Access to rehabilitation programs in California often depends on a patient’s access to affordable insurance that can offset the high cost of treatment. This makes insurance coverage a critical factor for families and individuals looking to start their rehab journey. Thankfully, federal and state legislation requires most insurance providers to at least partially cover treatment for substance use disorders.
In this article, we’ll cover the general information you need to know about insurance before entering rehab, how California offers multiple pathways to access rehab coverage, and how you can learn more about the specifics of your coverage. If you’re ready to make the next step today, you can reach out to our admissions team at Safe Harbor to see if your insurance covers our comprehensive rehab.
Federal & State Protections
The protections and regulations regarding what insurance must cover for mental health treatment are twofold at the federal and state levels. To start, two federal acts have a significant impact on the affordability of care:
- The Affordable Care Act (ACA, colloquially known as “Obamacare”) mandates that marketplace insurance plans cover both substance use disorders and mental health concerns as essential health care. Common benefits covered include detox, inpatient rehab, outpatient treatment, and medication-assisted care.
- The Mental Health Parity and Addiction Equity Act (MHPAEA) mandates that insurance providers offer their mental health and substance use disorder benefits at the same level as their medical and surgical benefits.
California state law further strengthens these protections by requiring coverage for medically necessary treatment for substance use disorders. Coverage will apply across multiple types of insurance, including private and employer-sponsored plans, as well as Medi-Cal and Covered California plans. The scope of benefits will vary from plan to plan, but protections are in place to help prevent insurance from becoming the primary barrier to care.
Types of Insurance That Cover Rehab
In this section, we’ll discuss different types of insurance and what they generally cover. Each type of insurance will have its own unique requirements, such as preauthorization or in-network provider restrictions that can affect how much of your rehab stay is covered.
- Private insurance plans will usually cover at least part of the cost of rehab. Coverage will vary widely by provider and plan, but typically, care such as detox, inpatient, and outpatient services is at least partially covered.
- Employer-sponsored plans are generally regarded as one of the most common ways Californians can afford rehab. Employer plans often allow coverage for a spouse and dependents, increasing access to care.
- Medi-Cal, the California-specific Medicaid program, provides low- or no-cost coverage to residents who qualify. Medically necessary inpatient and outpatient rehabilitation services are covered.
- Covered California plans, being ACA-compliant, must include mental health care and substance use disorder treatment coverage as essential health benefits.
- Medicare is also known to cover rehabilitation services for older adults or those with qualifying disabilities, but coverage may be limited compared to other options, specifically Medi-Cal.
What Services Are Typically Covered
Coverage levels differ between plans. While some plans may pay for care in full, others require copays, coinsurance, or yearly deductibles. We highly recommend that every patient work with both their prospective rehab and insurance to learn what their specific insurance plan covers. We at Safe Harbor are happy to help verify your insurance benefits to help you gain a clearer understanding of the financial aspects of our drug rehab programs.
When medically necessary and in-network, generally, plans cover the following types of services:
- Detox programs
- Residential or inpatient rehabilitation
- Outpatient treatment services (group therapy, counseling, etc.)
- Medication-Assisted Treatment (MAT) for opioid and alcohol use disorders
- Aftercare and ongoing support
Key Considerations for Patients
There are many variables for patients to consider when researching how their insurance benefits will cover rehab. The best course of action is to verify coverage directly with your insurance provider, since benefits vary widely across companies and plans. A key component to ask about is network restrictions, which often determine whether a particular rehabilitation center is covered at all. Additionally, many plans require preauthorization for residential rehab, and failing to obtain approval before treatment begins may result in coverage denial.
Even with quality coverage, patients may be required to pay deductibles, copays, or coinsurance. This can significantly affect the affordability of care. Another key consideration is that of continuity of care and aftercare plans.
Many Insurances Cover Rehab in California
Thankfully, insurance coverage for rehab in California is widely available due to the actions of the California and federal governments to expand access to mental health and substance use disorder care. While most plans offer coverage, the extent of the benefits offered will vary wildly depending on plan details. Patients are advised to carefully review their insurance documents and contact their provider directly for the most accurate and up-to-date information.
While insurance coverage significantly reduces barriers to rehab, informed navigation of benefits is essential for patients who need to maximize their access and minimize their costs. At Safe Harbor, our team of experts is here to help you verify your insurance benefits and get started on the path to recovery today. If you or a loved one is ready to take the next step in recovery from substance use disorders, contact us today to get started.
