Insurance Coverage for Addiction Treatment

When planning to receive addiction treatment, it’s important to also plan for how to pay for it. Luckily, due to both the Affordable Care Act (ACA) and the Mental Health Parity and Equity Act, health insurance companies are required to provide just as much coverage for addiction and mental health treatment as they do for physical injuries. Therefore, individuals can now use various types of health insurance plans to help pay for their rehab programs. 

In-Network vs. Out-of-Network Insurance Providers

Whether a person is using health insurance to pay for traditional physical ailments, injuries, addiction, and/or mental health treatment, that person will need to know if he or she can receive care from in-network and out-of-network providers. In-network insurance providers are healthcare facilities that make a deal with certain health insurance companies to accept high levels of coverage from their members in exchange for referrals to their facilities. Therefore, if a person is under a health insurance plan that only allows him or her to receive care from in-network providers, then he or she will need to make sure to attend an addiction treatment center that contains his or her type of health insurance within its network. 

Out-of-network insurance providers are healthcare facilities that have not made a deal with a particular health insurance company. Therefore, the amount of coverage that out-of-network healthcare facilities will accept to cover is much less than the amount of coverage that in-network healthcare facilities would accept. This means that it likely costs more to receive care from a healthcare facility that’s out of your health insurance company’s network than in your health insurance company’s network. 

Types of Health Insurance Plans

There are certain types of health insurance plans that are available within nearly every health insurance company or service. These types of health insurance plans include health maintenance organizations (HMOs), preferred provider organizations (PPOs), and point-of-service (POS) plans.  

Health Maintenance Organizations (HMOs)

Health maintenance organizations, or HMO, plans are types of health insurance plans that require their members to receive care from physicians and healthcare providers that are within the health insurance company’s network to receive coverage.

Preferred Provider Organizations (PPOs)

Preferred provider organizations, or PPOs, are health insurance plans that are more flexible about receiving care from out-of-network providers than HMOs. In fact, PPOs will cover some of the cost of care at an out-of-network healthcare provider, just at a lower rate than they would for in-network healthcare providers. 

Point-of-Service (POS) Plans

Point-of-Service plans are a mixture between HMO plans and PPO plans. This is partly because, similar to PPOs, POS plans offer more flexibility when it comes to receiving coverage for out-of-network providers than HMOs. POS plans also offer more coverage for care at out-of-network providers than HMOs and PPOs. 

On the flip side, individuals with POS insurance plans must fill out more paperwork than individuals with HMOs or PPOs do to receive such out-of-network care. Individuals with POS plans also must contain a primary care physician that refers them to other healthcare providers to receive care. Therefore, similar to HMOs, individuals that contain POS plans still must have a designated in-network primary care physician. 

Important Health Insurance Terms 

To further understand health insurance, it’s important for individuals to understand common health insurance terms. Below are common types of health insurance terms that everyone should know.

Premium

The premium is the cost that individuals pay each month for their health insurance when talking about different types of health insurance plans. 

Deductibles

A deductible is the amount of money that individuals are responsible for paying out-of-pocket before the insurance provides coverage. Individuals can choose health insurance plans with high-deductibles and lower premiums or higher premiums and lower deductibles. It all depends on what best suits the individual’s needs. 

Copays and Coinsurance

Copay is the set rate of money that individuals must pay for medications and different forms of healthcare. Coinsurance is the remaining percentage of the cost of care that individuals must pay after their deductible is met.

Addiction Treatment Coverage With Health Insurance in PA 

There are various forms of addiction treatment, all of which cost money to receive. Once individuals choose the type of health insurance plan that they want, they can use that health insurance to cover some or all of the cost of all of the following addiction treatment programs in PA. 

Medical Detox and Medications

Prior to receiving addiction treatment, individuals that are getting clean from substances will likely need to attend medical detox. Medical detox is the process of ridding one’s body of all substances under the watchful care and eye of physicians as well as a medical team at a detox facility. 

Medical detox can get expensive. This is especially true if individuals need to use medications to help them manage their withdrawal symptoms while detoxing. Luckily, individuals can use their health insurance to cover some or all of the cost of medical detox and the medications some patients might be prescribed. 

Inpatient Forms of Addiction Treatment

Inpatient addiction treatment is rehab that requires patients to live in rehab facilities 24/7 while receiving care. There are two different forms of inpatient treatment. They are standard inpatient treatment and residential treatment. The difference between standard inpatient treatment and residential treatment is that standard inpatient treatment is slightly more structured. 

The cost of inpatient forms of addiction treatment is much more than that of outpatient treatment. Thus, having different types of health insurance to cover some or all of the cost of inpatient forms of rehab is very beneficial. 

Outpatient Forms of Addiction Treatment

Although less expensive than their inpatient counterparts, individuals can also use health insurance in PA to cover the cost of outpatient forms of rehab. There are three different kinds of outpatient forms of rehab. 

The most intense form of outpatient rehab is partial hospitalization program (PHP) treatment. This form of outpatient rehab requires patients to receive care for five to eight hours a day, five to seven days a week. Though it varies based on the addiction treatment facility. 

The second most intense form of outpatient rehab is intensive outpatient rehab, or intensive outpatient programs (IOPs). This form of rehab usually requires patients to receive intensive care for a few hours a day, a few days a week. 

The least intensive form of rehab is standard outpatient rehab, general outpatient programs (OPs). This form of rehab typically requires patients to receive care a couple of hours a day, once or twice a week. 

How To Pay for Addiction Treatment Without Health Insurance

Not everyone has health insurance. Individuals that don’t have health insurance must find other ways to pay for their addiction treatment. Some common ways that people can find the funds to pay for rehab include:

1. Grants or Scholarships

There are grants and scholarships that are just for people that need assistance paying for addiction or mental health treatment. For example, the Substance Abuse and Mental Health Services Administration (SAMHSA) offers a grant for drug addiction treatment. All individuals must do to receive this grant is first, contact the SAMHSA to see if they qualify, and then apply. 

Scholarships for rehab are available through many different organizations. For example, the Beds Scholarship Program gives individuals $10,000 for addiction treatment. Also, the Sobriety Optimization League gives out scholarships for addiction treatment.

2. Get a Loan

If you can’t get a grant or scholarship to pay for health insurance in PA, then you can try to get a personal or healthcare loan. All individuals need to receive such a loan is good credit. Individuals that don’t have good credit can potentially get a third-party healthcare loan. 

3. Health Savings Account (HSA) Funds

Health savings account funds are always available to help pay for addiction treatment. In fact, using HSA funds to pay for addiction treatment will save individuals money.

4. Payment Assistance

Some healthcare facilities are kind enough to allow some of their patients to pay for addiction treatment on a sliding scale. Paying for rehab on a sliding scale will ultimately save people money. 

5. Medicare and Medicaid

Medicare and Medicaid offer federal and state benefits that can help pay for addiction treatment. To qualify for Medicaid benefits individuals must be over the age of 65 or under the age of 19. 

Pregnant women or individuals that make a certain range of income may also qualify for Medicaid benefits. To qualify for Medicare benefits, individuals must be over the age of 65 or have a disability. 

6. Host Fundraisers

Individuals that are really looking to get the funds to pay for rehab can throw different kinds of fundraisers. Fundraisers that individuals can throw to help get money to pay for rehab include everything from yard sales to GoFundMe fundraisers, and more. 

7. Borrow Money

Individuals that suffer from addiction often burn their bridges with close family and friends. One way that they often do this is by stealing money from them. Thus, many people may not trust to allow addicts to borrow money from them. That’s why it’s so important to make good use out of money that individuals do lend to people to use to pay for rehab.

8. Pay Out-of-Pocket

When all else fails, see if you can pay for the cost of addiction treatment out-of-pocket. While this is one of, if not the least, desirable way to pay for rehab, it’s worth it to overcome addiction once and for all. 

Use Health Insurance To Help Pay for Rehab At Little Creek Recovery

At Little Creek Recovery, we offer various, unique forms of addiction treatment for men only. That way we can focus on building a strong foundation of recovery that caters to male patients’ needs. 

To ensure that you don’t miss out on your opportunity to receive such rehab services due to money, make use of any health insurance benefits that you have. You can also contact us here at Little Creek Recovery to verify if we accept coverage from your type of health insurance. 

To learn more about Little Creek Recovery and the different addiction treatment programs and services that we offer, contact us today! We would love to hear from you.