Insurance for Addiction Treatment

Addiction, or substance use disorder (SUD) is a severe problem that affects more than 20 million Americans aged 12 and over. Furthermore, according to the National Center for Health Statistics (part of the CDC), from April 2020 to April 2021, almost 92,000 people in the U.S. died from drug overdoses. This is the single highest death toll during a 12-month period. They regard this situation as a “public health emergency.”

Fortunately, it is getting easier to get insurance to cover the costs of treatment. In the past, insurance companies offered little to no drug rehab  insurance coverage. But, in 2010, a law was passed that changed that.

The Affordable Care Act of 2010 offers ways to link people who want medical insurance with companies that sell it. And if a company wants to be in the ACA marketplace, it is required to cover certain health conditions. This includes coverage for mental health issues and addictions. Also, all state Medicaid programs must offer mental health care and some provide help with SUDs. Due to these changes, insurance providers that aren’t in the ACA marketplace are also starting to offer addiction treatment.

MHPAEA

The purpose of the Mental Health Parity and Addiction Equity Act of 2008 was to prevent health insurance companies and group health plans that offer mental health or SUD benefits from limiting those benefits. They are required to provide coverage that is equal to the medical/surgical benefits offered in the plan. In 2010, it was amended by the ACA to include individual health insurance coverage.

Does Insurance Cover Rehab?

The types of SUD treatment that insurance might cover are:

In most cases, medical detox is necessary. During medical detox, you stay in a detox center with 24-hour supervision by medical personnel until the drug or alcohol toxins are successfully eliminated from your body. Because some withdrawal symptoms may be life-threatening, it is important to have medical assistance available.

However, it is possible that you won’t need to be medically monitored during detox. You may only need supervision to make sure you don’t relapse before you have detoxed. The length of time you spend in detox depends on the substance you used, how much you used, and how long you have been using it.

In an inpatient or residential treatment program, you live in the treatment facility. The facility provides a safe, controlled environment with structured programs. Additionally, you have the benefit of 24-hour medical availability if necessary. For individuals with severe, long-term addiction and/or a co-existing mental health condition, this type of program is essential.

If an outpatient treatment program is determined to be a viable option for you, that means that you will continue to live at home and attend therapy sessions during the day or evening, depending on what the treatment center offers. There are several levels of outpatient programs that vary in intensity according to the amount of time required for treatment at the treatment center.

Oftentimes, outpatient programs are used as step-downs from higher levels of treatment. For example, you may complete a residential program and step down to an outpatient program to continue your care and increase your chance of long-term recovery. Outpatient programs are also typically less expensive than inpatient, which makes insurance companies more likely to cover them.

Many times, an individual has a mental issue that is fueling their substance abuse and vice versa. In these situations, it is important for both conditions to be treated at the same time, preferably by the same treatment team. These conditions feed off each other and failing to treat them simultaneously only serves to make both of them worse.

After completing a formal treatment program, you are not “cured.” You will need to continue therapy or self-help groups to help prevent a relapse. Or you may find that a sober living home works best for you if you don’t have stable housing or a suitable support network when you leave treatment.

Depending on the substance abused, you may need ongoing medication to help you maintain your sobriety. These medications help reduce cravings and help prevent a relapse.

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4 Reasons Why You Need Professional Treatment

If you were facing a life-threatening medical issue, you wouldn’t question whether professional treatment is needed. SUD and mental illness are no different. They can both be fatal if left untreated. Sadly, the social stigma around addiction and mental illness keeps many people from getting the help they need. Just some of the reasons to seek professional help are:

  1. Improve your chances of recovery
  2. Financial impact of addiction
  3. The mental health/SUD connection
  4. The generational effect

Addiction specialists are dedicated to helping addicted people find effective treatment strategies. There is no one-size-fits-all cure for SUD, so you need a professionally structured program meant just for you if you want your best chance at recovery.

Substance abuse is an expensive problem. Depending on the substances being used, addiction can cost a person thousands of dollars a year. Your drug of choice may be relatively inexpensive, but the cost goes up as your tolerance increases. When you add in the associated costs such as attorney fees, fines, and lost work, the expense only increases.

As mentioned, substance abuse and mental health issues influence each other. Substances are often used to self-medicate a mental disorder. On the other hand, individuals addicted to drugs might develop mental health problems. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), 7.9 million adults have co-existing mental health and substance use disorders.

Children are more likely to become involved in some type of substance abuse if they grow up around adults who do drugs. The effects of drug abuse across generations can be prevented if the cycle is stopped by treating the parents’ SUD.

Where Can You Get Treatment?

There is a range of settings where a person can receive addiction treatment. Clinics and doctor’s offices are regarded as outpatient care. Live-in rehabs are considered inpatient care. However, just because a treatment center and program are available, it doesn’t mean your insurance provider will pay for them. Not every doctor, facility, or program is approved by every insurance company.

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What Does “In-Network” and “Out-of-Network” Mean?

When a health provider accepts your health insurance plan it is said to be “in-network.” They may also be called participating providers. If you go to a doctor or provider that doesn’t take your plan, they are “out-of-network.” The main differences between the two are the cost and whether your plan helps pay for the care you get from out-of-network providers.

What Companies are In-Network at Magnolia City Detox?

Magnolia City Detox is  proud to be in-network with the following insurance companies:

  • Aetna
  • Humana
  • MHNet
  • ValueOptions
  • Verity Health

Our admissions specialists are able to verify your coverage and help you choose a plan that is appropriate for your situation and needs.

FAQ About the ACA

Under the ACA, individual medical plans are required to cover 10 essential health benefits to be recognized as a Qualified Health Plan. Residents of some states may not be able to enroll in an ACA-compliant plan. To find QHPs in your state, go to www.HealthCare.gov.

  • Visit www.HealthCare.gov and click on “sign up” under “get important news and updates.”
  • Follow on social media.

The health insurance open enrollment period runs for a six-week period and generally begins on Nov. 1. If you miss that 6-week period you may have a hard time getting insurance unless you can qualify for a Special Enrollment Period.

You may qualify for Special Enrollment if you or anyone in your household  had these changes in the past 60 days:

  • You got married
  • Had a baby, adopted a child, or placed a child in foster care
  • Got divorced or legally separated and lost health insurance
  • Move to a new home in a new ZIP code or county
  • Move to the US from a foreign country or US territory
  • Died–if someone on your marketplace plan dies and causes you to lose your coverage

Only moving for medical treatment or staying in a vacation location doesn’t qualify for the Special Enrollment Period.

Moving can have an effect on your health insurance savings and coverage options. Make sure to update your application in your new area. You may qualify for the Special Enrollment if you move.

Can Treatment Be Covered by Medicare or Medicaid?

Medicare is a federal government program meant to provide coverage for seniors and people with disabilities. Original Medicare will cover mental health services. This includes treatment for alcoholism and SUD at 80% of the Medicare-approved amount, as long as you go to a participating provider. Medicare will pay for the treatment of substance abuse disorders and alcoholism in both outpatient and inpatient settings. Covered services and items include:

  • Psychotherapy
  • Patient education
  • Follow-up after hospitalization
  • Outpatient prescription drugs
  • Inpatient prescription drugs including methadone
  • SBIRT (structured assessment and brief intervention)

SBIRT is an early intervention for people who have not reached the severity of substance abuse to be diagnosed with SUD.

Medicaid is a state-administered program that is partly sponsored by the federal government. The purpose is to make sure that low-income and certain other qualifying people have access to health care coverage. Because the administration of the program rests with the individual states, there are some slight differences in how it works depending on where you live.

Also, whether Medicaid will cover drug rehab for you depends on whether you qualify for coverage. You need to check with your state Medicaid program.  However, Medicaid does offer some type of addiction treatment coverage in every state.

Because of the ACA and other legislation, Medicaid must offer some services under the heading of addiction treatment such as:

  • Health screenings to discover whether you have an addiction and how it is affecting your health.
  • Alcohol and drug testing
  • Interventions
  • Inpatient and outpatient rehab
  • Family counseling
  • Medication
  • Medically assisted detox
  • Dual diagnosis services if relevant
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Begin Your Recovery Journey at Magnolia City

Located in Houston, Texas, Magnolia City Detox can provide you a safe, professional facility to get you started on your journey. We have special programs that caters to as:


We know you want to recover. And you know that recovery starts with the difficult period of withdrawal. A supervised detox is the safest way to comfortably go through substance withdrawal without giving up and giving in to a relapse. Find out how Magnolia City Detox can help you get started on your journey. Remember, a journey of 1000 miles begins with a first step. Give us a call today.

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