Does Insurance Cover Rehab? Understanding Your Benefits

Does Insurance Cover Addiction Treatment?

Under the Mental Health Parity and Addiction Equity Act (MHPAEA) and the Affordable Care Act (ACA), most health insurance plans are required to cover substance use disorder treatment at the same level as other medical conditions. This means that if your plan covers medical or surgical care, it generally must also cover addiction treatment — including detox, inpatient rehab, outpatient programs, medication-assisted treatment, and therapy.

However, the specifics of what is covered — including which treatment centers are in-network, how many days of treatment are approved, and what your out-of-pocket costs will be — vary significantly by plan, provider, and state.

How to Verify Your Insurance

• Contact us through our form and a treatment specialist can verify your insurance benefits at no cost
• Call the member services number on the back of your insurance card
• Ask about your substance use disorder treatment benefits
• Request information about in-network treatment providers in your area
• Ask about any prior authorization requirements

What to Ask Your Insurance Company

• What is my deductible and how much has been met?
• Is inpatient/residential treatment covered, and for how many days?
• Is outpatient treatment (IOP/PHP) covered?
• Is medication-assisted treatment (MAT) covered?
• What are my copays or coinsurance for addiction treatment?
• Do I need prior authorization?
• What treatment centers are in my network?

If Insurance Denies Coverage

You have the right to appeal a denied claim. Under federal law, your insurer must provide a reason for denial and information about the appeals process. Many denials are overturned on appeal. Patient advocacy organizations and treatment centers can often help navigate the appeals process.

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