The ABCs of Health Insurance

When people want to get sober, one of the most pressing details is simply, “How?” Usually, individuals will require a detox period and other therapy while they’re getting their footing in recovery. Inpatient and outpatient treatment cost money, and most people who need treatment can have health insurance pay. So how does health insurance work for somebody who is trying to get sober? What expenses can you expect?

Does Health Insurance Cover Treatment?

Yes, every health insurance plan that is sold in America must provide mental health services. Substance use disorders fall into this category of medicine. Insurers must provide help for your addiction just as they would for any physical health ailment. It is illegal for them to deny care for a substance use disorder or another mental health diagnosis.

It’s important to note that your insurance company won’t cover treatment at places that charge outside of what is considered the “allowed amount.” If a place charges luxury spa prices, your insurance may tell you they won’t cover it. Charges need to be considered fair or average in the field and the geographic area. This is why it’s essential to make sure insurers cover your treatment center.

Some insurance companies have better benefits than others, especially when people have private insurance.

What’s Private Health Insurance?

Private insurance is also called group insurance, and an employer usually subsidizes it. Many people have healthcare benefits through their workplace or union and can add their family members.

Workplaces also sometimes have other benefits you can use to fund your treatment stay, such as medical savings accounts. The ACA rates different plans based on their copays and services.

Young people under the age of 26 can be added to their parent’s insurance, giving access to more healthcare choices in many cases.  

Health Insurance Market

Many people who have insurance purchase it through the Health Insurance Marketplace, established by the Affordable Care Act. The marketplace in California is called Covered California, and it offers many options for individuals and families. (You can sign up on the website to learn about open enrollment dates.) Licensed insurance agents in California can also help you select a plan.

If you don’t make enough money to pay for health insurance, there are subsidized plans, including Medicaid. You can get access to those benefits through Covered California as well.

How Much Will You Pay for Treatment?

The costs of treatment depend on various factors, including the benefits that your current healthcare plan will cover. Usually, you will pay copayments, which are charged per visit or day. You may also pay a certain amount out-of-pocket before your insurance begins to cover you.

The money you will pay will be broken down in different ways:

• Co-insurance: Co-insurance is the percentage of the bill you pay, and your insurer covers the rest. Usually, you must meet your deductible before your co-insurance kicks in.
• Copayments: Some insurers charge copayments instead of co-insurance. A copay is a specific amount you pay every time you use services. For example, when you see your primary care doctor, you spend $35, and the insurance covers the rest. There are certain copayments for hospital stays, emergency room services, and even inpatient treatment that you can find in your health plan’s guide.
• Deductible: In many cases, before your insurance will cover a benefit, you must pay a certain amount of money out-of-pocket in total. For example, you may have a $500 deductible and pay your therapist’s fee the first several times. The therapy visits must add up to $500. Then your copay or so-insurance rates kick in.

Many people spend more money on their healthcare plans so they can have a small deductible. Your insurance won’t cover things entirely until you have reached the deductible.

The cost of treatment may seem expensive until you see how much insurance pays. If you are under the age of 26, remember you have the option to be added to your parent’s healthcare plans. There are also many options for people who have subsidized healthcare.

Addiction is a chronic, life-threatening illness. Don't delay asking for help because you're worried about the costs. There are always options.

Getting Help With Treatment and Insurance Issues

Not every treatment center accepts insurance. Insurers will say that they only cover in-network providers or cover a portion of out-of-network expenses.

Calling around to find out if your insurance plan is accepted is a great first step to getting help.

We can answer your insurance questions and help you learn more about our programs. Please gives us a call to learn more!