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Health Insurance
How It All Works

Using private health insurance for addiction treatment gives you more options and is cheaper than fully paying out of pocket.

Most insurance policies include mental health coverage, which covers rehab. Health insurance also usually covers ongoing consequences of drug and alcohol use like heart medications or marriage counseling. However, even at the same insurance company, each policy sets its own rules and costs. That’s why you have to call with your insurance information and we have to call the insurance company directly to give you answers on your specific coverage and any costs.

Private insurance usually comes from an employer, but it can be purchased directly. The largest health insurance companies in the U.S. are: UnitedHealth Group, Anthem (Blue Cross), Aetna, Cigna and Humana. Check your drug and alcohol rehab insurance coverage, start with our free rehab insurance verification form.

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Treatment is for: Myself Loved one

The 4 Most Common Questions

Every policy offers different coverage, but here’s the basic idea:

  1. Regardless if you ever use your health insurance, you pay a monthly premium. That’s a set amount you pay just to be included on the policy. Employers may cover some of this cost.
  2. When you have a healthcare expense, you pay until you meet your deductible. This is a set amount you pay before insurance companies pay anything. It resets every year. Some plans have no deductible, though the average is $1,500.
  3. Then, you pay coinsurance, which is the percentage of healthcare costs that you share with your insurance company after your deductible — unless your policy covers 100%. For example, if you have a $100 healthcare cost and your plan has 80% coinsurance, you owe $20.
  4. But, you stop paying if you hit an out-of-pocket maximum. Insurance covers 100% at that point. The national average is $7,150. If your loved one didn’t have any healthcare costs earlier in the year, that is all you owe. If you loved one received care throughout the year (including other treatment), you may owe $0.
  5. That said, many facilities offer payment plans (as low as $10 a month) or even complete financial scholarships to help you get the treatment you need.

Don’t be overwhelmed. The provider should give you clear costs upfront and handle everything with insurance, including fighting to get you coverage. Regardless of insurance decisions, Ambrosia never charges you more than discussed on the initial recorded call with Admissions.

Costs with health insurance (including monthly premiums) average $9,000 to $13,000 for the year and most facilities provide payment plans to help. Plus, insurance covers any healthcare needs. Compare that to $18,00 to $100,000+ for quality treatment without insurance.

The catch is that you can only get insurance during specific dates. If you’re looking to buy on your own it’s November 1 to January 31. Go directly to insurance companies to compare. If you or your family’s employer offers health insurance, talk to HR. The timeframe is set by each company, usually sometime October to December.

You’re also eligible within 60 days of:

  • Losing existing health coverage (including Medicaid)
  • Turning 26 on a parent’s plan
  • Getting married or divorced
  • Having a baby or death in the family
  • Moving to a different ZIP code
  • Moving to or from a shelter
  • Leaving jail
  • Becoming a U.S. citizen

Plans lock you in for a year. Most cover treatment, but limitations and out-of-pocket costs vary widely. Ask about addiction coverage up front. Children can be on your plan until age 26.

Don’t be scared by the term “out-of-network.” All it means is that the insurance company does not have a specific contract with a provider. Many plans still cover out-of-network treatment. If your plan does, you’re better off going out-of-network. You get more days and more advanced treatments because the provider isn’t locked into a standard (usually low) contract. If only in-network is covered with your policy, your insurance company will have a set list of places to choose from.

NOTE: Ambrosia has both out-of-network and in-network coverage. For questions about your specific insurance policy, call (888) 492-1633.

While public insurances like Medicaid and Medicare are great for medical needs, coverage for addiction is limited. Few facilities are contracted with the government to accept these policies. They are generally hospital-type settings, often with wait lists. The SAMHSA search tool is the best way to find a facility. Filter for your address and use the arrow next to Substance Abuse to filter for Medicaid, Medicare or free facilities.

You can get public insurance if you meet the criteria.

  • Medicaid – your income is below the levels set by your state
  • Medicare – you’re 65 or older, you paid taxes for 10+ years and you enroll between October 15 and December 7

Check your eligability at Healthcare.org.

Read More

Does Cigna Pay for Drug Detox and Treatment?

Like most major health insurers, Cigna does pay for drug treatment. But the amount you'll pay after your benefits apply can vary, depending on the type of plan you have and the provider you choose. You'll need to investigate carefully.

Does Aetna Pay for Detox and Drug Rehab?

Aetna has a surprisingly progressive view of addiction recovery and treatment. Many plans offer full coverage for detox and rehab, but there are exceptions. And you'll need to take several steps before you enroll to make sure your care is covered and unexpected bills aren't headed your way.

Does Blue Cross Blue Shield Pay for Treatment?

Blue Cross Blue Shield is active across the United States, but each BCBS outpost is locally owned and operated. They all offer some form of addiction coverage, but the details can vary widely from company to company and plan to plan.

Insurance for Rehab

Addiction care is an essential benefit, so insurance companies are required to pay for it. But all insurance programs work a little differently. You'll need to do a little homework to use your program effectively.

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I don’t know if I need treatment.

You’re here because you know the problem is out of control. You’ve spent months if not years trying to convince yourself (and those around you) that your drug or alcohol use isn’t “that bad.”

Don’t let denial drag out the suffering. Addiction is serious. You can (and should) get help before it completely takes over your life.

I don’t know what treatment would be best.

Have you tried getting help before? If so, it’s time to follow the science. The most effective process involves detox, rehab and outpatient treatments.

Don’t be overwhelmed! All you have to do now is call to talk about where you’re at. You’ll take it one step at a time from there. Before you know it, you’ll be sober. You can do this!

I can’t convince my loved one to go.

Even if you’re feeling powerless, there’s always hope! Donny, our dedicated ARISE interventionist, can talk to you today about your options. Following his advice, three of every four people come directly to treatment.

I'm not sure if you can help.

Feelings of doubt and helplessness are part of addiction, but you can find hope here. Our treatment is backed by research partnerships with two universities and hundreds of online reviews. From the Washington Post to CNN to Vice News, our expertise is trusted by the top news sources, as well as professional athletes.

The fact is — thousands of people across the country are living sober, productive lives after their time here. You deserve the same chance.

Now is not a good time.

You may worry about missing out on family or work, but the truth is you’re missing out now when your thoughts are preoccupied on your next fix or you’re too sick or high to show up.

Your job is guaranteed by law. And, your spouse, parents and kids all need you sober.

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