You’ve officially been diagnosed with bipolar disorder and a substance use disorder. After years of confusion, you’re questioning if insurance for drug rehab will help you. 1 in 5 American adults have a mental health disorder. The global perspective on mental health is steadily shifting, in a desperate attempt to balance the uncertainty of the pandemic.
Navigating insurance plans for drug abuse and mental health can present challenges for what you qualify for. Addiction treatment facilities usually accept insurance plans. It’s best to research the treatment center before making any decisions. The cost of treatment can be affected by the location and services provided by the center.
The cost of rehab may deter someone from receiving the care they need. Drug addiction can be draining on the individual dealing with substance abuse, their loved ones, and their finances. A rehab center may not be within distance of your area.
Mental health and substance use tend to go hand in hand. Health insurance can help cushion some of the obstacles of treatment. It’s important for a person struggling with addiction to be aware of their resources. From support groups to telehealth, there are more options available to adapt to this difficult period.
Health insurance plans used to exclude pre-existing conditions, raising the cost for treatment. Additionally, health insurance plans will include copays and deductibles depending on the plan. Insurance coverages can be a safety net for the financial costs of healthcare treatment. Despite many changes in laws and requirements, there are people who do not seek drug and alcohol rehab.
The Race for Accessibility in Mental Health Care
With greater access to healthcare resources, the greater the chances for the individual to recover. Millions of Americans are still without health insurance.
According to Forbes, the market size of the Mental Health and Substance Abuse Centers industry in the US has increased faster than the Healthcare and Social Assistance sector overall. As of 2021, the market size of the Mental Health and Substance Abuse Centers industry reached $19.2 billion USD, with a growth of 3.7%.
The increase of insurance coverage has enabled many Americans to access treatment for mental health and substance use disorders. An estimated 45.3% of industry revenue is derived from Medicaid and Medicare reimbursement payments, with an expectation to increase from federal funding.
In 2019, spending on mental health treatment and services have reached $225 billion USD according to the Open Minds Market Intelligence Report. A recent report estimates that depression alone accounts for $44 billion USD in losses in workplace productivity.
For example, a person with major depression spends an average of $10,836 on health care costs. The cost of psychotherapy can range from $65-250 per session for individuals without insurance.
Accessibility still needs to be addressed in mental health treatment. Health insurance coverages may not protect you fully. Rural parts of the country tend to lack access to more specialized treatment options, with 112 million Americans living in areas of scarce resources. Drug and alcohol rehab have become lifelines during the global pandemic.
With promising awareness through Mental Health Awareness Day, accessibility of mental health care has been on the forefront. 56% of psychiatrists accept commercial insurance compared to 90% of other, non-mental health physicians. Less than half of Americans with mental health disorders commit to treatment. This is indicated in communities of color and low-income environments.
What are the Common Types of Insurance Plans?
Insurance plans are crafted for a variety of reasons, from medical to automobile to home insurance. The types of insurance plans are designated to fit your specific needs. Health insurance can be offered through your employer, family member, or government-assisted programs.
Deciding on an insurance plan can be frustrating considering the buffet of unexpected changes. Facilities that offer drug and alcohol rehab will outline the insurance providers they take. Rehab coverage is essential for people with struggles against substance abuse.
HMO (Health Maintenance Organizations)
The HMO insurance plan is generally more affordable. The insured has required primary care provided, with options for in-network providers such as hospitals and other medical services. This helps establish a relationship between you and your physician to get a better understanding of your history. HMOs prioritize in-network providers by offering lower premiums, copays, and coinsurance.
PPO (Preferred Provider Organizations)
The PPO insurance plan is slightly more flexible than the HMO plan. PPOs offer in-network and out-of-network providers. Although it’s cheaper to access care through in-network providers, you have the option to reach out to out-of-network providers. If your conditions require more specialists, then this would be best suited for you.
POS (Point of Service Plan)
POS can be characterized as a combination of HMO and PPO. Generally, the costs are lower but the network is smaller. POS requires you to choose a primary care provider, serving as the home base for your care. If you need a specialist, you are required to seek out a referral. You can discover specialists in and out of the network, but the share of costs will be higher along with a responsibility to file a claim.
EPO (Exclusive Provider Organization)
With an EPO, you have the option to choose from any participating provider, but it does not include coverage for out-of-network providers unless it’s an emergency. You will likely have to pay the full cost of care if you visit a provider or facility outside of your network. Although, you may not be required to choose a primary care provider. You won’t need a referral to seek a specialist as well.
What is the Affordable Care Act?
The Affordable Care Act of 2010 expanded Medicare and Medicaid benefits for millions of Americans. Affordable care had been made accessible to the under/uninsured, outlining 10 core essential health benefits. The Affordable Care Act has been a lifeline to cover substance abuse.
Medicaid is a federal and state-funded program designed to provide accessible financial assistance to low-income individuals or individuals with disabilities. Medicare was crafted to provide insurance coverage for individuals over the age of 65 and specific illness-related conditions.
These government programs account for a majority of the payments towards healthcare costs. For example, Medicaid has been attributed to the main source of payment for US births. Depending on your case, you may qualify for both programs to cover your healthcare costs.
The Health Insurance Marketplace has offered low-income or uninsured Americans a chance to enroll throughout the year for insurance coverage. The Affordable Care Act of 2010 requires insurance companies to accept those with pre-existing conditions. This is beneficial for those with co-occurring disorders. Co-occurring disorders can be classified as a combination of a substance abuse condition and mental health disorder.
Pre-existing conditions were a constant source of conflict between the insurers and the insured, especially for rehab coverage. The Affordable Care Act of 2010 also bans caps on insurance limits such as benefits caps (or annual/lifetime caps).
COVID-19 has demonstrated the separation of those uninsured and the accessibility for proper healthcare, including the cost of rehab. Substance abuse treatment can require a massive commitment. Preventative care costs have been reduced for those under the Affordable Care Act. The Affordable Care Act also extends Medicaid coverage to children with parents who exceed the qualifications.
Do Affordable Care Act Plans Cover Mental Health?
As of 2014, most individual and small group health insurance plans are required to cover mental health and substance use disorder services. Rehab centers are steadily becoming more available. Medicaid Alternative Benefit Plans are required to cover mental health and substance use disorder services.
These plans must comply with mental health and substance use disorder services under parity requirements. In fact, coverage for mental health and substance use services cannot be more restrictive than coverage for medical and surgical services. For example, addiction treatment can be costly for individuals with severe cases of substance abuse.
If employed-based insurance plans offer mental health and substance use services, parity protections may be required. Research your insurance plan’s enrollment material or any other information. Additionally, your health insurance provider is required to provide you with clear, understandable material.
All state Medicaid programs provide some mental health and substance use services. These services can include:
- Medication management
- Social work services
- Peer support
- Substance use disorder treatment
However, Medicare has a 190-day lifetime limit on psychiatric patient care, which can be challenging for those with severe cases of mental health conditions at a young age. Medicare may not offer the most diverse network of mental health professionals. Employee assistance programs could help offer free or reduced mental health benefits. Poor mental health and substance abuse can introduce dire consequences.
Is Mental Health Care Covered by my Insurance Plan?
Mental health care can be covered by insurance. Preventative services are usually free but may depend on your insurance provider. Contact your health care insurance provider to determine what is covered.
What are Alternatives for Mental Health Care?
- Make an effort to educate yourself about insurance options and plans
- Explore multiple options. Devise a plan on what you want from a mental health provider.
- Reimbursement Protocols. Your insurance plan could reimburse you with a claim. Check your summary of benefits and coverages.
- Develop strategic saving patterns. HSAs can enable you to pay out-of-pocket for mental healthcare costs with pretax dollars.
- Telehealth. Online therapy has become more available. Multiple studies have shown to be just as effective as conventional therapy methods. Telemedicine is recognized for being more convenient and less expensive.
Does My Insurance Plan Cover Substance Abuse?
Under the Affordable Care Act of 2010, treatment for substance use disorders is considered a priority. Rehabilitative services are considered essential benefits under the Affordable Care Act. Insurance may be able to cover some or all parts of addiction treatment. The continuum of care is crafted to treat the various stages of addiction recovery.
Substance abuse treatment is not a straight path for everyone. Addiction is a complex disease that requires treatment on multiple fronts for an increased chance of recovery. Specialists must address the underlying factors of addiction in order to tailor the substance abuse treatment to the patient.
Evidence-based therapies and approaches have shown consistent results for patients. This opportunity allows staff to recognize what therapies will be best suited for your history and substance use patterns. Mental health and substance abuse have to be managed by trained medical staff to handle the symptoms.
Maintaining sobriety happens after the initial substance abuse treatment through a lifelong process. Relapse is a common element that wanes on those struggling with substance use disorders. The behavioral and chemical changes that happen in a recovering individual requires targeted measures. Substance abuse treatment can uncover your coping mechanisms in a distraction-free environment.
Depending on your insurance plan, you may be covered for:
- Inpatient Addiction Treatment
- Outpatient Addiction Treatment
- Partial Hospitalization Programs
- Medical Detoxification
- Medication-Assisted Treatment
- Dual diagnosis and co-occurring mental health condition treatment
- Continuing care
- Maintenance medication
What are the Costs of Addiction Treatment?
The cost of addiction treatment is one of the main reasons a person struggling with addiction may opt-out. With rising costs of healthcare treatment, this can be devastating for those in dire need of help. The thought of leaving your family behind for inpatient residence and paying for medication can influence these decisions.
The factors that impact the cost of addiction treatment include:
- Type of facility
- The location of the facility
- Treatments provided
- Scope of the program
- Length of the program
- Amenities offered
The recommended length of addiction treatment for substance use is 30 days, although 90 days is optimal. Through the continuum of care, the average cost of inpatient services is between $14,000 and $27,000 for a 30-Day Program. Outpatient addiction treatment fees typically reach up to $500 per session. Detoxification can range from $600-1,000 a day.
Reports have suggested that individuals who remain in the continuum of care at some form have increased chances of maintaining sobriety after a year. See if your insurance has benefits for continuing support.
Payment plans and loans are offered by some treatment facilities. Scholarships can be offered to those who may not have the financial support for treatment. Reaching out to family members is another option for individuals struggling with addiction.
Recover through BRC Healthcare
Channeling the strength to undergo addiction treatment for substance use disorders requires motivation and support. Mental health care can provide life-changing alternatives to those with mental health conditions. BRC Healthcare understands that these aspects of life are treatable and managed by trained medical professionals.
All patients deserve the utmost detailed and quality care to meet their personal goals through addiction treatment. See if your insurance provider is accepted by BRC Healthcare. Coverage for drug rehab should be straightforward. If you or a loved one are struggling with substance abuse, please contact one of our facilities today.