Does Insurance Cover Alcohol Detox?
By Midwest Detox Staff
Having an alcohol abuse problem is already hard enough, but figuring out a way to pay for treatment can make the process even more challenging. Fortunately, if you have a comprehensive health insurance plan, there’s a good chance that you can get coverage for alcohol detox. However, there are a few caveats to consider, and having health insurance does not guarantee that you’ll get full or even partial coverage at the detox clinic of your choice.
But if you’re currently preparing to go to alcohol detox or you’re considering the best recovery path for yourself, you probably have a few insurance-related questions. First and foremost, does your insurance cover alcohol detox? What types of insurance typically cover alcohol detox? Are some insurance carriers more commonly accepted than others? Are there any types of insurance that private detox clinics won’t accept? Finally, where can you access a high-quality alcohol detox clinic in Wisconsin?
In today’s guide, we will answer all of these questions and more, but first, let’s take a look at the type of insurance you’ll need to get detox coverage:
Which Types of Insurance Cover Alcohol Detox?
In the United States, the Affordable Care Act (ACA) requires most types of health insurance to cover substance use disorder treatments, which includes alcohol detoxification. However, the extent of your coverage or even the ability to secure coverage can vary from one plan to the next. Generally speaking, you can expect to get some degree of detox coverage with any of the following insurance plans:
- Employer-Sponsored Plans - Many Americans access health insurance through their employers. While each employer will offer different kinds of insurance that may or may not have extensive coverage for substance use disorder treatment, larger employers tend to offer plans that include detox and other kinds of treatment. However, it’s important to remember that some employers may have strict policies related to substance abuse, which could cause issues at your workplace if you attempt to get coverage for detox or rehab. Fortunately, the Family and Medical Leave Act (FMLA) and the Americans with Disabilities Act (ADA) provide certain legal protections for employees seeking treatment for drug or alcohol abuse.
- Private Marketplace Plans - If you purchased your health insurance through the Health Insurance Marketplace, you can rest easy knowing that your plan is required to provide certain essential health benefits, including coverage for mental health and substance abuse treatments. Alcohol detox would typically be covered under these services.
- VA Insurance - Many active military members and veterans get their health insurance through TRICARE, which covers treatments for substance use disorders (including detox). Additionally, veterans may be able to access drug or alcohol abuse treatments directly through the Department of Veterans Affairs (VA).
- Medicare & Medicaid - Medicare and Medicaid will often cover alcohol detox and rehab in an inpatient or outpatient setting. However, there are huge gaps in what Medicare will cover, as it has strict guidelines for the type of care that qualifies. Additionally, Medicaid coverage can vary from state to state, making it harder for many lower-income beneficiaries to get the coverage they need. Due to the complex rules and barriers, most private detox clinics do not accept Medicare or Medicaid. As a result, only 6% of Medicare/Medicaid beneficiaries actually seek out substance use disorder treatment.
Most Common Insurance Carriers For Addiction Treatment
Since most Americans will need to get detox coverage through private or employer-sponsored health insurance plans, it’s important to understand the degree of coverage offered by different carriers. First, you’ll need to figure out the process required by your carrier to be reimbursed for detox or access funds to cover part of your treatment. Many insurance carriers will require you to get “preauthorization,” which essentially means that you’ll need to have the treatment approved by your insurance carrier before you can begin.
It’s also important to consider the out-of-pocket costs of alcohol detox. Even if your insurance provides full coverage for your treatment, you will likely have to make copayments. If you haven’t met your deductible for the current benefit period, you will also have to pay out even more before your insurance plan kicks in.
In the sections below, we’ll go over some of the most common insurance carriers that offer addiction treatment coverage:
Humana
Humana provides health insurance to more than 17 million people nationwide, making it one of the most popular carriers in the country. While Humana does offer alcohol abuse treatment coverage with most of its standard health plans, the degree of coverage can vary from person to person. You will need to consider the type of plan you have, such as HMO or PPO, to know where you can get treated and whether or not you will be covered. It’s also important to note that Humana offers Medicare Advantage plans, but again, these are not accepted at most private detox clinics.
Cigna
As of the latest data, more than 18 million Americans use Cigna as their primary health insurance carrier. Most of Cigna’s non-Medicare plans provide some degree of coverage for substance use disorder treatments. However, in the vast majority of cases, you will need to get preauthorization, which may include a face-to-face assessment provided by a specialist. This allows Cigna to determine if alcohol detox is medically necessary for you.
Aetna
More than 39 million Americans rely on Aetna for health insurance, a number that has grown substantially since the company was acquired by CVS Health. If you have a non-Medicare Aetna plan, you can likely get coverage for alcohol detox. Additionally, Aetna encourages Screening, Brief Intervention, and Referral to Treatment (SBIRT) as the best practice to identify alcohol abuse and begin the treatment process.
While Humana, Cigna, and Aetna are not the only insurance carriers that will cover alcohol detox, they are a few of the largest carriers in the country. If you don’t have insurance through one of these carriers, continue reading to see how you can verify your insurance with Midwest Detox.
How to Verify Your Insurance Detox Coverage
As you can see, most insurance carriers will offer some degree of coverage for alcohol detox and other substance use disorder treatments. However, if you have Medicare or Medicaid, you may struggle to find a clinic that will accept your insurance. Even when you have an employer-sponsored health plan or a private insurance plan from the Health Insurance Marketplace, there may be certain limitations on how much coverage you can get and where you can go for treatment.
Fortunately, Midwest Detox can make the process of getting coverage just a little bit easier. By reaching out to us directly, we can help you figure out how much coverage you can get for alcohol detox with your current plan. And, since we accept health insurance from most of the major carriers (as well as smaller insurance carriers in Wisconsin), there’s a good chance that you can get your treatment covered with us.
So, if you’re unsure what your health plan will or won’t cover, contact us as soon as possible. Not only do we provide excellent detox treatment in a comfortable and modern facility, but we also work hard to make sure that you get as much coverage through your insurance as possible.
Don’t wait until it’s too late. Reach out to Midwest Detox at 414-409-5200 or send us a message today.