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Pay for Drug Rehab: Common Questions About Treatment Coverage

There are a wealth of resources available that inform people about the nature of addiction.

In school, adolescents and teens are taught the dangers of alcohol and drugs and ways to resist the peer pressure. For adults, there are entire television shows that offer one cautionary tale after another, helping to divert many of those who might have become curious about alcohol and drugs in middle age.

Most primary care providers also perform subtle assessments of their patients and provide substance abuse education when and where they feel it’s needed. However, despite the many addiction education initiatives that serve to keep people informed about this potentially deadly disease, there is still much that people don’t know about addiction.

There’s a shortage of resources available that help people with choosing the rehabs that best address their needs. Similarly, there has been little information made available regarding some of the finer details of finding and enrolling in an alcohol and drug treatment program. And incidentally, paying for substance abuse treatment is often one of the last considerations.

More often than not, finance is only mentioned when the person is actually about to begin treatment. It seems that many people either overlook the financial aspect of recovery or assume that covering the cost of addiction treatment is something that tends to work itself out.

There are many people who are under the impression that all they need to do is hand their health insurance cards to the intake coordinators at their rehabs and they’ll be good to go; however, it’s not always so simple and straightforward.

As such, the following are some of the most frequently asked questions that people have with regard to health insurance coverage and the cost of their addiction treatments.

Will My Health Insurance Plan Cover the Cost of Treatment?

The short answer is: kind of.

Most people assume that when their insurance covers their addiction treatments, the coverage is total. In other words, they assume that their health insurance plans will cover 100 percent of the cost of treatment, but that’s rarely, if ever, the case.

In reality, health insurance covers only specific parts of substance abuse treatment. The percentage that it pays also depends on the insurance provider or the health insurance plan, among other factors.

All health insurance providers now consider addiction to be a mental health condition and, therefore, provide some level of coverage to those who are covered by their insurance plans and require substance abuse treatment. In most cases, substance abuse treatment coverage is broken down into the individual services that a provider is willing to cover.

If My Insurance Company Denies My Claim, What Can I Do?

If you’ve been denied coverage by your health insurance provider, there are two ways you can go about trying to get substance abuse treatment coverage.

The first step would be to file an appeal with your insurance provider, which requires you to gather and submit evidence that the addiction treatment is a necessity and without the professional treatment you’ll be at risk of death. Next, you’ll write an appeals letter and send it—along with an appeals form—to your insurance company with all the evidence and documentation you’ve gathered.

Alternately, you could pursue subsidized treatments or treatment costs that calculated according to need, which often means a sliding scale. In other words, you’ll only pay what you’re able to pay based on their calculations. On a sliding scale, it’s likely that the cost of your treatments would be significantly easier to cover.

Does Medicare Pay for Drug Rehab or Alcohol Addiction Treatment?

If the drug or alcohol addiction treatment program meets certain criteria and you’re eligible for treatment, then yes, Medicare will cover the cost of your treatment.

The longer answer is that there are three specific criteria to be met for a Medicare plan to cover the cost of inpatient or outpatient substance abuse treatment. First, the treatment must be offered by an approved provider or facility that participates in the Medicare program. Second, your doctor or primary care physician must state that the treatment services are medically necessary. And finally, your doctor must set up and approve your entire treatment plan.

Won’t “Obamacare” Pay for My Substance Abuse Treatment?

With the passage of the Affordable Care and Patient Protection Act—also known as ACA and colloquially as “Obamacare”—treatment for addiction became one of the essential health benefits that are eligible for coverage by a person’s private or government health insurance plan.

Some assume this means an insurance plan is legally required to cover the cost of a substance abuse treatment, and while Obamacare has made treatment much more affordable, there will still be a percentage of the cost that the client is responsible to pay.

Each level of insurance pays a set amount. Bronze plans cover 60 percent, silver plans cover 70 percent, gold plans cover 80 percent, and platinum plans cover 90 percent of the cost of treatment.

The good news is that insurance plans obtained through the official marketplace will provide a large percentage of coverage for any services that are deemed necessary, including brief intervention services, alcohol and drug testing, addiction evaluation, home health visits, family counseling, medications, clinic visits, and anti-craving medication.

Can I Still Receive Treatment If I Don’t Have Insurance?


Not having insurance doesn’t disqualify anyone from receiving treatment for a substance abuse problem. The main problem with not having insurance is that it leaves the client responsible for the entire cost of treatment. Without insurance, you must either pay for treatment out of pocket, find scholarships or grants that can be applied to the cost of your treatment, or take out a loan. Regarding loans, there are a number of lenders that offer financing options specifically for those needing to pay for drug rehab, and these loans often have perks that wouldn’t be available with other times of loans.

Drug Treatment Center Finder Is Waiting for Your Call

If you or someone you love would benefit from a free consultation with one of our experienced recovery specialists, call us at 855-619-8070. We’re available anytime, day or night, to help you or a loved one find the right rehab and begin the journey to lasting health and happiness.

  1. 23 year old son needs dual diagnosis drug treatment inpatient . He has optima medicaid insurance.

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