Addiction Treatment Insurance Guide

Addiction Treatment Insurance Guide

Seeking treatment for opioid or alcohol addiction is a vital step in regaining control and getting your life back on track. Many addiction treatment programs cost between $5,000 and $18,000 per month, making it difficult, if not impossible, to afford out of pocket. Thankfully, most insurance companies offer drug and alcohol treatment coverage, including medication-assisted treatment and counseling.

Explore insurance coverage for recovery programs in this helpful addiction treatment insurance guide. Learn what health insurance typically covers and how to find out if your health insurance will pay for your treatment.

Does Insurance Cover Addiction Treatment?

Yes, most private and public health insurance plans offer some coverage for addiction treatment. Your insurance will likely provide full or partial coverage for the following types of recovery programs and treatment approaches:

Your total cost of addiction treatment will vary based on the program you choose, your recovery needs, and the length of your stay. Your coverage for the program will vary based on your health insurance plan.

Private insurance

In 2010, the Affordable Care Act (ACA) changed the type of coverage private insurance companies offer to members. Regarding addiction treatment, the ACA regulates several factors that allow for better access to recovery programs for anyone struggling with addiction. According to Healthcare.gov, all insurers must cover:

  • Pre-existing conditions, including substance use disorder
  • Mental health treatment (counseling and psychotherapy)
  • Substance abuse treatment

These regulations provided by the ACA mean that your health insurance can’t deny you coverage for having a mental health or substance abuse issue. Additionally, the ACA says that plans on the government marketplace can’t limit the amount of coverage you receive over your lifetime for this type of benefit.

Most private insurers also offer coverage for maintenance medications. If you undergo MAT using a medication like buprenorphine (Suboxone) as part of recovery with the Right Path Addiction Treatment Center, you may need to stay on the medication for long-term success. While each insurance provider’s coverage may differ, many plans pay for the medication throughout your recovery process.

Public insurance (Medicare and Medicaid)

If you have coverage through Medicare or Medicaid, your plan must follow the same guidelines put forth by the ACA as private plans. However, these public programs have an application process and coverage limits that you should determine before entering treatment.

Medicaid coverage varies by state, so it’s essential to check with your treatment facility and state Medicaid office to understand your benefits and how to apply. For example, Right Path Addiction Treatment Centers accept Virginia Medicaid. If you have VA Medicaid, your plan should cover your treatment with Right Path in full, including your counseling, medications, and physician visits.

However, the VA Medicaid program sets its own rules for who is eligible for coverage. These guidelines include income maximums and age restrictions. You must apply for VA Medicaid coverage through the local Department of Social Services.

What Should You Do Before Entering Treatment?

What Should You Do Before Entering Treatment? Contact the treatment center and your insurance provider before entering treatment at any rehab facility. It’s best to contact your insurance company first to know exactly what your plan covers. Then contact the facility where you want to undergo treatment to verify that it accepts your insurance.

Your first step in checking on what your policy covers is to look at your Summary of Benefits and Coverage (SBC). The ACA requires this document for every insurance plan. It gives you an easily understandable outline of what types of services your plan covers.

After viewing your SBC, you’ll want to contact your insurance company directly. Recoveryanswers.org suggests that you ask several specific questions regarding treatment to find out what your plan should cover once you start treatment.

Write down the name of the representative you speak to and the time and date of your call. Ask the following questions during the call and take notes on the representative’s responses:

  • What’s your plan type?
  • How long of a stay does your insurance cover?
  • What stages of treatment does your insurance cover?
  • What levels of clinical care are covered?
  • Coverage levels for in-network versus out-of-network facilities?
  • What does coverage look like for detox, inpatient, outpatient, and hospitalization?
  • Does your insurance require pre-approval, prior authorization, or a referral?
  • What are your maximums for out-of-pocket expenses?
  • What are your expected co-pays for different treatment options?
  • What are your insurer’s criteria for determining medical necessity regarding addiction treatment?
  • How do you find in-network treatment facilities for your insurance?

With the answers to these questions, you can contact potential treatment centers located in-network. You can also narrow down your search for a facility that offers treatment approaches covered by your insurance.

What Insurance Does Right Path Addiction Treatment Center Accept?

What Insurance Does Right Path Addiction Treatment Center Accept? Right Path Addiction Treatment Centers accept most major private health insurance carriers so you can seek treatment for substance use disorder.

Our list of accepted insurance providers includes:

  • BlueCross BlueShield Federal Employee Program
  • Anthem BlueCross BlueShield
  • BlueCross BlueShield Association
  • United Healthcare
  • WellPoint
  • MedCost
  • SAMBA Federal Employee Benefit Association
  • CareFirst BlueCross BlueShield
  • Assurant
  • TRICARE
  • Sentara
  • Optima Health Insurance Services
  • Mutual of Omaha
  • MultiPlan
  • Humana
  • Anthem HealthKeepers
  • Cigna
  • Aetna/Coventry Health Care
  • Guardian
  • Great-West Life
  • VA Medicaid

Contact our helpful staff to determine if Right Path accepts your health insurance plan. Remember, it’s also important to contact your health insurance provider directly to determine your policy’s coverage options for addiction recovery before starting treatment.


Written by Sergey Zhitar, MD Medical Director

Native of Moldova, Dr. Zhitar is Board Certified in Addiction Medicine as well as Internal Medicine and completed his training at UPMC Shadyside, Pittsburgh, PA in 2000.

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