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Highmark Insurance Coverage for Drug & Alcohol Rehab

Drug and alcohol addiction can be a serious, debilitating, and life-threatening condition that can hinder all aspects of a person’s life. Highmark insurance may be able to help those covered by their plans cover some or all of the cost of addiction detox and rehab.1 Understanding what Highmark insurance is and how it can be used to help cover the costs of addiction treatment can be an important step in achieving recovery.
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Does Highmark Cover Addiction Treatment?

As part of the Affordable Care Act (ACA), Highmark provides marketplace insurance plans that cover some or all the costs of drug and alcohol rehab programs. Since the ACA mandates that plans provide some degree of coverage for the medically-necessary treatment of substance use disorders, you may be able to use your Highmark insurance plan to cover some or all of your rehab costs.

Highmark typically provides some level of coverage for substance abuse rehabilitation programs since substance abuse is considered an illness. The amount of coverage depends on your plan, so the amounts and types of coverage vary. There may also be coverage available if you have been diagnosed with a co-occurring mental illness that contributed to your drug or alcohol addiction.

Highmark covers a variety of recovery programs, including both inpatient and outpatient treatment facilities. Be sure to carefully review your Summary of Benefits or speak with a Highmark representative to accurately determine your coverage prior to undergoing treatment.

The amount of coverage you have 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.

What Types of Addiction Treatment Does Highmark Cover?

With most Highmark plans covering at least some of the costs of treatment for alcohol addiction or drug addiction, the types of treatment can vary in intensity and frequency. Types of treatment may include:5,6

  • Medical Detox: Medical detox helps you withdraw safely from drugs and alcohol. Under 24/7 medical supervision, staff will work closely with you—and may prescribe medications to help ensure that you withdraw safely and that your symptoms are addressed as needed.
  • Inpatient or residential treatment: With inpatient treatment, you receive treatment and live at the facility. Inpatient treatment typically involves group and/or individual therapy. It is often recommended for individuals with co-occurring mental health issues, limited outside support, home environments that don’t lend themselves to sobriety, and poor treatment outcomes in the past.
  • Partial hospitalization: These programs allow you to live at home throughout treatment and spend your days at the treatment facility. This is sometimes referred to as day treatment.
  • Intensive outpatient programs: These programs typically involve attending treatment programs approximately 3 evenings a week. People in these programs can live at home and go to work during the day.
  • Outpatient treatment: An outpatient facility lets you meet with doctors and therapists, and you can even attend group sessions and recovery meetings before heading back home at the end of the day. With a residential program, you get the chance to focus solely on your recovery without any daily tasks getting in your way or slowing down your progress.

When you decide to get treatment for a drug or alcohol addiction, you will need to decide what type of treatment is best for you.

Addiction Treatment Length Highmark Will Cover

There is no set time limit for addiction treatment, and oftentimes the extent of treatment and the coverage for said treatment will vary. The duration of substance abuse treatment can vary. The most common residential programs last from 28 to 30 days, but there are 60-day and 90-day programs, and some programs that last a year or longer.2,3 It’s important to reach out to any potential rehab centers to try and determine the length of treatment, as this information can help you more accurately determine costs.

Check Your Highmark Rehab Coverage

Before choosing the right rehab treatment center for you, check your Highmark policy benefits to determine which costs will be covered by your insurance company and which will be out-of-pocket for you. Call the number on the back of your insurance card or log in to your account on Highmark’s website to learn more about what your specific policy plan covers.

Knowing exactly what your Highmark plan covers can give you peace of mind while you or your loved one is in rehab. You can do the work of getting and staying sober without worrying about unexpected costs or financial struggles. For more information on Highmark insurance plans and to check what your plan covers, call , click here, or fill out the form below.

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

In most cases, you will need to seek drug and alcohol addiction treatment at a rehab facility that is in-network with Highmark to receive your full benefits. Even if you choose a treatment facility that is in-network, you may still be responsible for some of the treatment costs. If you choose a facility that is out-of-network, you may be responsible for all the costs of your addiction treatment. You may be able to discuss financing options such as a payment plan or scholarships offered by the facility.

Although out-of-network benefits are typically less than coverage for in-network providers, Highmark often pays up to 50% co-insurance for out-of-network providers. However, some providers do not accept Highmark insurance. Confirm coverage with your Highmark representative as well as your admission counselor before you begin treatment.


What Are Highmark’s Coverage Levels and Plans?

Highmark Inc. partners with healthcare affiliates and provider networks across the nation to offer insurance services and plans to its members. Its plans cover approximately 5.6 million people in Pennsylvania, Delaware, and West Virginia.1 Highmark Insurance is also a Blue Cross Blue Shield-affiliated organization. Individuals and families are eligible for a variety of Highmark insurance options through the Affordable Care Act (ACA).

Highmark provides the following types of managed care insurance programs for their clients:2-3

Preferred Provider Organizations (PPOs): A PPO plan typically provides members with the ability to obtain care from a network without having to choose a primary care physician (PCP). Members can also obtain care from providers who are not in-network but will need to cover any costs that are not covered by Highmark.

Exclusive Provider Organizations (EPOs): EPOs function like PPOs but you can’t go out of network. Members are not required to select a PCP to coordinate covered care, but it is recommended.

Point-of-Service (POS) and Open Access Programs: The POS benefit plan has members choose a PCP who will assist you in securing care and services. The PCP will ensure your services are within the network. Out-of-pocket costs for non-network providers will be covered by the member.

Health Maintenance Organizations (HMOs): The Highmark HMO plan is for Pennsylvania and Delaware members. This type of health care plan provides comprehensive services that members must use within the network of participating providers (except for emergency care and urgent care).

Highmark and the Affordable Care Act (ACA): Highmark insurance is also available through the Affordable Care Act (ACA), which provides comprehensive health coverage for those who don’t have insurance offered to them through an employer.

All medical insurance plans are categorized by metal levels. These levels have nothing to do with the quality of service you’ll receive; they simply reflect how much you’ll pay monthly and at the time of service. The metallic levels include:4

  • Gold: You pay a higher monthly premium and have lower out-of-pocket fees.
  • Silver: Your monthly payment is balanced with the out-of-pocket costs, so your costs are moderate for both.
  • Bronze: You pay lower monthly premiums and higher costs at the time of service.

Finally, if you are a Medicare recipient, you can choose a Highmark plan if you are enrolled in Part A and Part B.

How to Verify the Coverage of Your Highmark 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 specific services received.

Before deciding on a rehab center, check your Highmark 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 Highmark’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 Highmark. 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 Highmark Won't Cover the Total Cost of Rehab?

It can be challenging to pay out-of-pocket costs for treatment that isn’t covered by insurance, but it is important not to let finances stand in the way of getting help for an addiction that is chronic and debilitating. There are many other ways to finance your treatment and get the help you need. Some ways to pay for rehab include:

  • Payment plans: You pay off rehab in affordable installments.
  • Sliding scale: The rehab decreases your cost to something you can reasonably afford—typically based on your income level.
  • Grants or scholarships: The Substance Abuse and Mental Health Services Administration (SAMHSA), as well as individual rehabs, offer grants and scholarships to pay for people who can’t afford treatment.
  • Purchase affordable insurance on the Healthcare Marketplace.
  • Open a healthcare credit card or take out a specialized healthcare loan.
  • Use your savings or a credit card.

Make sure to do thorough research when looking for rehab so that you can find one that meets your financial needs.

Here are additional resources that provide more information about other ways to pay for rehab with or beyond what Highmark covers:

We know that finding a rehab center is a confusing task, but we’re ready to help you navigate through the world of treatment centers. Call one of our admissions navigators if you’re worried about a loved one or you’re ready to take action to begin the process toward recovery.

Insurance Providers and Rehab Treatment Coverage Levels


  1. Highmark. (2020). Our story.
  2. Highmark Health. (2020). Highmark Health Plans.
  3. Highmark Provider Manual. (2018). Page product information: Product overview.
  4. Highmark. (n.d.). ACA health insurance basics.
  5. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Types of Treatment Programs.
  6. National Institute on Drug Abuse. (2014). Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide: Treatment Settings. strives to provide you with the most updated information on each carrier’s addiction insurance coverage, but policy changes and errors do occur. Please check with your insurance carrier directly to confirm coverage levels.

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