Affording Treatment

While access to high-level recovery programs for substance use disorders are available nationwide, various barriers keep thousands of people from seeking the addiction treatment and services they need. Unfortunately, one of the top concerns preventing someone from getting help for a substance use disorder is how they’ll afford treatment, followed by finding a program suitable for their pressing needs.

No one should ever have to put a cost on their life and stop their path to recovery. Addiction affects more than just your health. It also affects your finances, relationships, and the ability to maintain a steady income. Those who fail to get the help they need may end up costing themselves more than addiction treatment will in the long run. You could lose your health, relationships, and drain your bank accounts because of addiction.

Freedom from addiction doesn’t have a price because it means you’re taking the necessary steps to save your life. In most cases, it means the individual will afford the freedom to live a productive life without the burden of chronic substance use.

Our understanding and grasp of addiction have become more evident throughout the 20th century. We now understand it’s more than a bad habit. Addiction is a disease that can be treated in addiction therapy. With the worsening of the opioid epidemic and these discoveries about addiction, insurance companies are required to treat this as a medical condition. Most private insurers now accept addiction treatment as a health disorder.

Unfortunately, navigating the nuances of insurance is a challenge, whether for addiction treatment or other types of care. At Recovery Hub, our focus is providing clarity that makes financing your recovery process a little easier. We understand you’re going through tough times, and it shouldn’t be compounded by trying to get the care you need.

If you’re wondering how you can afford addiction treatment, continue reading to learn more about financing options available to you and what insurance companies will cover in treatment.

Substance Abuse Insurance Coverage

Addiction treatment exists with a variety of options. Considering the epidemic that we face as a nation, addiction treatment professionals are devising new methods to treat it. Fortunately, there are dozens of existing options that present various degrees of effectiveness. Whether it’s alcohol or opioids, the process continues to be perfected.

While most insurance companies accept addiction treatment, they might not include all of the therapies or a specific treatment center you have been referred to for your condition. Certain treatment centers have developed relationships with insurance providers, so in those cases, it can be much easier to get treatment at a trusted center than at a facility the insurance provider does not know.

With that said, out-of-network facility options are not off the table. It’s possible to get coverage at the facility of your choice if you believe it’s suited for your specific needs. Your insurance company’s job is to evaluate that treatment center to determine if it meets their qualifications for coverage. 

Your insurance provider will consider these following options, which includes:

  • Is the facility in-state or out-of-state?
  • What treatment options do they provide?
  • Is it privately or publicly funded?
  • Other factors will be considered as well.

Fortunately, you won’t be responsible for these decisions and trying to navigate the coverage by yourself. You can use your primary care physician as a reference, your insurance company, and the treatment center you are interested in attending. However, you must investigate the type of treatment the facility provides and how it is best for your needs. 

What Is Covered?

You’ll find that different insurance companies offer different policies when it comes to addiction treatment coverage. Your insurance will often look at similar things to what was mentioned above, including if there is a clear need for treatment if the treatment center is reputable, and if it is grounded in scientific research. Holistic therapy, for example, is less likely to be covered than a center offering evidence-based treatment (EBT). 

Insurance companies, generally speaking, will likely cover the continuum of care. It is especially true for highly addictive drugs. The continuum of care consists of the following:

  • Medical Detox: Detox is the highest and most intensive level of care in addiction treatment. It involves 24-hour medically monitored treatment to ensure the safety of the client. Insurance companies will look to see if the person has a clear medical need. While some drugs cause uncomfortable withdrawal symptoms, they may not be deadly, which means some insurers might not provide coverage.
  • Inpatient Services and Partial Hospitalization: These services are considered the second-highest levels of care, and they also involve a clear psychological or medical need. It offers intensive clinical programs that help delve into the root of your addiction.
  • Intensive Outpatient Programs: These programs offer more than nine hours of clinical services per week and allow them to live at home. It is an excellent choice for those who require intensive care but don’t require intensive psychological or medical care.
  • Outpatient Services: The lowest level of formal treatment is ideal for those who complete higher levels of treatment. It contains fewer than nine hours of clinical services.

Insurance companies will look at two specific factors to determine if they’ll cover treatment – these include evidence-based treatment modalities that contain behavioral therapies. The second factor is to see if the client is making progress at the facility. 

State-Funded Treatment Centers

State and federal funded financing for treatment allows your state to provide treatment through centers of its own. These typically offer both residential and outpatient programs and will provide follow-up support services. An estimated 61 percent of admissions at publicly funded treatment centers were for outpatient services, while another 22 percent were for detox. 

State treatment centers have specific criteria for acceptance and will vary from one state to another, but a general guideline includes:

  • Proof that the person cannot afford treatment, such as no income, low income, or no insurance
  • Proof that they live in the state where they are seeking treatment
  • Proof of U.S. citizenship
  • Information about their addiction history

Federal Government Assistance

Fortunately, various channels exist for federal support. The Substance Abuse and Mental Health Services Administration (SAMHSA) provides services, information, and even grants that help treatment centers and abuse programs offer assistance to those in need but cannot afford them. 

Other public services for addiction treatment include programs like Medicaid, Medicare, Veterans Affairs (VA), and the Affordable Care Act (ACA). The plans contain levels of eligibility based on income, age, disability, and other social aspects. 

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Medicare and Medicaid

You’ll expect coverage for addiction treatment from Medicare Part A, Part B, and Part D. These programs cover residential and outpatient programs, which includes the medications necessary to treat substance use disorder. One exception, however, is the use of methadone. In some instances, it will also cover partial hospitalization treatment. Medicare will only include those over age 65 or if they have a disability.

The coverage Medicaid provides for substance abuse varies widely by state. Some states increase Medicaid through the ACA, which increases the availability to families. It will also offer support for low-income families. The eligibility varies by state, but the most common situations covered include:

  • Elderly individuals
  • Families with young children
  • Those with disabilities
  • Pregnant women
  • Individuals with a certain income

Sources

National Institute on Drug Abuse. (2018, June). Understanding Drug Use and Addiction. Retrieved from https://www.drugabuse.gov/publications/drugfacts/understanding-drug-use-addiction

National Institute on Drug Abuse. (n.d.). What is drug addiction treatment? Retrieved from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/what-drug-addiction-treatment

National Institute on Drug Abuse. (n.d.). Behavioral Therapies. Retrieved from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment/evidence-based-approaches-to-drug-addiction-treatment/behavioral-therapies

Substance Abuse and Mental Health Services Administration. (n.d.). Retrieved from https://www.samhsa.gov/

Cbhsq. (n.d.). Retrieved from https://www.samhsa.gov/data/sites/default/files/2015_Treatment_Episode_Data_Set_National/2015_Treatment_Episode_Data_Set_National.html

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