Addiction Treatment and Levels of Care
Alcohol use disorder (AUD) is a medical condition that impairs your ability to stop or control your use of alcohol. This means that even if using alcohol is causing problems with your social life, career, or health, you cannot seem to slow down or stop drinking. 1
According to NIAAA, about a third of people who successfully complete a rehabilitation program show no further symptoms 1 year later and have fewer alcohol-related problems. When it comes to selecting a treatment setting, it is important to familiarize yourself with the available options, such as: 1
- Alcohol detox. This process often includes medication and helps you stop drinking safely and control the unpleasant withdrawal symptoms.
- Inpatient – Patients live in the facility full-time, and it is typically a 30-day, 60-day, or 90-day program. In an inpatient facility you have medical supervision and participate in behavioral and other therapies during the day.
- Extended Care or Long-term Rehab – A form of inpatient rehab that is also residential, and is unique for its longer length of stay (typically between 6 and 12 months, depending on the program).
- Outpatient – Rehab where the patient, in some cases, may attend 3 to 6 hours per day, participate in group, family, and/or individual therapy. Patients typically go home when not in treatment and are able to work or go to school.
Generally, the longer the program and the higher the level of care and the more expensive the treatment will be. If your alcohol use disorder is more severe, you’ll need treatment that is longer and more intensive. Also, the type of rehab and the amenities will impact the price as well. A private or luxury rehab will cost more than a community program or one with fewer amenities.
Is Rehab Covered By Insurance?
The most common method of payment for rehab is using health insurance. The Affordable Care Act, passed in 2010, requires all long-term health plans to include at least some coverage for mental health and addiction treatment.3,
Your specific coverage will depend on your plan, so be sure to contact your insurance provider to get details about what is covered.
You’ll likely have some costs that you’ll have to pay, such as:4
- A deductible. Which is the amount you pay before your insurance coverage kicks in for the year. If you’ve already paid your deductible due to other health care needs, you won’t need to pay it again within the same year.
- Copayments and coinsurance. This is the portion of the cost of care for each service. Your insurance plan typically covers the rest.
Together, deductibles, copayments, and coinsurance are your out-of-pocket costs, which is the amount you pay for your care.
Some of the health insurance plans that might be able to help you with coverage for rehab include United Insurance, Blue Cross Blue Shield, Aetna, Cigna, Humana, and Kaiser Permanente.
Medicaid and Medicare Plans for Rehab
Medicare and Medicaid are both government programs that help specific people pay for healthcare. Medicare is a federal program that helps those who are 65 and older, along with those who have specific medical conditions. Medicaid is a state-based program for lower-income Americans.
Both of these programs will help you cover some or all of your cost of rehab. Medicare covers addiction treatment when it is reasonable and medically necessary. This includes inpatient treatment, outpatient treatment, professional services, and more.5
In order to get Medicare, you must be a U.S. citizen or permanent resident who has lived in the country for at least five years, and one of the following must also be true:6
- You’re age 65 or older
- You’re under 65 but disabled and receiving disability benefits from Social Security or the Railroad Retirement Board
- You have Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease
- You have end-stage renal disease (ESRD)
Medicaid plans vary from one state to another, but they are subject to the Affordable Care Act and must provide at least some coverage for addiction treatment. You’ll want to contact your state’s specific program to learn more.
To qualify for Medicaid, you will need to meet the requirements in your specific state. This may include meeting the income requirements, having children, receiving Social Security Income (SSI) benefits. You’ll want to contact your state’s Medicaid office to apply.7
Local and State-Funded Rehab
Many rehabs receive funding from the federal government, their state, or their local community. These grants can help them offer lower-cost or even free treatment to qualifying individuals. The government has found that every $1 invested in rehab centers saves $4 in health care costs and $7 in law enforcement costs.8
If you’re able to attend a state or federally-funded rehab facility, your out-of-pocket costs could be much lower. The eligibility requirements will vary depending on where the rehab center is located and the type of grant they’ve received. It is best to contact the center directlt to learn more about how to qualify.
The types of treatment we mentioned above, including inpatient, outpatient, partial hospitalization programs, and aftercare are all available at local or state-funded rehabs.
The Affordable Care Act (ACA)
The Affordable Care Act (ACA) is a law that was passed in 2010. It significantly expanded the types of healthcare that health insurance plans were required to offer by setting up 10 essential health benefits that all plans have to cover. One of the 10 essential benefits is mental health and substance abuse services.9
Another important part of the law is the Mental Health Parity and Addiction Equity Act (MHPAEA), which requires health insurance plans to cover mental health and substance use disorders at the same level that they cover other medical needs. That means that out-of-pocket costs, days of treatment, treatment limits, and more have to be the same for mental health and addiction treatment as they are for other medical needs.3
Many treatment programs and rehab facilities are able to work with families to set up payment plans that work within a family’s budget to make payments manageable. These payment plans are generally set up before admission into a treatment program, and individuals are responsible for making payments in a timely fashion, often through automatic monthly payments or via a graduated payment plan. Treatment facilities may even offer a “sliding scale” for payment, allowing people to pay what they are able to for services
Find Rehab Treatment
Entering a rehab program is often the first step in moving toward a healthier, substance-free life. Our addiction specialists are available to talk to you confidentially and help you navigate through the options for rehab.
If you or a loved one is struggling it’s important to talk to a qualified professional who can walk you through the process of finding the most cost-effective options for treatment that will also provide the care you need.
Does My Insurance Cover Alcohol Rehab?
American Addiction Centers can improve treatment outcomes for those in recovery for alcohol use disorder. Find out if you or your loved one’s insurance covers treatment at an American Addiction Centers facility by filling out the confidential form below:
- National Institute of Alcohol Abuse and Alcoholism. (2021, April). Understanding Alcohol Use Disorder.
- National Institute of Alcohol Abuse and Alcoholism. (2021, December). Rethinking Drinking – Alcohol and Your Health.
- Healthcare.gov. (n.d.). Mental health & substance abuse coverage.
- Healthcare.gov. (n.d.). Your total costs for health care.
- Centers for Medicare and Medicaid Services. (2019, May 10). Medicare Coverage of Substance Abuse Services.
- U.S. Department of Health and Human Services. (2014, September 11). Who is eligible for Medicare?
- Medicaid.gov. (n.d.). Eligibility.
- White House Office of National Drug Control Policy. (2012). Cost Benefits of Investing Early in Substance Abuse Treatment.
- Healthcare.gov. (n.d.). What Marketplace health insurance plans cover.