Benefits Of Going To Rehab After My Deductible Is Met

According to the 2023 National Survey on Drug Use and Health (NSDUH), over 48.5 million Americans had struggled with some form of substance use disorder (SUD) over the previous year. This includes 28.9 million individuals with an alcohol use disorder (AUD), 27.2 million with a drug use disorder (including both illicit and prescription drug abuse), and 7.5 million who experienced both. However, only 23.6% of those who needed treatment due to an SUD actually received it.

With such a large number of people needing treatment but not getting it, it is important that Americans understand their options for SUD rehab, as well as the different resources they can use to pay for treatment services. This includes a variety of different forms of public and private financial aid, cash payment options, and the option to use your personal health insurance benefits. 

In fact, going to rehab after your deductible is met can make SUD treatment (including both outpatient and residential rehab) much more affordable than it would otherwise be, giving you the best possible value as you participate in a recovery program with the potential to change your life for the better. 

Is Addiction Treatment Covered By My Health Insurance?

Addiction treatment services, including medical detoxification, outpatient treatment, inpatient rehab, and more, are covered by all Affordable Care Act (ACA)-qualified health insurance policies as essential health benefits.

In the past, addiction treatment was unevenly covered by regular health insurance plans when it was even covered at all. Providers treated behavioral healthcare and mental healthcare as separate services and not as valid medical care in and of themselves. 

However, this changed with the passage of ACA, also known as Obamacare, in 2010. Under the updated regulations, all Marketplace-qualifying plans must cover mental health and substance abuse services as essential health benefits. This includes government health insurance plans, like Medicare and Medicaid, as well as most forms of private and employer-sponsored health insurance (not including short-term health insurance plans and certain other exceptions).

Also, under the updated ACA requirements, health insurance providers are no longer able to deny coverage for pre-existing mental and behavioral health conditions, and they cannot implement spending limits for services that are considered essential health benefits. They are also required to provide “parity” in coverage for mental and substance abuse services relative to other medical services, meaning that your plan must use the same deductibles, copayments, insurance, out-of-pocket limits, and other terms and requirements for all essential benefits. 

What Is A Deductible Anyway?

Health insurance policies and benefits can be complicated and difficult to understand until you have some experience with them. Important elements of your health insurance plan that you should be aware of include your deductible, co-payments, co-insurance, and more.

Your Deductible

This is the amount of money you are required to pay for healthcare services before your insurer begins to pay for the cost of your medical care on your behalf (with the exception of certain preventable services like checkups and vaccinations). This amount resets each calendar year on January 1.  

Deductibles can vary widely from plan to plan, and are often quite high. In fact, according to CNN the average yearly deductible for an individual health insurance plan was over $5,100, and more than double that for a family ($10,300). 

Your Co-Payments

A co-pay is a fixed fee you must pay for a specific healthcare service, like a visit to your doctor, lab test, or prescription medication. Co-pays do not count toward your deductible, but they do count toward your out-of-pocket maximum.

Your Co-Insurance

After you reach your deductible, you will most likely still need to pay co-insurance on any medical care you receive. This is a percentage of the total cost of your medical bills that you must pay yourself, with insurance covering the rest. While a low co-insurance means that your insurance provider is paying more of the cost of your treatment after your deductible is met, a higher co-insurance percentage means that you are more likely to reach your out-of-pocket maximum more quickly.

Your Out-Of-Pocket Maximum

This is an amount of money representing a limit to the total amount you will pay for medical care in a year under your insurance policy, regardless of the total cost of the medical care you receive. In other words, it is the most you yourself would actually pay for medical services in a year, with all other costs after this amount being paid 100% by your insurance provider. 

Your Monthly Premium

Your premium is the amount that you pay monthly in order to have health insurance coverage. If you have an employer-sponsored health insurance plan, your premium will most likely be withheld from your paycheck. 

According to CNN, the overall average premium for a family was more than $1,100 each month, but this amount can change depending on the type plan and on the insured individual’s age, with older people usually paying more. Note that premiums do not count toward your health insurance deductible or out-of-pocket maximum. 

Going To Rehab After Deductible Is Met: Will Treatment Be Free?

Meeting your deductible “activates” your health insurance, requiring your insurance provider to begin paying for at least a portion of any following medical bills for the rest of the calendar year. If you have already reached your health insurance deductible, this means that the actual amount you pay for your substance abuse treatment will be much lower. 

This does not necessarily mean that your treatment will be free. You will still likely need to pay a co-pay as well as a co-insurance percentage, at least until you reach your annual out-of-pocket maximum. Once this happens, the rest of the cost of your treatment should be covered at 100%. 

In either case, if you have already met your deductible, you have the opportunity to access rehab services like medical detoxification, outpatient treatment, residential rehab programs, and medication-assisted treatment (MAT) at a better value than if you hadn’t yet begun paying toward or met your yearly deductible. This may be a great opportunity to get the care you need at a (relative) bargain.

What Other Treatments Can I Use My Health Insurance For?

Drug and alcohol abuse is often associated with a wide range of different acute and chronic health problems. Some of these issues may be open and obvious, but more often they are hidden under the surface and may require in-depth evaluation and treatment. 

Chronic alcohol abuse, for instance, is associated with the development of high blood pressure, cardiovascular problems, cancer, and nutritional problems that may result in the development of certain kinds of brain and memory damage. Methamphetamine, opioids, cocaine, and even marijuana, likewise, can contribute to everything from sleep problems to lung damage, malnutrition, infections, disfigurement, and more. And it’s common for people with SUD to also experience chronic pain and other physical problems that may be able to be addressed through surgery, physical therapy, medication, or other treatment options. 

If you have met your deductible and received treatment for SUD, you may have a golden opportunity to also evaluate and deal with any of these secondary health problems, working not only with your primary care doctor but also with other specialists in different areas of concern. This includes getting treatment for psychological issues, as mental health problems like anxiety, depression, bipolar disorder, and many others commonly co-occur with SUD and can feedback into each other if left untreated. 

What Else Should I Know?

While almost all health insurance plans have to provide coverage for SUD treatment by law, they vary greatly in details. So contact your insurance provider before arranging treatment and see what particular requirements, limitations, and network options they offer. 

You can also reach out directly to Ark Behavioral Health. We can help you understand your insurance benefits and estimate your costs, while also helping you understand your treatment options. Our team is compassionate, helpful, and dedicated to providing you and all of our clients with the best possible value, whatever your specific needs may be. We are able to provide comprehensive care for all forms of drug and alcohol use disorder as well as co-occurring mental health disorders in comfortable and relaxing surroundings.

To learn more about your options for affordable addiction recovery and the benefits of going to rehab after your deductible is met, please contact us today.