MassHealth Drug and Alcohol Rehab Insurance Coverage
In Massachusetts, the Children’s Health Insurance Program (CHIP) and Medicaid are combined into the MassHealth program.1 If you’re struggling with drug or alcohol use, your MassHealth plan may offer full or partial coverage for treatment.
What Is MassHealth?
MassHealth provides eligible members health benefits and financial assistance to pay for them.1 Members are matched to a program to provide the most coverage based on factors like age and income level.
MassHealth has 6 programs, including:2
- MassHealth Standard: Provides the most coverage, including inpatient, outpatient, and medical services, well-child screenings, transportation services, and more. This program also provides coverage for inpatient and outpatient mental health and addiction services.
- MassHealth CommonHealth: Provides similar coverage to MassHealth Standard to eligible disabled adults and children, including coverage for certain mental health and addiction services.
- MassHealth CarePlus: Offers a broader range of coverage to those who are ineligible for MassHealth Standard, while still providing coverage for some inpatient, outpatient, and medical services, as well as certain mental health and addiction services.
- MassHealth Family Assistance: Provides coverage to those who are ineligible for MassHealth Standard, covering slightly less than MassHealth CarePlus. This plan covers certain mental health and addiction services.
- Premium Assistance: Offered to those who have access to other health insurance options but would like assistance paying part or all their household’s insurance premiums.
- MassHealth Limited: Offers coverage for emergency services to those with an immigration status that keeps them from receiving more coverage, such as emergency inpatient and outpatient services and ambulance transportation.
Does MassHealth Cover Drug and Alcohol Rehab Treatment?
Yes, most MassHealth plans cover some mental health and addiction services. Under the Affordable Care Act, insurance providers are required to provide coverage for behavioral health treatment (e.g., counseling and psychotherapy), mental and behavioral health inpatient services, and treatment for substance use disorders.3
Types of Addiction Treatment That MassHealth May Cover
Several types of addiction treatment may be covered by your MassHealth plan, such as:
- Medical detox: Some patients’ continuum of care will include medical detox. Although not always necessary, medical detox helps eliminate a substance from the body comfortably and safely. This helps to facilitate the transition to ongoing addiction treatment.
- Inpatient programs: Inpatient rehab programs allow patients to get help for addiction in a residential setting. Most inpatient programs involve a combination of group and individual therapy as well as other activities designed to support recovery.
- Outpatient programs: Outpatient programs allow patients in recovery to live at home while attending treatment at a rehab facility during the day.
- Intensive outpatient programs (IOP): IOPs are a form of outpatient program involving more frequent, longer treatment sessions than a typical outpatient program. Patients in an IOP attend treatment multiple days a week for a few hours at a time.
- Partial hospitalization programs (PHP): A PHP offers a similar level of intensity to an inpatient program while still allowing patients to go home in the evening. Patients typically attend a hospital-based program at least 5 days a week for sessions lasting 4 to 6 hours.
- Aftercare: Aftercare programs help ensure patients maintain recovery and identify ways to prevent relapse.
Check Your MassHealth Rehab Coverage
Choosing the rehab facility or program that’s best for you or a loved one can feel overwhelming. Knowing beforehand what your insurance will cover can give you peace of mind and help guide the decision-making process. To learn what your specific insurance plan covers, call the number on the back of your insurance card to speak with a representative from MassHealth or fill out the form below.
What Rehab Centers Take MassHealth?
Many drug and alcohol rehab facilities and programs accept MassHealth. You can verify your coverage online or contact us at to learn whether your MassHealth plan may cover the full or partial cost of treatment at one of American Addiction Centers’ rehab locations. Not ready to talk just yet? You can sign up for text support. It’s free and confidential and there is no obligation to enter treatment.
Do Rehab Centers Need to Be In-Network?
All medical facilities and providers accept different insurance plans and programs. Facilities and providers who accept your insurance are referred to as “in-network” while those who do not are referred to as “out-of-network.” While you can see providers both inside and outside of network, your insurance will not always cover treatment received from those that are out of network. That’s why it’s important to choose an in-network provider and facility whenever possible to receive treatment.
Does MassHealth Cover Mental Health Treatment?
Yes, several MassHealth plans offer coverage for mental health treatment. Under the Affordable Care Act, all health insurance companies are required to provide coverage for 10 essential health benefits, including mental health and substance use disorder treatment.3 For those looking to find help for mental health or a substance use disorder, this means it is likely that there are treatment options available to you that are at least partially covered under your MassHealth insurance plan.
MassHealth also provides mental health and substance use services through the Massachusetts Behavioral Health Partnership (MBHP).4 With a network of over 1,200 behavioral health resources (e.g., clinics, programs), MBHP can help you find the provider best suited for you and what you’re struggling with.5 To find a behavioral health provider, fill out this form on the MBHP website. You’re also able to find a primary care clinician covered by your MassHealth plan using the form found on the Massachusetts state website here.6
Does MassHealth Cover Private and Luxury Rehabs?
American Addiction Centers has private and luxury rehab programs throughout the United States. If you believe this may be the best option for you or a loved one, your MassHealth insurance plan may cover some, if not all, of the cost of a private or luxury rehab program. For more information on these types of programs and to verify your benefits to see what is specifically covered by your plan, visit the private rehab and luxury rehab pages.
How Much of the Rehab Cost Does MassHealth Cover?
Insurance coverage of any given rehab program will vary based on the specific MassHealth plan you have. However, based on the amount of medical care you’ve already paid for this year, some or all of your rehab may be covered. If you have already met your MassHealth plan’s deductible, insurance plans typically pay between 60% to 90% of covered care. Additionally, once you reach or if you have already reached your plan’s out-of-pocket maximum payment amount, your insurance will pay for any covered medical services you receive through the end of the year.7
What Should I Do If the Cost of Rehab Is Not Fully Covered?
If your MassHealth insurance plan does not fully cover the cost of drug or alcohol addiction rehab, there may still be options available to make rehab affordable for you. Some facilities offer sliding scale fees and will work with you to establish treatment fees based on what you can pay. Others offer scholarships or payment plans to help pay for treatment at their facility. Though payment for rehab treatment may be tricky to work out, rehab is a priceless investment in yourself or a loved one struggling with addiction. You can’t put a price on getting your life back and breaking the cycle of addiction.