You are currently viewing Tips on Getting Your Insurance to Cover Your Inpatient Rehab

Tips on Getting Your Insurance to Cover Your Inpatient Rehab

According to the U.S. Department of Health and Human Services, more than 46 million Americans, or about 16 percent of the population, meet the criteria for having a substance abuse disorder. The main variable that impacts recovery rates from all kinds of substance abuse issues is treatment.

People fail to get treatment for a variety of reasons. Unfortunately, one of those is cost. The good news is that, in many instances, health insurance will cover different treatment options.

If you want to learn how to get insurance to pay for inpatient rehab, keep reading. This article covers some tactics that will optimize your chances of gaining coverage.

Seeking help with addiction takes a lot of courage. The last thing you want is for your costs or your health insurance plan to stand in the way.

Types of Health Insurance

There are two main types of health insurance: public and private. Public insurance includes programs like Medicaid and Medicare. Both of these offer coverage for substance abuse treatment.

Private plans are those you obtain through an employer, called “group plans.” You can also buy private insurance on your own, including through the federal Health Insurance Marketplace.

Both public and private plans are required to provide some level of substance abuse coverage. How much depends on the type of coverage that you have.

What Is Inpatient Care?

Inpatient rehab programs mean that you live at the facility for around-the-clock programming and assistance towards achieving sobriety. It is important to distinguish these from other types of rehab. This includes outpatient programs, which offer treatment while living at home.

Aftercare is another type of program for people who have completed inpatient or outpatient programs. It helps them maintain sobriety through the support of groups and networks, such as Alcoholics Anonymous.

Inpatient care can include medical detox, but not all inpatient care programs necessarily do. This is a specific regimen where physicians monitor patients’ health as they experience withdrawal symptoms, as sometimes these can be life-threatening.

Understand the Law

In the past, many insurance companies would not cover substance abuse treatment of any kind. They also could deny coverage based on the idea that it was a preexisting condition.

Since the passage of the Patient Protection and Affordable Care Act (ACA) in 2010, addiction can no longer be considered a pre-existing condition. The legislation also requires addiction treatment to be as comprehensive as other medical procedures.

Understand Your Policy

How much coverage you will receive for inpatient substance abuse care depends on your policy. That is why the first step in trying to obtain insurance coverage is to understand every detail of your policy. This includes the amount of your deductible and how much of it you have met for the year.

The level of coverage will depend on the type of plan you have. For instance, with Marketplace plans, you can expect gold and platinum plans to cover a larger percentage than catastrophic or bronze plans.

How to Get Insurance to Pay For Inpatient Rehab?

There are several things you can do to get insurance coverage for inpatient rehabilitation services. Here are the main ones to consider.

Ensure Your Premiums Are Paid

First, you need to make sure your insurance plan is in good standing. This means you have paid all premiums for that point in the plan year. These are your monthly or quarterly charges for maintaining coverage. 

Meet Your Deductible

Also, you will need to have met your full deductible. This is the amount out-of-pocket you are expected to pay for health services before insurance kicks in.

These amounts vary by coverage level. Typical ones are a few thousand dollars. However, lower tired Marketplace plans can be upwards of $8,000 for the year.


It does not stop there. Even if you have paid your premiums and met your deductible, you may still have to pay copays. This is a certain amount you owe for any given service or office visit.

Ask your insurance company what copays you will be charged for inpatient rehab. Since these are based on a percentage of the medical care cost, they are likely to be more than, say, a routine office visit.

Find In-Network Providers

Like other medical services, you want to ensure that a treatment center is in-network. This means that they already have a relationship with the insurance company. This also can be a huge asset because it leverages the expertise of medical professionals who have dealt with such issues in the past.

Do Not Overlook Co-Occurring Conditions

Often, people who struggle with addiction or substance abuse issues have co-occurring mental health disorders. Common ones include anxiety and depression.

Many times, insurance companies will be more apt to cover treatment for these conditions than substance abuse disorder. It is not guaranteed, but if some of the inpatient care overlaps with treatment for mental health conditions, this may give you a better shot at gaining coverage.

Out-Of-Pocket Maximum

Finally, all insurance plans that ACA standards must include an out-of-pocket maximum. This is the total amount you have to pay for covered services in a plan year.

This is often a very large amount, but it could come into play if you have already spent a lot on health services in the plan year. If you want to know how to get insurance to pay for inpatient rehab, be sure you know what the out-of-pocket max is. It could be the magic bullet that gets you comprehensive rehabilitation coverage from your policy.

Learn More About Treatment Options and Health Insurance Coverage

Now that you know some strategies for how to get insurance to pay for inpatient rehab, you can begin the process. Some reputable treatment centers will assist you in working with insurance. Getting coverage will help you not worry about paying for treatment so that you can focus all your energy on recovery.

Altitude Recovery Community is dedicated to guiding every client on a journey to long-term, sustainable recovery from all types of substance abuse. We also have worked with most major insurance carriers and can help you navigate getting coverage. Reach out to us today to learn more.