Using Insurance for Rehab

Rehab may be a complicated thing to deal with and having insurance can go a long way toward helping. Thanks to legislation passed, insurance providers can now cover rehab. However, the level of coverage varies depending on the package that a person chooses for their insurance coverage and whether the rehab center is in-network. In some cases, insurance providers will cover the total value of the rehab. In other cases, the insurance plan will only take up some of the cost of treatment, and the rest relies on the individual to cover it.

How to Use Insurance for Addiction Treatment

Health insurance will usually cover substance abuse treatment and other forms of mental illness treatment. Each health insurance plan usually has a stipulation in what they can cover and the amount they are willing to put out per patient. As with all forms of health insurance, providers offer coverage based on what the client is willing to pay out. Some health coverage plans will cover the total cost of treatment, while others will limit how much they will cover and even what type of treatment they are willing to pay for. Rehab centers also know whether a particular insurance provider will cover treatment at their facility. Discussing this with a facility directly will offer insight into whether your insurance will cover the treatment process.

Insurance providers also offer different plan levels, depending on the premiums that their clients pay. The lowest end of the scale usually pays the least amount in premiums. Since the Affordable Care Act (ACA or Obamacare) was written into legislation, many people opted for the cheapest health insurance, even though it didn’t offer much coverage. With each successive step, the health insurance covers more and will even reach out to out-of-network providers to serve their clients if the need arises. In many cases, however, health insurance providers have preferred rehab facilities that they deal with.

What Is Drug and Alcohol Rehab Insurance?

Insurance For Rehab

The cost of professional treatment for drug and alcohol abuse can be prohibitive. Detox can range from $1,000 to $1,500, each day. Inpatient rehab stays can last between 30 and 90 days and range in cost from $12,000 to $60,000 or even more. The cost of treatment in these cases varies by the center’s location and the type of treatment the patient will get.

On the high end of the scale, luxury inpatient treatment centers may charge as much as $5,000 a day, making a 30-day stay $150,000. Medical insurance providers are well aware that these types of treatment facilities provide the same care as those that cost less and are not willing to pay for a patient’s stay there. They are much more likely to cover the cost of a stay in a typical inpatient facility.

The cost of rehab can make it seem an impossible task to overcome. Drug and alcohol rehab insurance cover the cost of treatment, including medicine and inpatient stays if necessary. All marketplace options for health insurance are required to cover drug and alcohol addiction treatment. These conditions would have been considered pre-existing conditions in the past, and insurance companies would be within their rights to refuse coverage.

However, the ACA made it mandatory that health insurance coverage deals with this pervasive problem for their clients. Many centers have accepted drug and alcohol rehab insurance as a crucial part of recovery. They liaise directly with health insurance providers to get their clients the best care that their insurance allows them to have.

Does Health Insurance Cover Private Rehab?

While many people might not realize it, private rehab centers are covered by health insurance. Private rehab centers are those that exist outside of the public healthcare system. They typically have professionally trained staff and are for-profit organizations dedicated to helping their patients recover. They tend to have much higher levels of care than the public system. With such a high level of care, rehab at private centers usually costs more than in the public system. However, a health insurance provider must cover the cost of their patients’ treatment in these facilities if they choose to go there. Providers cover certain essential health services as a rule. The treatment of mental and behavioral issues falls under this category of necessary treatment.

Health insurance companies have a mandate to accept clients even if they might have had pre-existing conditions. In the past, insurance companies used the dual diagnosis as a pre-existing condition that allowed them to avoid paying for mental healthcare for individuals who wanted to recover from their addiction. The ACA outlined that this practice was unacceptable, and now health insurance will also cover dual diagnosis care from a private rehabilitation center. Regardless of what stage of recovery a patient is in, they can apply for health insurance and get coverage up to a certain amount. This helps a patient avoid paying for inpatient, outpatient, and detox treatment out of pocket while allowing them the benefits of these treatment regimes.

Different Insurance Types and Rehab Coverages

Purchasing health insurance through the ACA marketplace is simple, but there are many options for health insurance for rehab. The three types of health insurance that need to cover rehab include:

  • Private Insurance Policies
  • Medicaid
  • All Marketplace Insurance Plans


These plans must provide coverage for rehab in the same sense that they provide coverage for medical and surgical procedures. Providers don’t offer the same plans to each area, and plans’ coverage will vary from state to state. One benefit is that these coverage plans can’t limit how much they pay out in a year or a lifetime. As mentioned before, these health insurance plans won’t cover the cost of a stay in a luxury facility. And depending on the level of the plan, they may only cover some of the total costs of treatment. If you have a rehab center in mind, you can discuss the details of your insurance plan with them. Pathfinder’s Recovery Center will be happy to discuss the details of your coverage and if it’ll deal with all the costs of your treatment with us.

Can I Use The ACA Marketplace For Rehab?

ACA Marketplace For Rehab

The ACA marketplace is a collection of health insurance plans that you have access to for your rehab treatment. Some of the things that are included with ACA marketplace plans are:

  • Medication to deal with craving
  • Counseling for family members
  • Health visits to a patient’s home
  • Drug and alcohol testing
  • Clinic visits
  • Medication for managing addiction
  • Brief intervention and addiction management
  • Evaluation of progress in coping with and overcoming addiction


In addition to these services, ACA marketplace plans also offer coverage for elements of treatment like detox and inpatient treatment. While a person can get coverage from the ACA marketplace, some states have their own healthcare insurance marketplaces. There are distinct differences between ACA marketplace coverage and state healthcare insurance providers on their own marketplaces. On the ACA marketplace, there are five types of healthcare insurance coverage. Each offers a certain amount of coverage based on the level of the plan. These levels are:

  • Bronze plans: 60% expense coverage
  • Silver plans: 70% expense coverage
  • Gold plans: 80% expense coverage
  • Platinum plans: 90% expense coverage
  • Catastrophic: 60% total average cost coverage

What are my Options For Rehab Without Insurance?

It is entirely possible to enter rehab without insurance. However, based on the cost of care, it’s very likely that a person may need assistance to meet the demands of private rehab. Luckily, many rehab centers have provisions for such a situation. Pathfinders Recovery, for example, works with each patient to work out a way for them to cover the costs of treatment if they don’t have private insurance. This might mean covering treatment costs and then putting a payment plan when the patient re-integrates into society. Individuals have several options for entering rehab without access to private insurance coverage.

In some cases, patients may be able to leverage their health insurance from work to cover some or more of the cost of treatment. In these cases, insurance provided by employers will deal with the cost of treatment for the employee so they can recover comfortably. Some states offer financial aid to individuals who may want to recover from addiction but have no monetary means to do so. Alternatively, states may provide free rehab facilities. However, the states that opt for this option usually won’t pay for private rehab centers.

Another standard method for patients without insurance coverage to access healthcare is through scholarships. These scholarships are issues on a needs basis, with facilities seeking to help the most vulnerable deal with their addiction. The criteria for issuing these scholarships vary from institution to institution. Enquiring about support and payment methods will give you the information to see if you qualify to apply for the scholarship.

A few patients have the option to ask their family members to support them financially with rehab. In some cases, family members do so on their own, trying to help their relatives recover from their addiction. If a person has a large enough family, they can raise funds to support the recovering person to overcome their addiction through treatment. More commonly, a single relative will cover the cost of treatment and allow the recovering person to get on their feet again.

How Can I Know The Cost Of Attending Rehab?

Cost Of Attending Rehab

The cost of attending rehab varies depending on what services the patient will access and how long they will be staying at a facility (if at all). Among the elements that may affect the cost of a stay are:

  • Inpatient Treatment: Inpatient treatment centers are the most expensive treatment methods, but they also have the highest recovery rates. Inpatient centers keep the recovering person out of environments that might lead to relapse. They also offer therapies that help a recovering person deal with their urges under the watchful eye of a mental health professional.
  • Outpatient Treatment: Outpatient treatment is more flexible as it allows patients to come into the rehab center for treatment at intervals. The treatment is much the same as if they were doing inpatient treatment. However, a lot more responsibility is put on the recovering person to attend their therapy sessions. Since the patient doesn’t stay at the facility, the costs are more manageable than inpatient treatment. The downside is that many individuals who undertake outpatient treatment may be tempted into relapse by their environment or associations.
  • Detox: The first step in any addiction treatment is detoxification. Detox usually requires a specialized location with medical staff on hand in case of complications. Most rehab centers charge for detox services. Some patients believe they are clean after detox, but the procedure is only the first step to recovery.

What’s The Difference Between In-Network And Out-Of-Network?

The terms in-network and out-of-network in medical insurance show up a lot. Insurance companies tend to prefer specific rehabs to do business with. In some cases, they have stringent demands on those rehab centers to meet a certain minimum level of care. If the rehab centers can maintain this level of care, the insurance providers reward them with more business in the form of recovering patients. In-network rehab centers usually cost less because of the agreements between the provider and the rehab center. Out-of-network rehab centers cost more to go through recovery, and in some cases, the insurance provider won’t deal with out-of-network rehab centers altogether. Talk to the rehab center directly to determine if they’re in-network with your insurance provider.

Insurance For Rehab Is Accepted At Pathfinders Recovery Centers

If you need rehab and aren’t sure how you’ll get it, come in and talk to Pathfinder’s Recovery today. Our facilities are staffed with professionally trained individuals that are used to dealing with private medical insurance. We provide the best care possible for our patients and work to ensure they can cover treatment costs. Contact us today, and let’s help you overcome addictions and start on the path to a lasting recovery!


  • 7580 E Gray Rd Suite 201 Scottsdale, AZ 85260
  • (877) 224-0761
  • Mon-Sun: 24x7
  • Mon-Fri: 8:00AM – 4:00PM

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