Addiction Treatment Insurance

Addiction, regardless of the substance being abused, can have far-reaching implications. For those struggling with substance abuse, you might be dealing with physical symptoms, financial issues, and even the loss of personal relationships and professional opportunities because of drugs and alcohol. Your loved ones and the community around you can also be negatively impacted by substance use, reeling from criminal activity taking place in the community, poor mental health related to the stress of wondering where or how you are, and beyond.

Getting the prompt and effective treatment you need is critical to healing from the damage already done and setting yourself up for a successful future. The problem? Treatment costs money, and this can sometimes be a barrier to those ready to take the next steps in their journey to recovery. This is why it’s important to explore insurance and how it can be a tool in breaking down these barriers. Let’s take a closer look at addiction treatment insurance, what you need to know, and how you can leverage it to get the help you need.

Understanding the Basics of Insurance Coverage

Private insurance companies offer some form of mental health service coverage, which is an integral part of the recovery process. However, many will be surprised that insurance companies also offer some form of coverage for drug and alcohol rehab as well.

With that in mind, you need to know that the degree of coverage will depend entirely on the insurance plan that you have as well as the type of support you need. There are many forms of drug and alcohol rehab services, including inpatient and outpatient support, medical detox, counseling, medications designed to support sobriety, and more.

You should also consider federal and state laws surrounding insurance coverage and whether or not rehab is covered by your insurance. The good news? Federal laws offer protections to ensure insurance has to cover rehabilitation services, and Illinois has made it so that mental health and substance use disorder treatments are treated the same as medical and surgical treatments in certain situations. We’ll take a closer look at this in the sections below.

The Affordable Care Act (ACA) & Addiction Treatment

The Affordable Care Act is a game-changing piece of legislation that has made healthcare more accessible for many Americans. Most notably, the ACA redefined substance use disorder as one of the ten elements of essential health benefits. What does this mean? Whereas substance use may have been considered a preexisting health condition that might not have been covered in the past, the ACA made it so that all health insurance plans (for newly eligible adults after 2014) that are being sold on Health Insurance Exchanges, as well as those provided by Medicaid, have to include substance use disorder services.

As a result, the ACA has expanded access to treatment for many Illinois residents who may have otherwise struggled to afford care in the past. However, these are not the only changes that can benefit Illinois residents looking for support for substance use disorder or alcoholism. In fact, Illinois has made its own efforts to help make addiction services more affordable and available for its citizens.

Illinois-Specific Insurance Laws & Regulations

The Mental Health Parity and Addiction Equity Act (MHPAEA) is a federal law that is designed to ensure health insurance issuers and large group health plans treat mental health and substance use disorder services the same as medical and surgical benefits, preventing them from imposing unfavorable benefit limitations on the former.

While this doesn’t require them to offer these services (which the ACA does, fortunately), it does serve to prevent insurance providers from placing less emphasis on mental health and substance use disorder and barring recipients from getting the support they need.

It’s important to remember that this is a federal law. Illinois actually has its own State Parity Laws, which build upon Federal Parity Laws to further support citizens who need mental health and substance use disorder support. How? Illinois State Parity Laws do this by expanding this rule to nearly all health plans (with the exception of Medicare plans as well as some small employer fully ensured plans) as well as requiring providers to cover things like opioid antagonists as well as acute treatment and clinical stabilization services.

Put simply, if you need support, both federal laws and state laws have legislation in place designed to support you when you leverage addiction treatment insurance in order to afford your care.

Private vs. Public Insurance: Coverage & Considerations

Understanding your options is critical to getting the best possible coverage when you begin your journey to recovery. Arguably one of the most crucial considerations is deciding between private and public health insurance.

Private health insurance, whether employee-sponsored or paid for individually through the marketplace, gives you greater agency over what plan you have and what benefits that plan offers. This means that you can look for something that will specifically help you secure treatment with ease. That being said, public insurance may be the best route for some. Even though it comes with greater restrictions, those who can’t afford private insurance can rely on it when they need help affording rehabilitation services.

With all of this in mind, there are qualifications that need to be met in order to be eligible for Medicaid. These include:

• Low-income individuals ranging anywhere from below 18 to over 65
• Disabled or blind
• Pregnant
• Under 26 and formerly in foster care
• Be a citizen or be lawfully in the country
• Meet the income requirements

The Illinois Department of Insurance can be an excellent resource in helping you learn more about health insurance in the state, and they play a critical role in regulating policies and ensuring compliance.

Navigating the Complexities of Insurance for Addiction Treatment

While getting insurance is not a challenging process, it can be rather complex.

Take your time to shop around to see what different plans offer based on what you’re able to afford. The type of plan you choose will ultimately affect the level of coverage you receive once you get mental health and substance use disorder treatment. You also have to consider the pre-authorization process for insurance, utilization reviews (to determine if something is medically necessary), and appeals process (in case you get a claim rejected or coverage is ended). Planning ahead can make utilizing your insurance that much easier.

Another consideration is the type of insurance you choose and how it affects seeing out-of-network and in-network providers. With an HMO, you might save more money, but you will need a referral for in-network providers and will not be covered if you see someone out-of-network for care. PPOs are a bit more expensive, but they come with greater flexibility and you can see any specialist without a referral. Do your due diligence to get the best plan for your needs.

Overcoming Financial Barriers: Tips and Resources

Financial barriers are often the deciding factor of whether or not to seek treatment. However, they shouldn’t be. There are ways to navigate this challenge and secure care without worrying about severe financial hardship as a result.

Beyond public insurance, see if there are any assistance programs in your area or in the state as a whole that will support you as you undergo treatment. You might be surprised to learn that scholarships and grants are available to many seeking treatment as well, which can make it easier to get the funds you need without having to worry about paying them back the moment you’re out of rehab.

Don’t forget that many rehabilitation centers are willing to work with you as well. For example, you may be able to negotiate certain aspects of treatment, like mental health care. Many therapists will work with you to help you afford care until you’re back on your feet. Similarly, rehabs may offer payment plans so that you can pay them in installments. People want to see you succeed, and there are options out there to help you do so.

Frequently Asked Questions

Insurance can be life-saving, offering those with substance use disorder the support they need to break down cost barriers and access effective treatment. If you know that you need help with your addiction and you need financial support, it’s important to take the time now to understand your insurance rights, prioritize your health and safety, and seek help.

Are you ready to take the first steps toward recovery? If so, Illinois Recovery Center is here to help! Reach out today so we can learn more about your unique situation and how we can support you as you work toward sobriety.