Medical Insurance

In view of the fact that the US does not have a socialized healthcare system, it is not surprising to learn that one survey on drug treatment admissions found that the number one reason individuals in need of drug treatment do not enter rehab is that they believe they cannot afford it. This finding is especially concerning because there is a wide gap in the US between the number of people who need treatment for addiction and those who actually get it. According to a National Survey on Drug Use and Health, while an estimated 22.7 million need treatment for substance abuse, only 2.5 million received help at a specialized drug rehab.

But paying for rehab is not an insurmountable obstacle. There is always some form of recovery treatment available to those in need, be it in a hospital setting, a state-run program, or private rehab facility.

Talking Dollars and Sense: The Need for Rehab and Its Cost

 

Much of the talk about the cost of rehab turns to the cost of not going to rehab. Per the National Institute on Drug Abuse, the abuse of illicit drugs, alcohol, and tobacco costs the US more than $700 billion each year in related healthcare fees, lost or diminished work productivity, and crime. Against this benchmark, the cost of rehab is minimal on the national scale, but it may feel like a burden at the level of individual pockets.

The good news is that there are many ways to find no-cost or low-cost recovery services for those with limited finances and assets. For individuals with health insurance or those who decide to pay out of pocket, a key question may be: How much does rehab cost?

Well, it depends. Many private rehab programs tailor treatment plans to the individual client’s specific needs. As there is no typical client, there is no typical treatment plan or set cost. For this reason, many rehabs do not explicitly publish information about costs on their websites. However, a rehab center may offer a free intake consultation and provide an estimate of fees. Short of this, it can be helpful to look at nationwide survey findings on the topic of rehab costs.

According to some sources, the average cost for a 28-day residential program was $25,166 in 2011. But note, the rehab centers that offered onsite medical detoxification had an average cost of $27,399 while those that did not offer this service averaged $15,491. Regarding outpatient treatment, t a 10-week intensive outpatient rehab program had an average cost of $7,000. These costs may be alarming to some, but it is important to keep in mind that there are many potential offsets, such as insurance coverage (public or private), negotiated discounts, or payment plans.

Understanding the Rehab Landscape

 

There are several strategies that can be employed to find a rehab center, depending on any number of factors, such as cost. The following are some approaches that may be taken to find a recovery center that can feasibly work within the financial parameters of the individual in need of drug addiction treatment or a concerned third party, such as a family member:

  • Contact the insurance provider, if any, to learn which drug treatment providers are included in-network.
  • If the person in need of treatment has little to no income or financial assets, apply for Medicaid and, if eligible, obtain a drug treatment service provider directory.
  • Identify no-cost rehab centers and recovery services.
  • Search for low-cost rehab and recovery services.
  • Inquire with private rehab centers as to whether there are any charity beds available. In some instances, a nonprofit program may have trained individuals who can work with a person to find such beds; one example is ANGEL in Gloucester, Massachusetts.
  • If paying out of pocket, ask the rehab center if a discount is possible.

When figuring out how to pay for rehab, it is helpful to find out where people in the general population obtain health insurance coverage. In 2014, the Henry J. Kaiser Foundation conducted a state-by-state survey to determine the number of Americans who receive different types of insurance. Take Texas residents, for example. The foundation’s survey revealed the following:

  • Of all Texas residents, 47 percent received health insurance coverage through an employer
  • About 18 percent of the population received Medicaid.
  • About 10 percent were on Medicare.
  • About 6 percent had private insurance.
  • About 2 percent had public insurance other than Medicaid.
  • About 17 percent were uninsured.

Taking these Texas rates into account, it would seem that Texans who seek recovery services would mainly pay through employer-sponsored health insurance. Less than one in five Texans would use Medicaid. These assumptions may not play out in reality, but this data interpretation highlights how individuals who enter rehab have different funding sources. It also shows that some people will need to apply for health insurance, possibly with the help of a social worker or addiction counselor. Irrespective of a person’s insurance status, virtually all rehab centers accept direct, out-of-pocket payment from the recovering person or a third party, such as a family member.


To put into focus what payment options are available across different rehabs, it is helpful to consider a government survey on this topic. The Substance Abuse and Mental Health Services Administration (SAMHSA) collected data from 13,688 participating drug recovery centers and made the following findings:

  • Of all rehab centers surveyed, 76.3 percent offered some form of payment assistance.
  • There were 539 facilities that offered free drug treatment services to all clients (equals 3.9 percent of surveyed group).
  • A total of 6,609 drug rehab centers gave free drug treatment services to clients who showed they could not pay for recovery (equals 48.3 percent of the survey group).
  • There were 6,540 drug rehab centers that did not provide free treatment to clients (47.8 percent of the surveyed group), but around 50 percent of these facilities did provide a lower-cost sliding fee scale to such clients.
  • The Department of Veterans Affairs provides free drug treatment services to eligible veterans who do not have the financial means to pay for rehab.

The SAMHSA survey reveals that there are numerous options for low-cost and no-cost treatment across the US. Further, many of the rehab programs that do not offer such options may work with clients in some capacity to make the stay affordable. Not included in the survey, but also relevant is that Medicare may provide coverage or reimbursement for eligible elderly or disabled individuals who are in need of drug treatment services.

A Note on ACA Insurance Plans

 

The Affordable Care Act (ACA), known colloquially as Obamacare, has opened up access to private plans and Medicaid. According to one study, since implementation of the ACA, the rate of uninsured individuals has fallen from 15.5 percent to 11.7 percent.

From a consumer standpoint, one of the most helpful aspects of the ACA is its creation of the marketplace (also known as the healthcare exchange). Shopping for a healthcare plan in the marketplace makes it convenient to find an affordable policy. Specially trained navigators can guide a person through the insurance application process. Uninsured individuals who need insurance for rehab, provided it’s the open enrollment season or they qualify for a special enrollment, can find a plan on the marketplace. One of the greatest achievements of the ACA, vis-à-vis drug recovery services, is that an individual cannot usually be denied coverage under an ACA plan due to a pre-existing condition, such as a substance use disorder.

The ACA has brought about numerous health insurance reforms, including new laws regarding coverage for drug treatment services.

Explains the Office of National Drug Control Policy, under the ACA, substance use disorders are one of the 10 elements of essential health benefits. This designation means that anyone who has a marketplace health insurance plan or Medicaid must receive a minimum level of recovery services for the treatment of substance abuse. Services may vary by private plan or state Medicaid plan, but at a minimum, all plans should provide therapy and counseling for drug abuse recovery.

Further, individuals with marketplace plans (private or Medicaid) cannot be charged more in copays or other fees for substance abuse treatment compared to treatment for physical conditions, such as heart disease. Also, covered individuals who need drug treatment services cannot be barred due to lifetime or annual dollar limits. It is important to note, however, that each private marketplace plan has different coverage terms (i.e., some are more limited than others).

Also, Medicaid is a mixed federal and state program, which means that coverage allowances vary from state to state. For more information on Medicaid, individuals are best advised to contact their state department of health or an insurance claims processor at a rehab center of interest that accepts Medicaid.

If paying for rehab looks like a maze of information, it is important to keep in mind that it is navigable. There are numerous trained professionals who can help with the process of paying for drug rehab from start to finish. As discussed, there are different fee structures at different rehab centers, ranging from free to five-digit cost figures per month. The key for anyone looking for a rehab, be it the person in need or a concerned relative or friend, is to know the available options and pursue the most feasible ones.