Most folks know the importance of having health insurance especially when one considers the cost of primary healthcare these days. It is no secret that primary healthcare is getting more expensive with each passing day despite the government’s effort to reduce it.

We recommend that you read this article to find out some important facts about the economics of the U.S. healthcare system. This increase in the cost of treatment isn’t restricted to primary healthcare alone, mental health and addiction rehab treatment are also very expensive. Given that these categories of treatment do not fall under regular primary healthcare, individuals battling substance addiction of different types cannot help but wonder if their insurance also covers addiction rehab.

We can provide a simple answer to the title question, but such an answer will not do justice to the question because there are many factors involved that determine the answer. Also, not all scenarios and conditions are the same. Therefore, a definite answer will not be the best.

We have considered all these which is why we have compiled this informative article to provide you with not just an answer but an answer that addresses a wide range of scenarios and conditions.

Without further ado, let’s begin…

Can you Cover Substance Addiction Rehab with your Insurance?

The 2010 Affordable Care Act (ACA) made it mandatory that all health insurance plans provide cover for rehab and mental health care treatment to every American. Furthermore, the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 provides further backing for the ACA thereby ensuring that you are not deprived of this benefit. 

Therefore, you can cover addiction rehab with your health cover. However, before you rush to a rehabilitation center with this information, it is necessary that you get the full gist.

While you can use your coverage as payment for your addiction rehabilitation treatment, you need to know that certain plans and treatments aren’t accepted by every rehabilitation center.

Because of this, it is important that you have the full details of the extent of your coverage plan to ensure that you can receive the service and treatment that you need.

Rehab Services your Insurance Covers

Although the plans accepted by most centers differ, most plans will provide coverage for the following services:

i. Inpatient treatment     

ii. Outpatient treatment

iii. Detoxification

iv. Medication for detox, withdrawal, and recovery

v. Individual, group, or family counseling

vi. Screening, preventative, and intervention services

The above are basic services you get when going through withdrawal and recovery care. This means that any service that is not categorized as essential isn’t covered by your insurance. You might have to pay additional money for other more comprehensive services provided by certain providers. You should check out Optima Health drug rehab to learn more about basic addiction rehab services.

Furthermore, the majority of the policies available nowadays do not cover what is regarded as luxury services. These are services that some rehabs provide that are solely for comfort and luxury rather than helping the patient overcome their addiction.

Below are some luxury services provided by certain rehabs:

i. Holistic services

ii. Non-medical amenities

iii. Recreation facilities

iv. Gourmet food, etc.

Another thing that is worth knowing is that some states in the U.S. allow private insurance companies to turn away individuals who are intoxicated or affected by substance abuse. This permit is usually for emergencies whereby the individual requires treatment for illnesses or injuries caused by intoxication.

We very well know that emergencies are called emergencies because you can’t plan for them. Therefore, knowing that you won’t be bailed out of such emergencies by your policy can cause you to brace up and take your recovery more seriously.

What You Pay for Yourself

By now you should have a good idea of what services your plan covers. As such, those services not covered by your insurance are the things you get to pay for yourself.

We have listed the main services you pay out of your pocket below with brief descriptions so that you know what you are paying for exactly:

i. Premium – This is the money you pay for the insurance itself.

ii. Co-insurance or Co-pays – This fee is paid to your cover provider.

iii. Lifetime Limitation – Lifetime limitation insurance does not have limits regarding the expenses covered by your provider. If you don’t have such coverage, this service refers to the expenses that are above the limit that your provider has agreed to pay.  

iv. Deductibles – This refers to the amount of healthcare expenses charged to the policyholder.

Other Ways to Cover Addiction Rehabilitation

Insurance and out-of-pocket payment are not the only ways you can cover the cost of your addiction treatment. Therefore, if you don’t have enough cash or your insurance is not sufficient to cover your rehab costs, try the following ways:

1. Medicaid

Medicaid is a state and federal initiated program that was created in 1965 to provide funds for families and individuals to access primary healthcare. These days, you can also access the funds from this program to offset your addiction treatment cost thanks to the ACA.

Your eligibility to access this program depends on these factors:

i. Age

ii. Income level

iii. Disability

iv. Children

2. Medicare

Medicare was also created in 1965 and is funded by the state and federal governments. The only difference between Medicare and Medicaid is that the former is designed to cater to older folks above 65 years as well as people with disabilities. Visit to find out more about the differences between these programs.

You enjoy the following coverage from this program:

i. Inpatient treatment

ii. Outpatient treatment

iii. Medication

iv. Partial hospitalization

v. Therapy (Individual, group, or family)


Your health insurance provides coverage for your addiction rehab; however, it doesn’t cover all the services you might receive. The services not covered are usually luxury services that aren’t part of the basic treatment. Therefore, to ensure that you don’t pay for these services yourself, you have to stick to the basic rehab services.

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