How Does Health Insurance Help Pay for Addiction Treatment?

Public vs Private Insurance Coverage for Addiction Treatment

Private insurance plans refer to plans that are run by private insurance companies. How much of the cost you’ll bear will depend on whether you purchase the plan on your own, or whether your plan is partially or fully paid for by your employer.²

Public health insurance plans are run by the government and usually have eligibility requirements, such as low income, age, or certain disabling illnesses.²

In the United States, the biggest form of public insurance is Medicaid, a federal- and state-run program that provides health coverage for qualifying Americans.³ The other form of public insurance in America is Medicare, which is health insurance provided by the government to people ages 65 and up. Additionally, people who have specific disabilities or health problems, like chronic kidney failure that requires dialysis treatment or a transplant, can also get insurance through Medicare.⁴

Both private insurance plans and public plans will provide coverage for substance use disorder treatment,¹ though how much coverage is provided or which types of treatment will be determined by the plan and the insurance provider.

Health Insurance and Medical Detox

Medical detox can take place in a hospital, standalone detox facility, residential treatment facility, or even an outpatient facility. Services will be least intensive (and likely least expensive) in an outpatient environment. Inpatient and hospital environments will offer the most support and supervision and are often recommended for those in opioid, alcohol, or sedative (e.g., benzo) withdrawal.⁵

Medical detox is an incredibly important part of drug addiction treatment. In many cases, it is the first step of the journey, as helping an individual overcome their physical dependence on drugs and/or alcohol paves the way for long-lasting and effective therapy.

Can Health Insurance be Used to Pay for Medical Detox?

Often, yes. Medical detox orange county may be covered by your insurance plan, especially if it is deemed “medically necessary.” Whether they will pay for inpatient or outpatient detox may depend on the substances you’ve been using and the dangers associated with withdrawal. Some withdrawal syndromes, such as those for alcohol and benzodiazepines, can be life-threatening,⁵  so your insurance plan may pay for inpatient detox because not detoxing with supervision may put you at significant risk of harm.

Every health insurance policy has a summary plan description, which advises you on the terms of your coverage. When a patient has selected a rehabilitation center at which to receive medical detox, the onsite benefits coordinator will provide advice on the benefits and limits of the health insurance policy terms with regard to the coverage of medical detox.

Check Your Insurance Coverage at Laguna Treatment Hospital

At Laguna, we accept most types of private (non-government) insurance and offer a variety of payment options.

You can quickly and privately check your insurance benefits to see if you’re covered for addiction treatment services. We’ll be able to tell you if your provider is in-network with Laguna Treatment Hospital and all American Addiction Center locations.

How to Pay for Rehab Without Health Insurance

For those without any insurance, the thought of paying for rehab can be a scary one. However, there are options you may not know about, including:

• State-funded rehab treatment programs. If you’re uninsured or underinsured, you can search for rehab programs that will treat you at no or minimal cost. You can call the Substance Abuse and Mental Health Services Administration for help finding one of these programs at (800) 662-HELP (4357).
• Sliding scales. Certain addiction treatment facilities help patients afford their care by offering sliding scales that adjust the cost based on income and need.
• Financing/payment plans. If you need help immediately but can’t afford to pay for your care all at once, many programs will offer financing, allowing you to pay off the cost over time.
• Loans. Treatment centers may offer loans for your care, or you may be able to access funds from another bank or lending company.
• Scholarships. Some rehab programs will offer a discounted rate or waive the cost entirely for patients in significant need of treatment. You can ask about scholarships at any treatment center you call, and what qualifications must be met to get one.

In some cases, a qualifying life event may enable you to get insurance coverage outside of normal open enrollment. Qualifying life events (QLEs) may include:⁶

• Losing your health coverage. This may include changes in employment; no longer being enrolled in school; losing Medicare, Medicaid, or CHIP eligibility; or turning 26 and no longer being able to use your parent’s insurance.
• Changes in your household, such as getting married or divorced, having a baby or adopting a child, or experiencing a death in the family.
• Changes in residence. This can include moving to a different ZIP code or county, moving to or from the place you work or attend school, moving to or from some form of transitional housing.

Other QLEs may include:⁶

• Changes in your income that affect the coverage you qualify for.
• Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder.
• Becoming a U.S. citizen.
• Leaving incarceration (jail or prison).
• AmeriCorps members starting or ending their service.

Call 1-800-318-2596 (TTY: 1-855-889-4325) to speak to an ACA marketplace representative about applying during a special enrollment period.

Laguna Treatment Center is committed to getting lifesaving treatment to individuals who are ready to change their lives. We offer payment options to make covering your care easier, and we are available at any time at to help you understand how you can use your benefits to get treatment at our beautiful inpatient detox and rehab facility in Southern California.