Why costs vary so much
According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the cost of alcohol treatment can vary widely and depends on the provider, the setting, the services offered, and the individual's needs. There is no single price for a course of care, and costs vary with the provider, setting, services offered, and individual needs.
NIAAA also cautions that the most expensive option isn't always the best, nor is the cheapest. The agency recommends balancing cost and quality when comparing programs.
How providers charge
NIAAA explains that individual providers, such as medical doctors and therapists, generally charge by the hour or per office visit or therapy session. Addiction treatment programs, including hospital inpatient, residential rehab, and outpatient settings, may charge by the day, week, or month.
Because billing structures differ, the same total cost can look very different on paper. A per-session rate from a therapist and a per-week rate from a residential program are not directly comparable without knowing how many sessions or days are involved.
Services covered vs. billed separately
NIAAA advises that treatment providers can help you understand the costs for a typical course of treatment, which insurance plans they accept, which services are covered versus billed separately, what other payment methods are available, and whether payment plans exist.
Before enrolling, ask for a written breakdown of what is included in the quoted price and what is not. Ask the provider which services are included and which are billed separately, and request a written explanation.
Insurance and "behavioral health" coverage
Most health insurance covers some alcohol or drug treatment, according to NIAAA, though insurers may call this "behavioral health" coverage. The agency recommends contacting your insurer directly for details on covered inpatient days and outpatient sessions, medications, copayments, and whether treatment is limited to in-network providers.
SAMHSA adds that most health insurance plans cover treatment, but not all do, and some only cover certain levels of care. To learn what your plan covers, call the number on your insurance card and ask about the covered treatment and rate, co-pay or coinsurance, the number of covered appointments or days per year, preferred providers, and any available case managers.
Marketplace plan protections
If you get coverage through the Health Insurance Marketplace, the U.S. Centers for Medicare & Medicaid Services states that all Marketplace plans cover mental health and substance abuse services as essential health benefits. These plans must cover behavioral health treatment such as psychotherapy and counseling, mental and behavioral health inpatient services, and substance use disorder treatment.
Marketplace plans cannot deny coverage or charge more for a pre-existing condition, including mental health and substance use disorder conditions, and cannot place yearly or lifetime dollar limits on essential health benefits. They must also provide parity protections so that limits on mental health and substance abuse services are not more restrictive than limits on medical and surgical services. Specific behavioral health benefits still depend on your state and chosen plan.
Public programs and lower-cost options
SAMHSA notes that many treatment programs accept Medicaid, the Children's Health Insurance Program (CHIP), Medicare, Veterans Affairs (VA) Health Care, or private insurance. Medicaid and CHIP cover some mental health, drug, and alcohol treatment, but coverage amounts and services depend on the state. TRICARE also covers mental health, drug, or alcohol misuse programs.
NIAAA lists options for people with limited financial resources, including Medicaid eligibility, local or state health departments, and payment assistance or sliding-fee options. SAMHSA advises asking treatment providers about how to cover the cost of treatment and being honest about what you can afford. Free and low-cost treatment options exist across the country.
Questions to ask before you choose a program
Based on the guidance from NIAAA and SAMHSA, useful questions include:
- What is the total cost for a typical course of treatment here?
- Which services are included in that price, and which are billed separately?
- Which insurance plans do you accept, and are you in-network with my plan?
- How many covered days or sessions does my plan allow per year?
- What are my copayments or coinsurance for this level of care?
- Are payment plans, sliding-fee options, or financial assistance available?
- Do you accept Medicaid, Medicare, VA Health Care, or TRICARE?
No single answer fits everyone. Your costs will depend on your provider, setting, services, insurance plan, and individual needs.
