Insurance

How Does Drug Rehab Insurance Work?

In most cases, using insurance to pay for drug rehab is as simple as enrolling at a facility, They will bill your insurance company directly and often advocate on your behalf to ensure you receive as much financial aid as possible. Sometimes, you may need to first get a referral from your primary care physician before your insurance will consider you eligible for coverage.  

The Freedom Center accepts most major healthcare providers (If you’re not sure whether we take yours, use our quick verification form). However, we also offer assistance to those who don’t have insurance or whose policy does not cover rehab. Contact us today to explore payment options and find a solution that works for you.

 

What Will Insurance Pay For?

Private and public insurance can vary greatly in how much financial assistance they provide and for what types of treatment. However, most insurance plans include at least some coverage for substance abuse treatment as part of the “essential health benefits” that are outlined in the Affordable Care Act. Here are common services that are often at least partially covered by most instance plans:

  •  Inpatient or outpatient care (at an approved facility)
  •  Medical detox
  • Dual diagnosis (co-occurring disorders)
  • Maintenance medication
  • Follow-up counseling

Health insurance plans do not discriminate between which drugs or types of drugs are covered. If addiction treatment is an offered benefit, it does not matter the substance being abused. 

Insurance Verification Form

    Factors That Affect Insurance Coverage

    • The state where the health care plan was purchased
    • Whether it’s a PPO or HMO plan
    • If the facility is approved or an “in-network” provider
    • The type of treatment being sought (detox, inpatient, outpatient, etc.)
    • The kinds of medications needed & if they are for aftercare or maintenance

    What Is The Affordable Care Act (ACA)?

    The Affordable Care Act (ACA), commonly called Obamacare, covers drug rehab insurance in Maryland and every state. Substance abuse disorders, in general, are covered by Obamacare health insurance plans. This is also considered one of the 10 essential health care benefits.

    As for how much is covered, that changes from person to person. But it will rarely, if ever, be 100% coverage for treatment. This means that the patient will have to pay for some of the costs of treatment. This applies for both inpatient and outpatient programs. How much coverage one can get depends on cost-sharing. 

    In order to be sure about coverage details, the person will need to check with their insurer. While it is a partial help, it can cut costs significantly, which can definitely make a difference. Other expenses will be dictated by insurers of the patient, but they must provide the mentioned parity protections.

    The ACA helped regulate many health care requirements, making treatment more affordable. In fact, it is the measure that made all insurers be forced to provide coverage for substance abuse treatment.

    What If I Don't Have Insurance?

    Personalized Payment Plans 

    Payment plans allow the full amount to be broken down into parts. Similar to how a credit card balance can be paid off over time. Contact our admissions team today to find the right plan for you.  

    Grants

    Most people don’t know rehab grants or scholarships are available. These can be funded by the government or the rehab center itself. They are meant to help the patient pay for their treatment, either partially or in full.

    Private Loans

    Private loans, personal loans, or even home equity can be used to pay for treatment. While the thought of taking on debt can seem intimidating, addiction treatment is an investment in your health. Plus, remaining addicted can be much more costly in the long run.

    Marketplace Insurance 101

    Marketplaces, or “the exchange”, offer health insurance policy options subsidized by the government or private companies. People can sign up to see which plans they are eligible for.  These plans allow their health insurance premium costs to be reduced. These insurance plans can be changed at any frequency, too. But prices might fluctuate, and your qualification status might change as well.

    All marketplace plans have to provide coverage for rehab treatment. as mental and behavioral health services are considered essential benefits. There are several different options for drug rehab insurance in Maryland, which include:

    • State government marketplace – As the name suggests, this option is funded by the government of the state of Maryland.
    • Federal government marketplace – Since not all states have their own marketplace, some people rely on a federal option. It is possible to shop in the federal exchange even if your state does have its own marketplace.
    • Private marketplace – These are a great option for people to buy marketplace and alternative health insurance. There are more options that are more affordable, including some with less coverage.

    Marketplace insurance also comes with protections. One of them is that no one can be denied coverage or be charged more for pre-existing conditions such as mental illness. Another protection is that unlike other insurance options, those from the healthcare marketplace also cannot impose a limit for dollars spent on treatment for essential health benefits. Policies without these protections have coverage limits based on days or dollars to be used for treatment. Some of them are yearly, others are lifetime. There is also protection for mental health services. This includes many factors, from copayments and deductibles to the number of visits covered. It requires that limits related to mental health and substance abuse services do not exceed medical and surgical services.

    Medicare vs Medicaid for Drug Rehab Coverage

    Medicare and Medicaid are both state- and federal-funded programs established in 1965. The two programs offer coverage for drug rehab including those in Maryland. Like many of the offerings provided by government funding, there are yearly changes to these plans. As such, it is important to continue checking on your coverage every year. These programs are often confused for one another. In fact, it’s possible to qualify for both Medicaid and Medicare. However, there are key differences between the two, especially when it comes to coverage for services related to rehab.  

     

    What Is Medicaid?

    Medicaid provides healthcare coverage to low-income citizens who earn 133% below the federal poverty level. It is funded both by the individual state and the federal government. Unlike Medicare, this program is not age-restricted and covers adults, children, seniors, and those with disabilities in the United States and U.S. territories. Currently, there are over 72.5 million Americans covered by Medicaid, and it is the largest source of healthcare in the country.

    Using Medicaid to Pay For Drug Rehab

    Each state’s Medicare program is run independently and as such, income eligibility and program benefits varies in each state. If you are from out-of-state and wondering if your insurance will cover drug rehab in Maryland, you may need to consult with the rules specific to your state’s guidelines. Medicaid is great to use for addiction treatment as it’s required to cover all the basic aspects of care which includes:

    • Screenings
    • Intervention services
    • Counseling (and family counseling)
    • Detox
    • Inpatient
    • Outpatient
    • Mental health services
    • Maintenance medications (as part of aftercare)

     

    What Is Medicare?

    The Medicare program is an aid to those over the age of 65 or people with severe disabilities. Unlike Medicaid, Medicare doesn’t consider income for eligibility. 

    Eligibility requirements include: being over 65 and having paid Medicare taxes for at least 10 years; being married to someone who paid Medicare taxes for 10 years or more; having a severe disability (no matter what age); suffering from End-Stage Renal Disease. 

    Using Medicare To Pay For Drug Rehab

    Medicare coverage is not as comprehensive as that of  Medicaid. While it does cover both outpatient and inpatient treatment, there are a number of limitations. Medicare is divided into parts A, B, C, and D, with each covering different parts of rehab treatment. 

    Part A: Covers inpatient hospital stays or at other specialty types of health care such as a nursing facility, hospice care, and inpatient addiction treatment as well as the following services:

    • A semi-private room
    • Meals
    • Drugs
    • Nursing and other hospital services

    Note: Medicare does not cover more than 90 days in either kind of a facility for the entirety of the insured person’s life (does not renew each period) which can give it limited use for long-term addiction treatment.

    Part B: This applies to doctors’ services, outpatient care, medical supplies, and preventative services. 

    Part C: Medicare-approved private insurance; A separate optional cost that Medicare members can opt into.

    Part D: Covers the cost of prescription drugs and shots such as vaccines. For drug addiction treatment, this is necessary for coverage of maintenance medications such as Suboxone which are used both during and after treatment. Medicare has stricter restrictions to aftercare medications used in treatment, and will only cover these medications if indicated as being medically necessary.

    Sources:

    https://www.medicaid.gov/medicaid/index.html

    https://www.medicare.gov/what-medicare-covers/your-medicare-coverage-choices/whats-medicare

    Find Out If The Freedom Center Is Right For You

    Everyone deserves treatment, and there are many financial options available. We at The Freedom Center believe treatment shouldn’t have to be so hard to afford. We offer great programs for all needs, as payment issues should never stand between you and the treatment you need. 

    If you feel lost while trying to pick a treatment program, we would love to help. You can contact us today and we can tell you all about our coverage options. By speaking to us and your health care provider, you can figure out the best financial option for you.