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EmblemHealth Insurance Coverage for Drug & Alcohol Rehab

EmblemHealth is a not-for-profit health insurer that provides insurance plans to more than 3 million people in the New York tri-state area.1 EmblemHealth includes ConnectiCare, AdvantageCare Physicians, and WellSpark under its umbrella of companies.1
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Does EmblemHealth Cover Addiction Treatment?

Yes, EmblemHealth covers treatment for drug or alcohol use. The Affordable Care Act (ACA), enacted in 2010, plays a crucial role in this coverage. Under ACA, substance use disorder (SUD) is considered an essential health benefit, ensuring insurance plans like EmblemHealth must provide coverage for related treatment.2 However, the extent of coverage may vary depending on several factors, such as your specific plan, individual circumstances, and the type of treatment you need.

What Types of Addiction Treatment Does EmblemHealth Cover?

EmblemHealth can help pay for various types of addiction treatment near you or out of state, depending on your specific plan and what treatment your doctor recommends.

There are different types of addiction treatment that may be covered by EmblemHealth:3

  • Detox can help patients more comfortably and safely withdraw from certain substances (e.g., alcohol, benzodiazepines) while under the care and supervision of medical professionals. You might be given medications to help minimize withdrawal symptoms during this time. Detox can ease the transition into a formal treatment program.
  • Inpatient rehab involves living full-time at a safe, supportive facility. This allows patients to receive 24-hour care, helping them focus on their recovery. Inpatient rehab can vary in duration, but many programs last between 7 and 90 days.
  • Outpatient rehab involves patients living at home and attending treatment for a few hours a week. Outpatient care can vary in duration and intensity. For example, a partial hospitalization program (PHP) or an intensive outpatient program (IOP) requires more frequent and longer attendance than a standard outpatient program.
  • Aftercare services encompass any recovery-focused activity that takes place after a patient completes a formal treatment program. Aftercare services are designed to support long-term recovery and can include attending 12-step meetings or living in a sober living home.

Do Rehab Centers Need to Be In-Network To Accept EmblemHealth?

Selecting in-network providers ensures services are offered at pre-negotiated rates, resulting in lower out-of-pocket expenses compared to out-of-network facilities. Opting for an out-of-network facility could leave you responsible for the entire rehab cost.4 It’s advisable to prioritize in-network rehab treatment centers affiliated with EmblemHealth whenever possible. In the rare event you can’t find an in-network provider or prefer an out-of-network facility, consider discussing a payment plan with the facility. This allows you to manage treatment expenses gradually over time, ensuring access to the care you need.

Addiction Treatment Length Covered by EmblemHealth Insurance

The length of coverage provided by EmblemHealth can vary depending on the specific plan you have and your individual needs. Insurance coverage for addiction rehab typically falls under the category of behavioral health or mental health services. In the United States, the coverage for addiction rehab is often subject to the guidelines of the Mental Health Parity and Addiction Equity Act (MHPAEA). According to MHPAEA, insurance plans must treat mental health and substance use disorder benefits on par with medical and surgical benefits. This means that if there are limits on the number of days or visits for medical or surgical services, there should be similar limits for addiction rehab too.5

To determine the exact number of days of addiction rehab coverage under your specific EmblemHealth insurance plan, you should review your policy or contact EmblemHealth directly. They can provide you with specific information about your plan’s coverage for addiction rehab services.

How to Verify the Coverage of Your EmblemHealth Plan

The cost of drug and alcohol addiction treatment will vary from person to person. It will depend on the treatment center, the type of program attended, and the specific services received.

Before deciding on a rehab center, check your EmblemHealth policy benefits to determine which costs will be covered by your insurance plan and which will be out-of-pocket for you. Call the number on your insurance card or log in to your account on EmblemHealth’s website to determine how much you may need to cover in terms of copays and any deductible that must be reached before coverage kicks in for the services you need.

American Addiction Centers can also verify your insurance coverage for you. Visit our insurance verification page, enter your information, and you will immediately be able to see if the center you are considering is in-network with EmblemHealth. Or call to speak to one of our admissions navigators to have them check your benefits and help you understand what is covered.

What Should I Do if EmblemHealth Won’t Cover the Total Cost of Rehab?

If EmblemHealth won’t cover the total cost of rehab, there are several steps you can take to explore other options and manage the expenses:

  • Review your plan: Carefully review your insurance policy to understand the reasons for the partial coverage. It may be due to plan limitations, out-of-network providers, or specific treatment restrictions.
  • Look for in-network providers: Choose rehab facilities and providers that are in-network with EmblemHealth. In-network providers typically have negotiated rates, leading to more extensive coverage and lower out-of-pocket costs.
  • Verify out-of-network coverage: If you prefer an out-of-network facility, check if EmblemHealth offers any coverage for such treatment. It may be less coverage than in-network providers but still helpful.
  • Discuss payment options: Talk to the rehab facility about payment options. Some facilities may offer payment plans or sliding-scale fees based on income, making treatment more affordable.
  • Look for public assistance: Depending on your financial situation, you may qualify for state or federal programs that offer financial assistance for addiction treatment.
  • Research nonprofit and government programs: Explore nonprofit organizations and government programs that provide addiction treatment grants or scholarships.
  • Personal financing: Consider personal financing options, such as using savings, borrowing from family, or seeking personal loans, to cover the remaining costs.


  1. EmblemHealth. (n.d.). Our Story.
  2. (2021). Mental Health and Substance Abuse Coverage.
  3. (n.d.). Treatment options.
  4. (n.d.). Health insurance plan & network types: HMOs, PPOs, and more.
  5. Centers for Medicare and Medicaid Services. (n.d.). The Mental Health Parity and Addiction Equity Act (MHPAEA).


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