Though it has not always been this way, all commercial healthcare plans must cover substance use treatment. As explained by HealthCare.gov, “Mental and behavioral health services are essential health benefits… All plans must cover …substance use disorder (commonly known as substance use) treatment.” Further, though not all insurance companies advertise this information, 43 states currently require commercial health insurers to cover addiction treatment under their healthcare plans.
This is good news for those seeking drug or alcohol addiction treatment. If you already have insurance, you need only read the section on your individual policy’s coverage for substance use treatment or call the insurance company if you need help locating the relevant information.
As stated directly on the Medicaid website, “Medicaid is the single largest payer for mental health services in the United States and is increasingly playing a larger role in the reimbursement of substance use services.” In fact, the Centers for Medicaid and CHIP Services (CMCS) recently aligned specific priorities for the next few years regarding several things, including an “effective benefit design for substance use disorder services.” In Massachusetts, Medicaid and the Children’s Health Insurance Program (CHIP) are combined into one program called MassHealth.
For Medicare, coverage depends on a few things. First, the treatment must be completed in a facility with a provider that is compliant with Medicare. Treatment must also be doctor-recommended, and your doctor must set up your treatment plan. Treatment is generally covered if the person was hospitalized due to substance use and moved later to a facility for recovery (much like many other insurance plans).
First, if you do not have insurance and can’t get any, you may want to apply for Medicaid or other forms of state-funded insurance. You may be surprised and find that you may qualify. Of course, if you have a family member or patron who is willing to help with the cost of treatment, you may have an easier time funding your recovery. But you also have other options. In some cases, you may be able to secure a personal loan for treatment coverage. Different lenders may require different criteria for loan approval, but private loans to fund treatment are both common and can be a great help in your time of need.
Self-pay is especially helpful to those who feel trapped into entering only treatment facilities covered by insurance. While entering any treatment is better than no treatment, if you are looking for options and self-pay is the only way to seek alternative treatment, then it may be right for you. Some facilities offer a sliding fee scale, which allows payments to be based on income, stay length, an established amount of payments, etc. Private pay rehab may also offer a number of benefits to those who choose that route, including program options specific to individuals (tailored for you) and avoiding long waiting lists, which may result from government funding or insurance referrals.