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Insurance Coverage for Addiction Counseling and Therapy

Questions like “Does insurance cover addiction counseling and therapy?” are common when considering treatment for substance use. Thankfully, for many people, the answer is yes.

The Affordable Care Act (ACA) changed the landscape for mental health and substance use disorder (SUD) treatment and opened benefits for millions of Americans.1 Through mandated coverage expansion, SUD treatment must be covered in the same way that medical or surgical interventions are covered by insurance.

The ACA also expanded Medicaid benefits to millions of Americans who were previously uninsured. While the extent of coverage varies by policy and state, research shows that over 1.6 Americans with an SUD gained coverage that provides some form of addiction treatment because of the changes required by the ACA.1

What Is Addiction Counseling and Therapy?

Addiction treatment, which can include counseling and therapy, is designed to help a person stop compulsively using substances.2

There are several treatment options available. Depending on the severity of substance use, treatment can range from inpatient and partial-hospitalization programs (PHP) to outpatient programs and support groups such as Alcoholics Anonymous (AA). Whatever the setting, therapies to help change behavioral patterns and negative thinking, medication-assisted treatment (MAT) to help manage withdrawal symptoms, or a combination of both, can be expected in the treatment process.2

Several types of counseling or therapy are often integrated into both inpatient and outpatient programs. A combination of individual and group counseling tends to be more effective.2 Behavioral therapies, including cognitive-behavioral therapy (CBT) and motivational interviewing (MI), have been proven to be effective ways to modify attitudes concerning drug use.3 Both CBT and MI can help people find the motivation to stop relying on substances and develop healthy coping skills such as attending support groups or exercising.3

Does Insurance Cover Addiction Counseling and Therapy?

In short, yes, although coverage will vary by policy and state.

As mentioned above, the ACA expanded insurance coverage for addiction treatment by requiring insurance companies to cover SUDs just as they would medical or surgical procedures.1 The ACA also implemented a dramatic Medicaid expansion in some states, extending benefits to approximately 1.6 million Americans with diagnosed SUDs who did not previously have access to treatment.1

The appropriate continuum of care for a given person is based on several factors, ranging from early intervention to medically managed intensive inpatient services.

Levels of care that may be covered include:3,4

  • Medical detox: Medical detox can help patients withdraw from a substance comfortably and safely. Although not always necessary, medical detox can help facilitate the transition to ongoing addiction treatment, such as an inpatient or outpatient program.
  • Inpatient programs: Inpatient programs offer an intense, structured environment that is typically for people experiencing a severe SUD, co-occurring mental health disorder, or acute withdrawal. Individual therapy, group therapy, and 12-step support groups are often included in many inpatient programs.
  • Outpatient programs: Outpatient programs may also include individual and group therapy, but patients continue to live at home and can still fulfill obligations like work or school in many cases.
  • Intensive outpatient programs (IOPs): IOPs are similar to standard outpatient programs but require a bigger time commitment with patients attending treatment several times each week.
  • Partial hospitalization programs (PHPs): PHPs are commonly referred to as day treatment. Patients may still reside at home, but they can spend up to 4 to 6 hours a day, 5 days a week in treatment.
  • Aftercare: Aftercare is a general term for follow-up services after a person is discharged from a treatment program. Whatever the setting for aftercare, it will focus on relapse prevention and ongoing support, through counseling or support groups.

Does Insurance Cover Cognitive-Behavioral Therapy?

Yes, although coverage for cognitive-behavioral therapy (CBT) will vary by policy and state.

CBT can be an effective form of therapy for people with an SUD and a co-occurring mental health disorder such as anxiety or depression.3 CBT is a goal-oriented approach that helps patients understand how negative thought patterns can lead to harmful behaviors. There is a focus on developing healthy coping skills to manage potential triggers.

Does Insurance Cover Dual Diagnosis Treatment?

Yes, although coverage for dual diagnosis treatment will vary by policy and state.

When a person is diagnosed with having both an SUD and a mental health disorder, they are said to have a co-occurring disorder or may be described as having a comorbid condition.5

For someone with a dual diagnosis, addressing both conditions during treatment is important. Interacting conditions can exacerbate symptoms but treating them simultaneously can garner better outcomes.5 Fortunately, proper treatment can promote stability and recovery for people with a dual diagnosis.

Check Your Insurance Coverage

Finding the right rehab facility or treatment center can feel overwhelming but knowing exactly what your insurance will cover can alleviate some of the stress and uncertainty. For those who have insurance, simply call the number on the back of your insurance card to inquire about benefits. You can also verify your insurance online or fill out the form below to learn what your policy covers.

How Much of the Rehab Cost Does Insurance Cover?

The cost of insurance can vary widely, depending on factors such as your insurance provider, your plan, premium payments, deductibles, and beyond.6 Understanding what is and isn’t covered can feel overwhelming, but there are some things to remember that can help you feel empowered in the process.

There are three ways that marketplace insurance protects you from high medical bills. First, there are no yearly or lifetime limits, so they can’t put a dollar limit on what they will cover for essential benefits each year.6 Second, there is an out-of-pocket maximum, which means once you have met that amount, you will not pay more than that for any covered care that year.6 Third, there are reduced costs once you meet your deductible. For example, if you have a $1,000 deductible, your plan will pay a large percentage of covered expenses (often 60-90%) once you hit $1,000.6

What Should I Do if the Cost Is Not Fully Covered?

Although health insurance can help with the cost of rehab treatment, it may not cover the full cost. The good news is, there are other ways to cover your out-of-pocket costs.

Some facilities offer sliding scale fees in which they will work with you to establish fees based on your income and what you can realistically pay. Other facilities offer grants, payment plans, and scholarships, which can help pay for treatment.

The Substance Abuse and Mental Health Services Administration (SAMHSA) offers several grants for individuals seeking treatment.7 The purpose of these grants is to fund treatment for people without insurance or for those whose insurance doesn’t cover the appropriate length of services.7

Although paying for rehab treatment may feel overwhelming, getting the help you deserve is a priceless investment in yourself or a loved one struggling with substance use. You can’t put a price on breaking the cycle of addiction and getting your life back.

To learn more about addiction treatment or get answers to questions about your insurance coverage, you can contact American Addiction Centers 24 hours a day for help at

 

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