HealthSmart Insurance Coverage for Drug and Alcohol Rehab

Yes, HealthSmart insurance plans will provide at least some coverage for inpatient and outpatient alcohol and substance abuse treatment services, although the amount of coverage can vary widely based on your state of residence, whether the facility is in- or out-of-network, the length of your stay, and your insurance plan level. The cost of drug and alcohol addiction treatment will vary from person to person and will also depend on the rehab center, the type of program attended, and specific services received.

The Affordable Care Act (ACA) requires that insurance companies provide some degree of coverage for mental health treatment, which includes substance use disorder (SUD) treatment (including coverage for drug and alcohol addiction), so HealthSmart does cover addiction treatment.² HealthSmart insurance plans may cover rehabilitation as part of its mental health care services. However, HealthSmart may not cover every kind of therapy or all lengths of treatment. You may have to get a referral from your primary care doctor before HealthSmart is willing to pay for your claims in some cases.

Getting the proper addiction treatment is essential for your recovery effort. The type of treatment plan you need will depend on the severity of your addiction and where you are in the journey to well-being. You might start out at one level of treatment and work your way to another level, then continue until you don’t need treatment.

Some of the treatment programs that may be covered through HealthSmart include:^3,4

• Detox services: In some cases, you may need assistance when detoxing from drugs and alcohol, which can potentially be uncomfortable, painful, or even life threatening. Medical detox helps you safely withdrawal from drugs and alcohol, as you’ll receive around-the-clock medical supervision. You might also be given medications to help minimize withdrawal symptoms.
• Inpatient or residential care: Inpatient/residential live-in treatment centers provide drug and alcohol rehab while you live onsite at the facility. Most inpatient programs last anywhere from 15–90 days, depending on the program you’re in and your individual needs.
• Partial hospitalization program (PHP): Partial hospitalization programs give you the opportunity to live at home while attending treatment during the day.
• Intensive outpatient program (IOP): Intensive outpatient programs involve attending treatment programs a few evenings each week. In an intensive outpatient program, you can live at home and even go to work during the day.
• Outpatient treatment: Individuals who have completed inpatient treatment often attend outpatient treatment for ongoing support on their journey to sobriety. You live at home and spend 10–12 hours a week at the treatment facility for therapy and support.

In-network providers have a contract with the insurance carrier to offer services at a set price. This means that your out-of-pocket expenses will typically be lower than if you choose an out-of-network facility. In some cases, you may even be responsible for the full cost of rehab if you choose an out-of-network facility.

Whenever possible, try to choose a facility that is in-network with HealthSmart. If you are unable to find an in-network provider or prefer a facility that is out-of-network, you may be able to work out a payment plan with the facility so you can pay back the cost of treatment over time.

Before deciding on a rehab center, check your HealthSmart policy benefits to determine which costs will be covered by your insurance plan and which will be out-of-pocket for you. You can call the phone number on your insurance card or log in to your account on HealthSmart’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 HealthSmart. Or call to speak with one of our admissions navigators to have them check your benefits and help you understand what is covered.

If your insurance plan won’t cover the total cost of rehab, don’t despair; many facilities offer payment plans that will allow you to get the treatment you need. Government programs also offer aid that can prove helpful. Many facilities will work with you to figure out how to have access to treatment and make it affordable.

There are other resources to help you cover the cost of rehab. You can check with the rehab facility for a sliding scale fee or payment arrangement. Additionally, some facilities offer financial aid or scholarships for treatment. If those options aren’t available, you could try to get a loan from family or friends.

Here are some resources that can help:

• How to Pay for Rehab Without Insurance
• Frequently Asked Questions: Paying for Rehab
• How Much Does Rehab Cost?

What’s most important is that you can get the help you need to treat your addiction. There is a lot of information regarding health insurance that can be confusing and perhaps overwhelming. If you would like some help in sorting through this information to the get the addiction treatment you need, call your insurance company or speak with one of our admissions navigators today. They can outline the details of your plan and help guide your search.

American Addiction Centers (AAC) strives to provide you with the most updated information on each carriers’ addiction insurance coverage, but policy changes and errors do occur. Please check with your insurance carrier directly to confirm coverage levels.

1. HealthSmart. (n.d.). About HealthSmart.
2. Healthcare.gov. (2021). Mental Health and Substance Abuse Coverage.
3. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Types of Treatment Programs.
4. National Institute on Drug Abuse. (2014). Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide: Treatment Settings.