According to the Substance Abuse and Mental Health Services (SAMHSA), approximately 14.8 million people aged 12 or older had an alcohol use disorder (AUD) in 2018.1 However, only around 6.5% of adults with AUD actually seek treatment for the disorder.2 

AAC understands that making the decision to seek treatment for addiction isn’t easy, but we work to make it accessible for everyone in need. We accept many insurance plans and can work with you on a manageable payment schedule so that finances aren’t a roadblock to getting the help you deserve.

Read more below on how to pay for alcoholism treatment with AAC:

Does Insurance Cover Alcohol Rehab?

With the passing of the Affordable Care Act, substance use disorder treatment is now considered an essential health benefit, requiring all marketplace plans to offer coverage for treatment.3 Plans also can no longer discriminate against pre-existing substance use disorder conditions.3

Based on your insurance provider and specific policy, you may have more coverage than you think. Typically, health insurance for addiction treatment may cover the below at approved facilities:

  • Inpatient care.
  • Outpatient care.
  • Medical detox, including medications.
  • Co-occurring mental health conditions.
  • Follow-up counseling.
  • Maintenance addiction medication.

Anything deemed medically unnecessary though is less likely to be covered such as extra services at upscale treatment centers (e.g., gourmet food, certain holistic care services, recreation programs, or other non-medical amenities).

And, although insurance companies cover varying levels of treatment services, depending on the policy, they may not fully cover treatment for relapses. However, AAC offers a 90-Day Promise, which states if a person successfully completes our 90-day program and relapses, they will receive a complimentary 30 days of treatment.*

How to Use Insurance for Alcohol Treatment

To verify your insurance coverage with AAC, use the form below. There are different options available to pay for treatment, which include private insurance, Medicaid, and Medicare.

Once your insurance coverage is verified, you’ll need to do the following:

  • Have a conversation with a doctor about your treatment needs: Because of the general requirement that treatment must be medically necessary, this will be your first step in the process. An assessment will be performed by a doctor to determine the degree of abuse or addiction, and what type of treatment is needed. This is generally covered.
  • Find the treatment program that fits your unique needs: Along with factors such as location, amenities and cost, it’s important to make sure that your specific level of care is treated at whichever facility you choose.
  • Work with the treatment center to evaluate your level of coverage: The facility you choose can work with your insurance provider to determine how much of your specific program is covered. In some cases, the center will also be able to discuss additional ways to help pay for the portions that are not covered by insurance.
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1 Insurance Disclaimer: American Addiction Centers will attempt to verify your health insurance benefits and/or necessary authorizations on your behalf. Please note, this is only a quote of benefits and/or authorization. We cannot guarantee payment or verification eligibility as conveyed by your health insurance provider will be accurate and complete. Payment of benefits are subject to all terms, conditions, limitations, and exclusions of the member’s contract at time of service. Your health insurance company will only pay for services that it determines to be “reasonable and necessary.” American Addiction Centers will make every effort to have all services preauthorized by your health insurance company. If your health insurance company determines that a particular service is not reasonable and necessary, or that a particular service is not covered under your plan, your insurer will deny payment for that service and it will become your responsibility.

Ways to Pay for Alcoholism Treatment

Private Insurance

With private insurance, patients can review their specific policy to see what types of treatments are covered. The most common healthcare plans are HMOs and PPOs, with both offering a range of options based on your preferences.

An HMO plan typically has lower premiums than PPOs and allows patients to choose their primary care physician within a restricted network. When seeking a specialist or physician outside of the network, a primary care physician must send a referral first. PPOs allow patients to see healthcare providers in or out of their network without referrals and typically have higher co-pays and monthly premiums.

While your insurance provider can be a great tool for finding out more about your coverage, contacting substance abuse treatment facilities can be helpful as well. In some cases, they can work with your provider to figure out your payment options for you.

Medicaid

Medicaid is a government-funded insurance option for those who otherwise would not be able to afford private insurance. Over 65.6 million people are covered by this program in the U.S.4

The program helps men, women, and children of low-income families get quality healthcare and is based on program eligibility standards set forth by the US Government.

Since the ACA, Medicaid programs are also now required to provide coverage for substance abuse treatment. Using Medicaid can greatly decrease the cost of addiction treatment and may even cover the costs entirely, depending on your specific plan. It is easy to determine if you and/or your dependents qualify for Medicaid by visiting their website.

Medicare

Medicare is a federal health insurance program for those aged 65 or older, those younger than 65 with a disability, and people younger than 65 that have end stage renal disease.5 Although Medicare can be used to cover the cost of alcoholism treatment, there are certain guidelines that must be adhered to, such as:6

  • The provider must create a plan relaying the type of services and treatment needed, and how often, by the patient.
  • You must receive treatment from a Medicare-approved facility/provider.
  • The provider must state that treatment is medically needed.

There are three ways Medicare coverage is offered and broken down: Part A, Part B, and Part D.

  • Part A helps cover inpatient treatment at a hospital or inpatient rehab center.
  • Part B helps cover outpatient treatment services through a clinic or a hospital outpatient center.
  • Part D can help pay for drugs that are medically-necessary to treat substance use disorders.

Some additional services covered include medically-administered prescription drugs, patient education about treatment and diagnosis, psychotherapy, and post hospitalization follow-up.6 Check with your administrator to get a full list of items covered under Medicare.

Personal Costs to Consider

Whether you use private or government-funded insurance, there are still certain things you’ll have to pay for out-of-pocket. Typically, policyholders are responsible for the following:

  • Premiums: The monthly or annual cost to have insurance.
  • Deductibles: The amount of money the policyholder must pay before coverage starts.
  • Copays: The reduced fee paid in order to be seen by a doctor or to get service.
  • Lifetime limitations: Certain insurance plans only pay for coverage up to a certain amount, leaving the policyholder to be responsible for the remaining balance.

Contact AAC Admissions Navigators 

If you’re unsure of what coverage you have or how to best utilize the services under your plan, our Admissions Navigators are available 24/7 to chat about your treatment options. Or you can contact one of our facilities directly to speak with an insurance specialist who can help you navigate the specifics of your policy.

Sources:

[1]. Substance Abuse and Mental Health Services Administration. (2019). The 2018 National Survey on Drug Use and Health (NSDUH).

[2]. National Institute on Alcohol Abuse and Alcoholism. (2019). Alcohol Facts and Treatment. 

[3]. HealthCare.gov. (n.d.). Mental Health & Substance Abuse Coverage. 

[4]. Medicaid.gov (n.d.). Medicaid.

[5]. U.S. Department of Health and Human Services. (2014). Who is eligible for Medicare?

[6]. MedicareInteractive.org (n.d.). Treatment for Alcoholism and Substance Use Disorder. 

*Terms and conditions may apply, and results may vary.

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