Coverage Questions: What to Ask About Alcohol Treatment Costs
Before you compare treatment options, it helps to know what your health plan may cover and what questions to ask. This page collects the coverage questions that federal agencies suggest asking, based on their published guidance. It does not estimate prices, diagnose a condition, or promise that any treatment will be covered.
Start with the insurance card
The Substance Abuse and Mental Health Services Administration (SAMHSA) advises that most health insurance plans cover treatment, but not all do, and some only cover certain levels of care. To learn what a plan covers, SAMHSA suggests calling the number on the insurance card and asking about:
- The covered treatment and its rate
- Co-pay or coinsurance amounts
- The number of covered appointments or days per year
- Preferred providers
- Available case managers
Source: SAMHSA – Mental Health Treatment: What Does Health Insurance Cover?
What insurers can tell you
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) notes that most health insurance covers some alcohol or drug treatment, and insurers may call this "behavioral health" coverage. NIAAA says insurers can provide details on:
- Covered inpatient days and outpatient sessions
- Medications
- Copayments
- Whether treatment is limited to in-network providers
Source: NIAAA – What About Costs and Insurance?
Marketplace plans have specific rules
According to the U.S. Centers for Medicare & Medicaid Services (HealthCare.gov), all Marketplace plans cover mental health and substance abuse services as essential health benefits. Marketplace plans must cover behavioral health treatment (psychotherapy and counseling), mental and behavioral health inpatient services, and substance use disorder treatment. Specific behavioral health benefits depend on the enrollee's state and chosen health plan.
HealthCare.gov also states that 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. Plans must provide parity protections so that limits on mental health and substance abuse services are not more restrictive than limits on medical and surgical services, including financial limits, treatment limits, and care-management requirements.
Source: HealthCare.gov – Mental health & substance abuse coverage
Public programs vary by state
SAMHSA reports that Medicaid and the Children's Health Insurance Program (CHIP) cover some mental health, drug, and alcohol treatment, but coverage amounts and services depend on the state. Many treatment programs accept Medicaid, CHIP, Medicare, Veterans Affairs (VA) Health Care, or private insurance. SAMHSA also notes that TRICARE covers mental health, drug, or alcohol misuse programs.
Sources: SAMHSA – What Does Health Insurance Cover? and SAMHSA – How to Pay for Treatment
Ask providers about cost
NIAAA advises that treatment providers can help a person understand costs for a typical course of treatment, accepted insurance plans, services covered versus billed separately, other payment methods, and any payment plans. SAMHSA similarly advises asking treatment providers about how to cover the cost of treatment and being honest about what one can afford. SAMHSA also notes that free and low-cost treatment options exist across the country.
Sources: NIAAA – What About Costs and Insurance? and SAMHSA – How to Pay for Treatment
Cost and quality together
NIAAA states that the cost of alcohol treatment can vary widely and depends on the provider, the setting, the services offered, and the individual's needs. The agency also advises that the most expensive option is not always the best, nor is the cheapest, and recommends balancing cost and quality. Individual providers (medical doctors, therapists) generally charge by the hour or per office visit or therapy session; addiction treatment programs (hospital inpatient, residential rehab, outpatient) may charge by the day, week, or month.
Source: NIAAA – What About Costs and Insurance?
Use the private worksheet
To organize the answers you gather from your insurer and treatment providers, try the budget worksheet. It is a browser-only tool that helps you record your own assumptions about coverage and costs. It does not submit data, make calculations for you, or provide a diagnosis or coverage guarantee.
For a broader look at what drives treatment costs, see cost components. For the full list of sources used on this site, see sources.
Reviewed by Allyssa Adams, MSW, SWC. This independent resource is published by NovCog and is not a treatment provider or insurer.
