Is Treatment for Substance Abuse Covered By Insurance?

Is Treatment for Substance Abuse Covered By Insurance?

 Seeking help for substance abuse is a hard step to take. Once you decide to break your addiction, it’s critical to select an outpatient program that meets your needs, and particularly, to determine if your health insurance pays for treatment.

Our team at White Lake Family Medicine in White Lake, Michigan, can fill both of those needs.

David Leszkowitz, DO, is board-certified in addiction and family medicine. As one of only a few Michigan physicians with this dual specialty, he has helped many people detox, recover, restore their health, and regain a fulfilling life.

You can also depend on our team to navigate insurance issues. We work with each patient, helping them learn about their insurance coverage and resolving problems. We support your journey as you begin life-saving treatment for an alcohol or drug addiction.

If you’re ready to learn more, start with this summary of insurance coverage for substance abuse treatment.

Medicare

Medicare is health insurance for people over 65. You can also qualify for Medicare at an earlier age if you have a disability or end-stage renal disease.

Medicare Part B covers outpatient treatment for alcohol and drug abuse, including prescription medications, patient education, and psychotherapy.

Medicare also covers early intervention services. These services include screening and treatment for people who abuse alcohol and drugs but haven’t developed an addiction.

Medicare requires you to pay a yearly deductible, typically 20% of the total costsunless you have a Medicare supplement plan. Supplement plans take care of part or all of your copayments.

You need to ask all your doctors if they accept Medicare before scheduling an appointment. 

Not all doctors take Medicare, but we do. That’s one less worry you have when we provide your outpatient substance abuse treatment.

Medicaid

Medicaid is health insurance for people who meet specific income and asset requirements, receive Supplemental Security Income (SSI), or are elderly, blind, or disabled.

Each state establishes its own Medicaid requirements. In Michigan, you may need to pay a monthly premium or small copayments for health care services.

The good news is that Medicaid covers all medically necessary treatments, including outpatient care for substance abuse. 

The potential roadblock is that your doctor must accept Medicaid. Fewer doctors accept Medicaid compared to Medicare and private insurance.

Like Medicare, we accept Medicaid for your substance abuse treatment.

Private Insurance

The Affordable Care Act (ACA) states that substance abuse treatment and mental health care are essential health services. The law requires plans purchased through the Health Insurance Marketplace (Marketplace) to pay for your treatment (but not necessarily the total cost).

Most private health insurers offering plans outside the Marketplace also include substance abuse treatment in their approved services. We’re in-network with many insurance companies that cover addiction care.

However, some large group commercial plans were exempted from the ACA requirements. If you work for one of those companies, your insurance may not include treatment for alcohol and drug addictions.

The most critical point to remember is this: If your private policy pays for your substance abuse treatment, your deductible and out-of-pocket costs depend on your insurance plan.

Connecting with your health insurance carrier to learn your benefits and what that means for your treatment is essential.

Connect with us to learn more

We’re dedicated to providing the care you need to break free of alcohol or drugs. To that end, we provide as much support as possible for completing insurance claims and resolving insurance concerns.

If you have questions or need help determining your benefits, don’t hesitate to call White Lake Family Medicine or use online booking to request an appointment today. 

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