If you have just made one of the biggest decisions of your life—the decision to enter drug or alcohol addiction treatment—you may be facing the glaring question of how you will fund treatment. Or maybe you are considering entering treatment and are unsure if you will be able to enter a facility due to lack of funding.
Which Insurance Plans Cover Drug And Alcohol Treatment?
Though it has not always been this way, all commercial health care plans are required to cover substance abuse 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 abuse) 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.
While the stigma regarding drug and alcohol addiction remains, addiction is medically recognized as a treatable disease. Also, due to the establishment of the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008, patients may not be discriminated against because of their addiction. This means that standards and limitations must be held to the same degree as the standards and limitations for all other medical benefits. In other words, while the MHPAEA does not require commercial insurers to provide coverage for specific treatments or disorders, it does hold that coverage must be available at the same standards as for other medical conditions.
This is good news for those seeking drug or alcohol addiction treatment. If you already have insurance, you need only to check into your policy to understand your individual policy’s coverage for treatment. If you are not sure where to look, it may be a good idea to give the insurance company a call and hear it firsthand. Either way, keep in mind that in most states, it is required that commercial insurers treat substance abuse as a medical, treatable condition under their healthcare plan guidelines. Some insurance plans require that the treatment be doctor-referred and that you be moved to a facility after initial hospitalization.
What About Medicaid And Medicare?
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 abuse 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 abuse and moved later to a facility for recovery (much like many other insurance plans).
What Other Ways Can I Utilize To Pay For Treatment?
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 which are specific to individuals (tailored for you) and also avoiding long waiting lists which may result from government funding or insurance referrals.
What To Do If You Do Not Have Treatment Funding
Everyone deserves treatment, even if they cannot afford it. If you are struggling to pay for rehab, there are some outside sources that may be able to help. Some places provide treatment and care for those in need with grants. The Substance Abuse and Mental Health Services Administration (SAMHSA) makes these grants available to the Center for Substance Abuse Prevention, the Center for Substance Abuse Treatment and the Center for Mental Health Services. For more information regarding specific programs funded by these grants, visit the SAMHSA website.
You may also be able to find scholarships from outside sources to fund personal treatment. For example, the Sobriety Optimization League (SOL) provides “financially disadvantaged individuals and families suffering from the disease of drug and alcohol addiction with customized best-odds-outcome resources designed to promote long-term sustainable sobriety.” Finding these scholarships may take time, but it will be well worth it in the end.
Beginning drug and alcohol abuse treatment can be a big step in the right direction, but it may also require some time spent on researching things like funding. Along the way, you may find you could use a helping hand, and we are here to provide that for you. Contact us at Vertava Health of Massachusetts to learn more about funding, our facilities and treatment options that may be right for you or your loved one.
- Department Of Labor — Mental Health And Substance Use Disorder Parity
- HealthCare.gov — Mental Health And Substance Abuse Coverage
- InsuranceQuotes.org — Addiction Treatment And Your Health Coverage
- MedicareInteractive.org — Medicare Coverage Of Treatment For Alcoholism And Drug Abuse
- WhiteHouse.gov — Substance Abuse And The Affordable Care Act