By taking these steps, you can gain a clear understanding of your rehab insurance coverage, helping you make informed decisions about your treatment options without unexpected financial burdens.

Type of plan

Private health insurance plans, employer-sponsored plans, and government-funded programs like Medicare and Medicaid all have different rules and coverage levels for rehab services.

Extent of coverage

Insurance plans may cover various types of rehab services, including inpatient, outpatient, and partial hospitalization programs. However, the proportion of costs covered, full or partial, and the duration of coverage can differ. Some plans may cover the entire stay at a rehab facility, while others may only cover certain aspects or a set number of days.

Pre-authorization and referrals

Many insurance providers require pre-authorization for rehab services. This means that the need for rehab must be medically justified. Additionally, a referral from a primary care physician or a mental health professional may be necessary to obtain coverage.

Coverage for different therapies

Insurance plans may also vary in terms of what types of therapies they cover. Traditional therapies, like individual counseling and group therapy, are commonly covered, while alternative therapies might not be.

Out-of-pocket expenses

Even if rehab is covered, individuals may still be responsible for certain out-of-pocket expenses like deductibles, copayments, or coinsurance.

Network restrictions

Some insurance plans have network restrictions, meaning that they only cover services provided by certain rehab centers within their network.

State and federal regulations

Insurance coverage for rehab can also be influenced by state and federal regulations. For example, under ACA (Affordable Care Act), insurance plans are required to cover mental health and substance use disorder services as essential health benefits.

Will Insurance Cover My Adult Child’s Rehab?

Yes, insurance will cover your child’s rehab treatment until they turn 26. However, the extent of that coverage will vary based on individual policies. 

Under the ACA (Affordable Care Act), insurance plans are required to offer dependent child coverage up to age 26. Even if your adult child has moved out or married, this rule applies to all individual and employer (PPO) plans. However, this rule does not apply to Medicare, and your child will require their own insurance if your policy is under this umbrella.

The ACA also mandates that insurance policies must extend coverage for substance use disorder treatment (rehab). This rule also covers dependents up to 26 years old. 

How Many Times Will Insurance Pay for Rehab?

The frequency with which insurance will pay for rehab depends on several factors, including:

1. The specific insurance policy, the type of coverage
2. Individual circumstances.

However, as a rule, insurance companies typically cover rehab services that they deem medically necessary. This typically just requires a healthcare provider’s assessment and recommendation for treatment. 

If a person relapses and needs additional rehab, a new assessment may be required to establish the medical necessity for further treatment.

For each rehab admission, pre-authorization might be required. Failure to obtain this could result in the insurance company refusing to pay for the treatment.

Laws such as ACA and MHPAEA (Mental Health Parity and Addiction Equity Act) can influence insurance coverage. These laws often require plans to provide coverage for mental health and substance use disorder treatments similar to other medical coverage.

If coverage for a rehab session is denied, individuals have the right to appeal the decision.

Understanding your policy’s appeal process is highly beneficial in these situations.

It’s essential for people to directly contact their insurance provider to understand the specifics of their coverage, including how many times rehab treatment will be covered. Each situation is unique, and policies vary significantly between different insurers and individual plans.

Qualify for Inpatient Rehab Today

Call today to begin treatment at our world-class inpatient rehab. Our program works with a variety of insurance plans to get you or your loved one the help you need.

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The ACA Act & Rehab Insurance Coverage

Rehab Insurance FAQ

Will health insurance cover rehab for drugs?

Most health insurance plans cover drug rehabilitation services, but coverage varies depending on the plan and the specific treatments required.

Does health insurance cover alcohol rehab?

Yes, health insurance often covers alcohol rehab, subject to the terms and limits of the policy.

Does insurance cover inpatient rehab?

Insurance may cover inpatient rehab if this is deemed necessary for the treatment of a severe substance use disorder or mental health condition. Again, the extent of coverage is contingent on the insurance plan and the nature of the inpatient rehab program.

Do you have to pay for rehab?

Yes, you usually have to pay for rehab, but the cost can be mitigated depending on and whether or not you have insurance coverage.

Begin Insurance-Covered Inpatient Rehab at Gratitude Lodge Today

• Talk therapy

If you’re asking yourself, does insurance cover rehab? our friendly team of recovery experts can help check your coverage for free. When you are ready to begin your recovery from addiction using health insurance, call Gratitude Lodge at 844-576-0144.