Commonly Asked Questions about Addiction and Treatment
Will insurance companies pay for substance abuse treatment?
Yes, many insurance companies do provide coverage for substance abuse treatment, but the extent and specifics of the coverage can vary widely depending on the individual insurance policy and the provider.
This coverage is largely due to the Mental Health Parity and Addiction Equity Act of 2008 in the United States, which requires health insurers and group health plans to provide the same level of benefits for mental and/or substance use treatment and services that they do for medical/surgical care.
Here's a closer look at some key aspects:
Types of Treatment Covered: Many insurance policies cover a range of substance abuse treatments, including detoxification, inpatient rehab, outpatient rehab, medication-assisted treatment, and ongoing counseling or therapy. However, the specific treatments covered will depend on your particular insurance policy.
Co-Pays and Deductibles: Even if an insurance policy covers substance abuse treatment, you may still be responsible for co-pays, deductibles, or coinsurance. These costs can vary depending on the specifics of your insurance plan.
Network Restrictions: Some insurance plans may only cover treatment provided by certain providers or facilities within their network. It's important to check with your insurance company to determine which providers are covered under your plan.
Preauthorization: Some insurance plans require preauthorization for certain types of substance abuse treatment. This means that the treatment must be approved by the insurance company before they will cover the cost.
Duration of Coverage: The duration of coverage for substance abuse treatment can vary. Some insurance plans may only cover a certain number of days of inpatient treatment or a certain number of therapy sessions, for example.
Affordable Care Act (ACA): Under the ACA, all health insurance plans sold on Health Insurance Exchanges must cover substance use disorder services.
What is the most common substance abuse disorder?
The most common substance use disorder globally is alcohol use disorder (AUD). This disorder, often referred to as alcoholism, is characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences.
Alcohol use disorder is defined by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of eleven criteria, within a 12-month period.
The criteria include issues like spending a lot of time drinking, or recovering from drinking, giving up important social or recreational activities in favor of drinking, developing a tolerance (needing to drink more to achieve the desired effect), experiencing withdrawal symptoms when not drinking, and continuing to drink even when it's causing physical or psychological problems.
It's important to note that substance use disorders can develop with the use of many different substances, including illicit drugs like cocaine or heroin, and legal substances like alcohol or prescription medications. The prevalence of these disorders can vary by region and demographic group.
Regardless of the substance involved, these disorders can have serious impacts on individuals' physical and mental health, relationships, and ability to work or study. Treatment can often help people with substance use disorders to recover and lead healthy lives. If you or someone you know is struggling with substance use, don't hesitate to seek professional help.
Is there Government assistance to pay for rehab?
Yes, in the United States, there are several forms of government assistance that can help pay for rehab.
Medicaid: Medicaid is a state and federal program that provides health coverage for some low-income people, families and children, pregnant women, the elderly, and people with disabilities. Many states' Medicaid programs provide coverage for a range of substance use disorder services, including detoxification, outpatient counseling, residential treatment, medication-assisted treatment, and more. The specific services covered and eligibility criteria can vary by state.
Medicare: Medicare, a federal program primarily for people age 65 and older, also provides coverage for some substance use disorder treatment. This can include inpatient rehab, outpatient treatment services, and medication-assisted treatment.
The Affordable Care Act (ACA): The ACA, also known as Obamacare, requires health insurance plans sold on the Health Insurance Marketplace to cover substance use disorder services. This means that individuals who purchase insurance through the Marketplace can access rehab services, often at a lower cost due to income-based subsidies.
Substance Abuse and Mental Health Services Administration (SAMHSA): SAMHSA offers grants to states and organizations to provide treatment and recovery services for individuals with substance use disorders. Individuals may be able to access services funded by these grants at little or no cost.
State and Local Government Programs: Many states and localities have their own programs to help residents access substance use disorder treatment. These programs may offer direct funding for treatment, operate state-funded treatment facilities, or provide vouchers to pay for private treatment.
Veterans Affairs (VA): The VA provides a range of substance use disorder treatment services to eligible veterans, including detoxification, rehab, outpatient counseling, and medication-assisted treatment.
Indian Health Service (IHS): The IHS provides a comprehensive health service delivery system for approximately 2.6 million American Indians and Alaska Natives, including services for substance use disorders.