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American Family Insurance Coverage for Opiates / Opioids Rehab

In response to the mandates required by The Affordable Care Act (ACA), insurance companies, including American Family Insurance, now offer opiates/opioids addiction treatment.

Before the Affordable Care Act was passed in 2010, most insurance carriers didn’t offer substance abuse treatment with their individual and family plans.

However, the new law requires that health insurance companies offer “ten essential benefits.” One of these ten essential benefits is substance abuse treatment. The Affordable Care Act requires that plans cover substance abuse similar to the way they cover any other medical event.

What Kind of Coverage Does American Family Insurance Offer for Opiates/Opioids Addiction?

American Family Insurance will pay for several types of rehabilitation including inpatient, outpatient, and aftercare. Most of the time, in order to determine which type of treatment is most appropriate, a medical professional will diagnose you with opiate/opioid addiction, assess your situation and make a recommendation as to which type of treatment is most appropriate.

How Much of the Opioid Rehab Cost is Covered?

The Affordable Care Act mandates that health insurance companies cover opiates/opioids addiction treatment similar to other medical events covered under your policy.

This is referred to as the mental health parity act. For example, if your policy covers 70 percent of hospital stays after you’ve met your $500 deductible, it must also cover 70 percent of opiate/opioid recovery treatment after you’ve met your $500 deductible.

In accordance with the Affordable Care Act, coverage is offered for up to 30 days from American Family Insurance for Opiates/Opioids Addiction Rehab.

If I Exhaust My Addiction Treatment Benefits Can I Pay for More Treatment Myself?

If you’ve exhausted your benefits and American Family Insurance will no longer pay for addiction treatment, you can pay for your remaining treatment out of your own pocket.

For example, if you’ve been in rehab for 30 days, and it’s decided that you need another two weeks in an inpatient facility; you can pay for the extra two weeks in order to continue your treatment.

Take Our “Am I a Drug Addict?” Self-Assessment

Take our free, 5-minute “Am I A Drug Addict?” self-assessment below if you think you or someone you love might be struggling with drug addiction. The evaluation consists of 11 yes or no questions that are intended to be used as an informational tool to assess the severity and probability of a substance use disorder. The test is free, confidential, and no personal information is needed to receive the result.

Inpatient Opioid Addiction Therapy vs. Outpatient Opioid Addiction Therapy

“The Affordable Care Act mandates that health insurance companies cover opiates/opioids addiction treatment similar to other medical events covered under your policy.”

Opiate/opioid addiction is a serious matter. According to the Center for Disease Control, opiate-related overdoses have more than tripled since 1999.

Because of its serious nature, oftentimes it’s required that the recovering addict remains in an inpatient facility. Inpatient therapy is typically offered for one, two, three or six months, depending on the particulars of each case.

Inpatient recovery protects the recovering addict from relapse and allows them to focus their attention on recovery. Outpatient therapy can be just as effective as inpatient therapy in many situations. If inpatient therapy is not feasible because of family, work or other commitments, outpatient therapy may be a viable option.

Should I Opt for an Inpatient Treatment Center?

Many recovering addicts opt for an inpatient treatment center. Some of the deciding factors are:

  • Cost
  • Insurance coverage
  • Addiction severity
  • History of treatments and their outcomes

Will American Family Pay for Local Treatment and Out-of-State Rehab?

Because the mental health parity law requires insurers to cover addiction treatment like any other medical event, if your plan offers out of state/out-of-network coverage, it must also cover opiate/opioid treatment out of state/out of the network.

If American Family Insurance has a network in the state in which you want to receive treatment, you may be able to receive out of state treatment and get in-network benefits! One of the disadvantages of receiving treatment outside of the network is balance billing.

Insurance companies have direct contracts with doctors and hospitals in their network. These contracts limit charges for certain procedures, so the doctor or hospital can’t bill you more than they’ve agreed upon with your insurance company. If you use out-of-network providers, the facility may bill you the portion of the cost your insurance company doesn’t pay.

If your health plan doesn’t offer out-of-network benefits, you’ll want to use in-network treatment centers. In this case, if you use an out-of-network provider, you’ll have to cover the entire cost yourself.

Does American Family Pay for Private or Luxury Treatment?

Luxury treatment offers the ability to recover from your addiction or disorder in a posh setting with extra amenities. Private treatment is simply a treatment that is provided in private, rather than in a group setting.

American families will pay for treatment that’s deemed to be medically necessary. In most, if not all cases, private or luxury treatment will not be covered because it won’t be considered medically necessary.

What Does Executive Treatment Offer Over Standard Treatment?

Standard treatment often restricts normal daily activities, especially if it’s an inpatient treatment center. Executive treatment centers offer an alternative to a standard-setting, oftentimes for CEO’s and celebrities who participate in business or daily activities outside of recovery. Executive treatment programs cater to people in a situation where they must maintain their professional lifestyle on a day-to-day basis.

What Lengths of Treatment Will American Family Insurance Pay For?

American Family will pay for opiate/opioid treatment. Unfortunately, American families will not pay for treatment programs that run 60, 90 or 180 days.

It’s best to have the treatment center pre-authorize your stay with your insurance company before you are admitted. Coverage through American Family Insurance for Opiates/Opioids Addiction Treatment is limited to 30 days.

What if I Don’t Have Insurance?

If you don’t have insurance, nearly all rehab centers will accept payment upfront. If you aren’t able to pay upfront, some offer credit, but will likely run a credit check before they do.

Here are some options to consider if you don’t have insurance, can’t pay upfront, aren’t able to get approved for credit, or simply prefer to explore other options first.

If you’re ready to start the recovery process, call our helpline at and we’ll point you in the right direction!

FAQ’s about American Family Insurance for Opiates/Opioids Addiction Rehab:

Will American Family Insurance Cover Multiple Rehab Stays?

American Family will only cover rehab treatment for up to 30 days per year. If you are readmitted in to a rehab facility and you’ve exhausted your benefits for that year, your second claim will be denied. However, if you are admitted to a rehab center the year after your original visit, you will have another 30 days of benefits.

Does American Family Insurance Pay for Aftercare?

If an aftercare program is deemed medically necessary, American Family will cover it. You’ll want to have pre-authorization from American Family for any aftercare program you are considering.

Could Going to Rehab Cause an Increase in My American Family Insurance Premiums?

You are protected by the Affordable Care Act from an insurance company raising your premiums due to your claims history or health history. However, premiums will increase in general, based on the amount of rehab benefits and other benefits that are used as a whole.

Has The Affordable Care Act Changed Substance Abuse and Mental Health Insurance Coverage?

The ACA has changed substance abuse and mental health coverage; for the better according to most people. Before the ACA was implemented, insurance companies could choose whether or not to cover mental health and substance abuse. The ACA made it a requirement for insurance companies to cover mental health and substance abuse the same way they cover other medical events.

Disclosure: This article is not intended to be a guarantee of payment or benefits. To learn more about the benefits American Family Insurance offers, call their customer service department. If you have questions about American Family Insurance Coverage for Opiates/Opioids Addiction Rehab/Treatment, please call us at .

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