lifetime dollar amounts on coverage.3
How Do I Know if My Insurance Covers Alcohol Rehab?
If you are considering seeking treatment for AUD but are unsure what kind of alcohol rehab insurance coverage you have, there are simple steps you can take to find out this information. Typically, when you first enroll in a new health insurance plan, you are sent a booklet in the mail that provides a detailed summary of benefits and coverage. This booklet will detail which substance use treatments and services are covered and at what coverage level. The paperwork will explain if you are responsible for any copays or deductibles upfront and what percentage of your treatment is covered.
If you do not have this booklet in your physical possession, many insurance companies provide this information online if you create an account. Another option is to call the insurance benefits line and speak to a representative directly who will be able to provide you with coverage details and answer any questions you may have about your alcohol rehab insurance coverage.
Pre-authorizations and Peer-to-Peer Authorizations
Many insurance companies require pre-authorization or peer-to-peer authorization to cover certain services. These forms of authorization require physicians to submit information about the services they intend to provide for the insurance company’s medical team to decide if it is medically necessary and a qualifiable covered service.4
This pre-authorization process can be a significant barrier to treatment, especially for those who need immediate care and support. Waiting for pre-authorization places the patient at risk of continuing substance use, experiencing medical complications, and overdose or death.5
In the past, health insurance companies have required pre-authorization for substance use treatment more often than for other healthcare services. However, this discrimination is no longer tolerated under the Mental Health Parity and Addiction Equity Act.5
As of April 20, 2020, 21 states and the District of Columbia have passed laws limiting public and private health insurance companies from imposing pre-authorization policies on substance use treatment, services, and medications.5
Denials and Appeals
Sometimes healthcare services are denied coverage. If this happens for you, speak with your doctor or treatment team about the denial. You can submit an appeal, but it will require additional paperwork signed by your medical team.
In-Network and Out-of-Network Providers
Most insurance policies will have in-network and out-of-network providers. The providers and treatment facilities listed as in-network will provide the most insurance coverage under your plan. Some insurance companies will provide no coverage for out-of-network providers, whereas others will provide limited coverage. Check your specific insurance policy to determine your coverage rates and which providers are in your network.
If you have difficulty finding an in-network rehab facility covered by your insurance, you may be able to submit an appeal for an out-of-network provider to be covered. You can call your insurance company directly for more information on your treatment and coverage options.
Can I Get Alcohol Rehab Insurance Coverage?
You may be able to get alcohol rehab insurance even if it is not in your plan. However, check your plan details thoroughly to make sure you didn’t miss it, as the law requires substance use treatment be covered as an essential benefit.2
If you do not currently have insurance through an employer, you can search for available insurance coverage through the government’s healthcare marketplace. You can search for insurance plans that provide the best coverage for alcohol use disorder treatment through this marketplace.
Does Medicaid/Medicare Cover Alcohol Rehab?
Both Medicaid and Medicare provide coverage for alcohol rehab and addiction treatment. Approximately 3% of Medicare beneficiaries and 6% of people eligible for both Medicare and Medicaid will have a substance use disorder in any given year. Of these people, 19.3% received substance use disorder treatment.6
Medicaid Alcohol Rehab Insurance Coverage
Approximately 20% of Americans have insurance coverage through Medicaid. The federal government has requirements for basic services that must be covered under Medicaid insurance, including substance use treatment. However, each state is unique and has different policies that may restrict or not cover certain services.6
However, Medicaid does not cover residential treatment in many states, especially for adults. Some states also restrict doses for medication-assisted treatment or require pre-authorization before treatment can be administered.5
If you have Medicaid, check with your specific insurance plan to see what coverage you have for substance use treatment.
Medicare Alcohol Rehab Insurance Coverage
Medicare covers almost all individuals in the United States over the age of 65, as well as those who qualify based on disabilities. Generally, Medicare Parts A and B and private plans under Part C cover inpatient (but not residential, as inpatient occurs in a hospital setting while resident does not) and outpatient alcohol rehab and AUD screening and brief intervention. Medicare Part D provides coverage for medications that may be prescribed to help people quit or reduce drinking.6
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Can I Go to Alcohol Rehab with No Insurance?
You can certainly go to alcohol rehab with no insurance coverage. However, these services can be expensive and are often not affordable for most people without some assistance from insurance companies.
That said, many treatment facilities will work with patients by offering sliding scale rates and payment plans. Public funding in the form of grants is also sometimes an option.
One such grant is the Substance Abuse Prevention and Treatment Block Grant (SABG) provided by the Substance Abuse and Mental Health Services Administration. SABG provides funding to all 50 states as well as the District of Columbia, the U.S. Virgin Islands, Puerto Rico, six Pacific jurisdictions, and one tribal entity to help prevent and treat substance use.7
SABG focuses heavily on prevention services but does have funding available for treatment for certain populations, such as pregnant people and those with dependent children.7 You can check with your state to see what funding may be available. You can also talk to the treatment center directly about funding options that they may have.
If you have further questions about alcohol use treatment options, call 800-839-1686Who Answers? to speak with an addiction treatment specialist.
- National Institute on Alcohol Abuse and Alcoholism. (June 2021). Alcohol Facts and Statistics.
- The White House Administration: Office of National Drug Control Policy. Substance Abuse and the Affordable Care Act.
- Gov. Mental Health and Substance Abuse Coverage.
- Akosa, A. (June 2006). Precertification, Denials, and Appeals: Reducing the Hassles. Family Practice Management, 13(6):45-8.
- Legal Action Center. (May 2020). Spotlight on Legislation Limiting the Use of Prior Authorization for Substance Use Disorder Services and Medications: An Analysis of Private and Public Insurance Standards.
- Substance Abuse and Mental Health Services Administration. (November 2016). Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Chapter 6: Health Care Systems and Substance Use Disorders.
- Substance Abuse and Mental Health Services Administration. (April 2020). Substance Abuse Prevention and Treatment Block Grant.