Does Insurance Cover Rehab in Massachusetts?

Yes, insurance covers rehab in Massachusetts, although several factors determine what’s covered. Every insurance plan is different. In a published report by the Massachusetts Bureau of Substance Addiction Services, there were more than 100,000 admissions into rehab treatment programs annually in previous years.¹ Many were covered by insurance if the provider accepted their insurance plan, including those with MassHealth (Massachusetts Health Coverage).

Does Your Health Insurance Pay for Addiction Treatment?

Several insurance plans will often cover at least some portion of drug and alcohol rehab. Your workplace, private entity, or state or federal medical programs should cover substance use treatment services provided by a licensed organization.

One thing to know is that while insurance often covers some cost of rehab, your particular health insurance will determine how much rehab treatment they will cover under your plan. There may also be out-of-pocket expenses that you may be responsible for paying.

Some plans offer only partial coverage, while others pay in full. Other variables to consider are the level of treatment you want, such as inpatient versus outpatient care.

Ultimately, it is best to check with your insurance provider before entering a rehab treatment center. That way, you know exactly what your insurance will cover and what you will be expected to pay.

To learn more about whether your insurance plan will cover rehab, contact us here at Boston Drug Treatment Centers at 857-577-8193. Our treatment support specialists will help you through the verification process.

What Types of Drugs and Alcohol Rehab Does Insurance Cover?

To some extent, health insurance plans will cover most types of addiction treatment programs. For those who receive coverage through MassHealth, they will cover all behavioral health and substance use disorder treatment programs, as long as the treatment center takes MassHealth.²

The types of rehabs potentially covered by your insurance include:

• Outpatient care
• Inpatient rehab
• Medical detox
• Medication-assisted treatment
• Dual diagnosis clinics
• Counseling
• Therapy

Which Insurance Providers Cover Addiction Treatment?

In March of 2010, the Affordable Care Act (ACA) passed requiring insurance companies to cover some form of substance use treatment care. The primary goals of the ACA are to make affordable healthcare available to more people, expand upon the Medicaid program (known as MassHealth in Massachusetts), and support initiatives to provide lower costs of health care in general.³

However, while insurances are required to cover addiction treatment, which treatment facilities are covered and how much they cover depends on your particular insurance plan.

The types of insurance that cover rehab include:

• Employer insurance: Insurance that is provided by your employer and that you pay into along with contributions by your place of employment.
• Private insurance: Coverage that you have selected and pay for without additional contributions from employers or another source.
• MassHealth: Medicaid health coverage provided by Massachusetts. It is often available to those who cannot get or afford insurance by other means, like employer-provided or private insurance you obtain yourself.
• Medicare: A national health insurance plan for Americans aged 65 years and older (or younger for persons with disabilities) and provided by the Social Security Administration and administered by the Centers for Medicare and Medicaid Services.⁴
• Health Insurance Marketplace: A resource for families, small businesses, and individuals to compare the coverage of health insurance plans, check the costs for coverage, and get answers about the type of coverage they need. You can also find out about tax credits and enroll in an insurance plan at the marketplace.⁵

For Massachusetts residents, several insurance providers cover rehab treatment care.⁶ Check the list below to see if your insurance provider is included. Do keep in mind this is not a comprehensive list and your provider may provide coverage even if not listed below:

• Aetna Health Inc
• AllWays Health Partners
• Blue Cross & Blue Shield of Mass.
• Boston Medical Center Health Plan, Inc.
• Central Mass Health
• Cigna National Health Insurance Company
• Commonwealth Care Alliance Massachusetts
• eternalHealth, Inc
• Fallon Community Health Plan, Inc.
• Harvard Pilgrim Health Care, Inc.
• Humana Insurance Company
• MedAmerica Insurance Company
• Professional Insurance Company
• Tufts Health Public Plans, Inc.
• UnitedHealthcare of New England, Inc
• WellCare Health Plans of Massachusetts, Inc.

PPO vs. HMO

When it comes to insurance, there are two primary types of insurance. They are known as a Preferred Provider Organization (PPO) and Health Maintenance Organization (HMO).

The difference between PPO and HMO health care plans is the amount of money you pay for medical expenses. Furthermore, Medicare allows participants to purchase additional insurance as long as they qualify should additional coverage be necessary.

Here is a breakdown of the different coverages provided between a PPO and an HMO:

Coverage	PPO	HMO
Plan Network	Offers a broader network of care providers, doctors and hospitals, giving you more choices of who to see for care.	Offers a more selective group of providers, doctors, and hospitals covered under the plan.
Primary Care Physicians (PCP)	No requirement for choosing a PCP is necessary by nearly all PPOs. You can see a specialist without a referral and without any additional out-of-pocket expenses for doing so.	Requires you to select a PCP as the primary point of contact. Your PCP will make referrals to specialists and other treatment care services.
Out-of-Network Care	Cost of care is lower if you seek treatment from an in-network provider. Also, services covered out-of-network are limited.	Out-of-network services are not generally covered except in cases of an emergency.
Costs	Monthly premiums are often more expensive because of the coverage and flexibility. There are also deductibles (the amount you spend at the time of care) for almost all PPO plans.	Premiums are typically lower than PPO plans as they do not offer the same level of coverages and flexibility. Also, HMO deductibles are often lower or not required at all.

How to Check Your Benefits

Regardless of the type of insurance you have, it is important that you stay within your network to avoid any unnecessary out-of-pocket costs of receiving treatment for substance use.

When you check with your provider to see what benefits your health insurance plan offers, make sure to discuss your in-network provider options. In-network means treatment providers that accept your insurance plan.

The best way to ensure that you get the treatment you need with little to no cost to you call our confidential helpline at 857-577-8193 to talk to a treatment specialist to begin the verification process. We are available 24 hours a day to assist you.

Frequently Asked Questions About Insurance Coverage for Rehab

Is the Total Cost of Drug Rehab Covered by Insurance?

For your insurance to cover rehab treatment costs, you are generally required to have behavioral and mental health coverage.

There are limited exemptions that classify some aspects of treatment as medical expenses. Therefore, treatment may then qualify as medical care under those policies. However, it is essential to check with your carrier before undergoing any form of rehab.

What Kind of Insurance for Rehab Does MassHealth Offer?

With MassHealth, behavioral health covers addiction services. MassHealth may cover inpatient rehab, outpatient rehab, residential rehab, medication, and counseling, depending on your individual coverage level.²

Individuals with mental illness and substance use disorders should seek the treatment they need through a rehab treatment facility that accepts MassHealth insurance plans.

Can You Go to Rehab if You Don’t have Insurance?

Yes. Whether you have insurance or not, you can seek treatment at an addiction rehab facility. The facility you enter may ask you to show proof that you can afford treatment, and expenses may be required upfront.

However, the best course of action is to see if you qualify for some form of insurance, like MassHealth, so that you are not required to pay for treatment completely out-of-pocket.

We can help you find the resources you need to receive the treatment best suited to meet your financial situation. You can also check out low-cost and free rehabs in Massachusetts.

Does Insurance Cover the Cost of Drug Detox Medication?

Under most circumstances, your insurance will cover the costs of drug detox medications. Most insurance plans offer prescriptions drug coverage, and if yours does, then all medications prescribed to you during detox will be covered.

It is a good idea to check with your provider to ensure that you have prescription medication coverage before entering a detox program. Although, often, the medication used in detox is covered even if prescription medication coverage is not part of your plan.

Furthermore, all plans you enroll in through the Health Insurance Marketplace cover the services provided by substance use treatment programs, including detox.⁷

Resources:

1. Massachusetts. Bureau of Substance Addiction Services. (2018, June 6). Mass.gov https://www.mass.gov/doc/admissions-statistics-statewide/download.
2. Covered services. (2021). Mass.gov. https://www.mass.gov/service-details/covered-services.
3. U.S. Centers for Medicare & Medicaid Services. (n.d.). Affordable care act (ACA) – healthcare.gov glossary. HealthCare.gov. https://www.healthcare.gov/glossary/affordable-care-act/.
4. What’s Medicare? (n.d.). Medicare.gov. https://www.medicare.gov/what-medicare-covers/your-medicare-coverage-choices/whats-medicare
5. D. C. D. (2017, August 4). What is the health insurance marketplace? HHS.gov. https://www.hhs.gov/answers/affordable-care-act/what-is-the-health-insurance-marketplace/index.html.
6. Division of Insurance. (2021). Massachusetts licensed insurance companies. Mass.gov. https://www.mass.gov/doc/massachusetts-licensed-health-insurerspdf/download
7. U.S. Centers for Medicare & Medicaid Services. (n.d.). Mental health and substance abuse health coverage options. HealthCare.gov. https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage/.
8. Avena, N. M., Simkus, J., Lewandowski, A., Gold, M. S., & Potenza, M. N. (2021, April 16). Substance use disorders and behavioral addictions during the covid-19 pandemic and covid-19-related restrictions. Frontiers in psychiatry. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8085389/.