What You Should Know About Rehab Insurance Coverage

A lot of people do not get the help they need from rehabilitation centers because they are afraid of costs, considering addiction treatment an expensive service. If you are one of them, you should also know that, most probably, your insurance provider can cover all or a considerable part of your expenses.

Addiction Treatment Benefits Versus Costs

Acknowledge the value you are getting by freeing yourself or your loved one from addiction. Before considering the cost of rehabilitation, estimate the benefits. Sober life means recovering and improving relationships with family and friends, a good job and career growth, and a happy balanced life!

insurance coverage insurance laws requiring commercial group health insurance to cover treatment for alcohol and other drug addictions

How much of the treatment costs will be covered depends on both the insurance company and the rehabilitation center. Contact both to find out how much of the cost of rehab your insurance company will cover.

Rehab Insurance Coverage

Most of the US states have laws, that require insurance plans to cover addiction treatment. States that do not have these laws are Arizona, Georgia, Idaho, Indiana, Iowa, Oklahoma, and Wyoming.

rehab insurance coverage insurance laws requiring commercial group health insurance to cover treatment for alcohol and other drug addictions

Besides, the Mental Health Parity and Addiction Equity Act (MHPAEA, 2008) is intended to eliminate discriminatory actions on the insurance companies that restrict coverage of treatment for substance use disorders. The Affordable Care Act extends the benefits of MHPAEA by mandating essential coverage for substance use.

Regardless, the coverage of addiction treatment varies by company and by insurance plan.

Usually, BCBS plans can fully or partially cover detox, rehab, aftercare services, specialty alcohol and drug treatment, and addictions such as internet, gambling, and porn. Amerihealth can cover up to 90% of substance dependency treatment. EmblemHealth covers at least part of the cost of any routine outpatient rehabilitation at any one of its network facilities without the need for prior approval, but it usually doesn’t cover inpatient rehab.

All standard Medical Mutual insurance plans cover at least some of the fees charged by both inpatient and outpatient addiction rehabilitation facilities. Assurant has a list of declinable conditions, which include alcohol and drug addictions. Regardless, it does have insurance plans that cover rehab treatment for substance abuse. Most United Healthcare substance abuse benefits will cover detox, but it may not cover rehab. If it does cover rehab, the insurance will cover just a part of treatment costs. Humana offers plans, that do not restrict to specific doctors, hospitals, or treatment centers, while the group insurance plans for employers should cover addiction treatment.

Insurance Coverage Facts

Insurance companies usually do cover substance addiction rehabilitation, because the costs of not covering rehab can be much higher. The economic cost of untreated addiction to the US is estimated to $328 billion a year. The cost savings available when adequate treatment is provided go up to $7.00-$12.00 saved for every $1.00 spent.

Insurance coverage depends on the length of the treatment. The average days of stay covered under insurance are currently between 11-14 days, of the 30 days often identified in policies. Average costs of outpatient treatment start at $1000 per month, $3,000-$5000 for a 3-5 day heroin detox. A 30 day inpatient program stay, without detox services, can cost about $30,000.

Like auto insurance, health insurance is a service you pay for but hope you will never need. It’s there for the unpredictable, unexpected and fundamentally uncontrollable problems that come up in people’s lives,” said Dr. Molly Cooke [3].

Insurance has the leading role for compensation of damages. The emergence of insurance enabled economic and social development. Insurance protects the health and property of individuals and enterprises against risks. As well, it assures the continuation of a society.

In all countries, regardless their economic status, the healthcare industry is one of the most important economic sectors. It is responsible for important national assets: human capital, and the standard of living. Insurance is the means by which healthcare becomes accessible. Furthermore, health insurance can be a guarantee of receiving medical care in case of an accident, injury, or sickness.

Insurance covers:

  • a large variety of cases and medical services;
  • aftercare or post-operative treatment;
  • costs, hospitalization, and treatment in case of major health problems or surgical interventions.

Insurance Distribution by State

There is an uneven distribution of insured people across the US. Some states, such as Massachusetts, Vermont, District of Columbia, Hawaii, and Minnesota have more than 94% insured. The smallest percentages of insured people are in Texas, Alaska, Florida, Georgia, and Oklahoma. Here, the rate of insured people does not surpass 85% (as of 2014).

The distribution of insured people is quite uneven across the country. The Midwest and Northeast are the “most insured” regions of the US. One underlying reason could be the average disposable income per capita (see map below).

rehab insurance coverage disposable income by state addiction treatment rehabilitation insurance coverage

Source: [2]

The distribution of insured people by state has a distribution pattern similar to disposable annual income by state.

Correlation of Insurance and Income per State

There is a positive correlation between the average disposable annual income and insured per 1,000 people. The higher the income, the more insured people.

rehab insurance coverage correlation of insurance and income disposable income by state addiction treatment rehabilitation insurance coverage

Source: [2] and [4]

Among top 10 states by disposable income, Massachusetts has the most insured per 1,000 people. It is also the fourth according to the average disposable annual income.

District of Columbia is the top state according to the average disposable annual income. It is the third in the top list of insured per 1,000 people.

Correlation of Insurance and Education per State

The correlation between education degrees and the number of insured per 1,000 people is positive as well. The more educated the people, the more insured they are.

rehab insurance coverage correlation of insurance and education disposable income by state addiction treatment rehabilitation insurance coverage

Source: based on [4] and [5]

Among the top 10 states by insurance coverage, Massachusetts has the most insured per 1,000 people. It also is the second most educated state, (people 25+ with a bachelor’s degree or higher).

Likewise, the District of Columbia is the top state by college education. It is the third most insured (insurance coverage per 1,000 people).

In conclusion, education and income are factors that determine the distribution of insured people by state. The higher the income and the higher the number of bachelor’s degrees, the higher the insured per 1,000 people.

  1. HBO Addiction  Can’t Get Treatment Through Your Health Insurance Plan?
  2. Statista – Per capita disposable income in the United States in 2015, by state (in U.S. dollars)
  3. U.S. News – Why do you need health insurance?
  4. United States Census Bureau – Health Insurance Coverage 2014
  5. United States Census Bureau – Annual Estimates of the Resident Population for the US

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