Does Insurance Cover Drug or Alcohol Rehab in Massachusetts?

In 2010, Congress passed the Patient Protection and Affordable Care Act, also known as the ACA. This law requires insurance companies to start covering pre-existing medical conditions. Many are unaware, however, that the ACA also defined 10 essential benefits that all health insurance plans must cover. Mental health services are included in these benefits, and it is now easier than ever to access addiction treatment in Massachusetts.

Before searching for “addiction treatment near me” and picking a rehab in Massachusetts, it’s important to determine what is covered by insurance, and explore the options for covering any out-of-pocket costs. Keep reading to learn more about the financial considerations involved in choosing an addiction treatment center in MA.

Insurance Coverage for Drug and Alcohol Rehab in Massachusetts

The good news is that many addiction treatment centers — including Topsail — accept health insurance coverage. We’re now in-network with Blue Cross Blue Shield, an insurance provider with more than 100 million members, expanding access to addiction treatment services. Prior to scheduling an admission or consultation, however, it’s important to understand how insurance coverage works for addiction treatment, as well as other types of mental health care.

Insurance companies prioritize effectively managing their costs. It would be extremely expensive and time-consuming for an insurance company to review all the potential causes of a disease and determine which costs of which cases to cover. For example, some patients are born with kidney problems, while others develop kidney disease due to drug use, high blood pressure, diabetes, heart disease or obesity. Rather than requiring physicians to determine whether each patient’s kidney disease is due to genetic abnormalities or lifestyle factors, insurance companies provide the same amount of coverage for every case of kidney disease, regardless of the likely causes. The same approach is used when determining addiction treatment coverage. It doesn’t matter if you or your loved developed a substance use disorder because a parent was an alcoholic, or as a result of depression. Insurance companies provide the same level of addiction treatment coverage to all members.

How Much Does Drug and Alcohol Rehab Cost?

Most insurance companies offer multiple plans, all of which have different rules regarding coverage limits and out-of-pocket costs. The best way to estimate out-of-pocket costs is by reviewing the plan summary, or contacting the insurance company. A fixed deductible may have to be paid before the insurance plan starts covering the treatment, or a percentage of the treatment costs might be charged instead. For example, some plans have a 70-30 split, which means the insurance company pays 70 percent of covered expenses, and the member pays the other 30 percent.

Types of Addiction Treatment Covered by Health Insurance

Addiction doesn’t affect everyone the same way, so there’s no one-size-fits-all treatment program that works for every person with a drug or alcohol use disorder. Some people have an increased risk of addiction due to a combination of characteristics in their genetic code. Others develop substance use disorders in response to trauma. If you or your loved one is ready to enroll in addiction treatment in Massachusetts, it’s important to choose a program that focuses on individual needs.

Detox

If the body is dependent on alcohol or another drug of choice, it can be difficult to stop using. As soon as the substance leaves the bloodstream, fatigue, tremors and irritability often set in. Drug and alcohol withdrawal also cause more intense physical symptoms, such as headaches, vomiting and abdominal pain. Instead of struggling through this process alone, it is recommended to visit a detox center, such as Mayflower Recovery for extra support. Drug and alcohol detox centers provide access to trained medical professionals, who attend not only to vital signs regularly, but also ensure that the patient is as comfortable as possible. Detox centers also help prepare for further addiction treatment.

Inpatient Treatment

If you or your loved one has a severe addiction, it may be advisable to start with residential treatment. This type of treatment is helpful because it allows those who are in recovery to escape stressful environments and situations, and focus completely on healing. Instead of going to work or taking classes, therapy sessions and participatory activities help patients uncover the root causes of addiction and learn how to cope with triggers without relapsing.

Outpatient Treatment

Inpatient treatment has many benefits, but not everyone can take time off from work or stop attending school to stay at a rehab center in Massachusetts for several weeks at a time. For these individuals, outpatient treatment is a good alternative. Outpatient treatment is also helpful for people who’ve completed inpatient treatment and need to “step down” to outpatient care before they return to their communities. For those who’ve already completed inpatient treatment, outpatient rehab provides opportunities for ongoing support.

PHP Treatment

PHP stands for partial hospitalization program. This is the most intensive form of outpatient treatment, as treatment sessions take place five days per week. Full-day PHP addiction treatment gives you or your loved one plenty of opportunities to speak with mental health professionals and participate in activities designed to help restore physical and mental health.

IOP Treatment

If PHP addiction treatment isn’t right for you, look into intensive outpatient treatment. Our IOP in Mass offers half-day treatment sessions several days per week, providing you or your loved one a strong support system, allowing for a gradual return to regular activities. Whether stepping down from residential rehab in Massachusetts or beginning recovery with outpatient care, IOP treatment can help you or your loved one develop better coping skills and examine ways to overcome obstacles without relying on drugs or alcohol.

Aftercare

Aftercare is available after the completion of an inpatient or outpatient treatment program. Each program is different, but aftercare typically includes ongoing therapy, support groups and services to help get back on track. For example, some programs offer services to help change careers or manage any legal issues arising from substance use. If you or your loved one is recovering from an addiction to opioids, an aftercare program may even provide medication-assisted treatment to help reduce cravings and avoid relapse.

Common Types of Insurance Plans

One of the most important factors in determining how much coverage is available for rehab is what type of insurance plan is being used. Some of the most common forms of health insurance are described below, and can also be found at this link.

Health Maintenance Organization (HMO)

A health maintenance organization, or HMO, is the most restrictive type of insurance plan. Members are required to use in-network providers if they want a plan to cover any of their care. HMO members are also required to choose a primary doctor to coordinate their care and provide referrals to medical specialists. HMO plans generally don’t cover out-of-network services unless there is a medical emergency.

Preferred Provider Organization (PPO)

PPO plans have provider networks, but members are typically allowed out-of-network providers if they don’t mind paying a higher percentage of the treatment costs. PPO plans are also more flexible than HMO plans, as members don’t have to choose a primary care physician or ask for referrals for specialty care.

Point of Service (POS)

POS plans are similar to HMOs, except they may cover some out-of-network services at a lower rate than in-network services. If you or your loved one has a POS plan, the primary care provider on file will have to be asked to provide a referral to see any type of specialist.

Exclusive Provider Organization (EPO)

EPO plans are very similar to HMO plans. EPO plans only cover services that are provided by facilities and health care professionals in their networks. If you receive care from an out-of-network provider, you’ll be responsible for the full cost.

Combining Primary and Secondary Insurance Coverage

Some people have two forms of health insurance. For example, a married person may have insurance through their employer, as well as insurance through their spouse’s employer. Individuals in their early 20s are often still covered by their employer’s insurance plan, as well as that of one of their parents. For those who have two forms of insurance, one plan acts as the primary plan, and the other acts as a secondary plan.

When a person receives addiction treatment or other medical services, the primary plan pays first. The secondary plan then pays the remaining covered costs. This doesn’t mean there will be no out-of-pocket expenses, but it can reduce the amount required to pay out-of-pocket for rehab treatment.

Payment Options for People with Limited Insurance Coverage or No Insurance

Health insurance can be expensive, so not everyone carries it. Even for those with health insurance, some plans may provide limited coverage for some services, leaving significant out-of-pocket costs. Fortunately, there are a few options for accessing the funds you or your loved one might need when seeking care.

Credit Cards

For those who have a credit card with a low interest rate, it may be wise to use that card to pay the remaining balance. CareCredit is another option. Although the interest rate is high, CareCredit often has 0% interest promotions, which means no interest is charged as long as the balance is paid off in full before the end of the promotional period. This can help you or your loved one access addiction treatment in MA even if you don’t have enough cash in the bank to cover your whole balance.

Medical Loans

Some companies offer loans specifically for people who need addiction treatment or expensive medical procedures. These loans are typically unsecured, meaning no additional collateral is required to secure funding. Most companies also offer fixed interest rates, making it easier to pay down the balance of the loan.

Help From Friends and Family

The loved ones of an individual in recovery want to see them bounce back from addiction and live their best life. Not everyone has significant financial resources, but one or more family members is financially stable, consider asking for an informal loan to pay for addiction treatment.

Scholarships

Some treatment centers offer scholarships to defray the cost of receiving needed care. A scholarship can help cover the expenses that aren’t covered by the insurance plan or pay for treatment when insurance coverage isn’t available.

Begin Your Recovery

Topsail has compassionate treatment professionals available to help you or your loved one recover from an addiction to alcohol or drugs. We accept several types of health insurance, and we’re also an in-network provider with Blue Cross Blue Shield. To request more information or have one of our staff members verify insurance benefits for rehab treatment, contact Topsail at (978) 475-0002.