Differences Between Private and Public Insurance For Addiction Treatment

Differences Between Private and Public Insurance For Addiction Treatment

Despite being a manageable health condition where complete remission is possible and an increase in treatment options, the stigma surrounding mental health and substance use disorder has remained constant. Addiction affects many facets of an individual’s functioning and a good treatment program focuses on many dimensions of their life and includes any number of components that may change over the course treatment and recovery. Such components of treatment may include:

  • A medically supervised detoxification
  • A comprehensive medical and psychiatric screening by licensed and certified staff members
  • Medications that counter the need for mood or mind-altering substances
  • Cognitive behavior therapy (CBT)
  • Counseling
  • Group Therapy and peer support programs as well as family therapy
  • Inpatient or outpatient clinic to long-term residential facility services
  • Life skill training

Now, an effective treatment regimen that addresses prevention and relapse management, including regular monitoring of individual progress may be off-putting to many addicts because it requires some sort of payment. Additionally, obtaining insurance for drug rehab may also not seem like a financially sound thing to do, especially when the only thing they need it for is to seek treatment for addiction. According to the National Survey on Drug Use and Health, people struggling with any form of substance use disorder do not receive treatment because they lack health insurance coverage.

Addiction is considered a diagnosable and treatable disease and an essential health benefit under the new health care laws, and it is illegal for insurance companies to refuse coverage for patients because of addiction. Private insurance plans such as those offered by Aetna insurance for drug rehab, Cigna insurance for drug rehab and United insurance for drug rehab will typically cover assessments, detoxifications, outpatient treatment and inpatient or residential treatment among other services.

Such insurance plans use specialty treatment, particularly for individuals with severe alcohol and drug use disorders. Unlike group or public insurances, private insurance plans are acquired independently either through a person’s employer or member association and offer more options for various types of treatments. They fall into either HMO plans, PPO plans, and Point-of-Service plans.

Public insurance plans are state- or government-funded and are ideal for individuals who may not be able to acquire or purchase a private insurance plan such as low-income families or unemployed individuals. Private insurance plans have eligibility requirements, for instance, you either need to be on a state-funded Medicaid (government-regulated public insurance benefit) to prove that you can’t afford private insurance or are receiving Social Security Income (SSI). Individuals who are 65 and older and on Medicare, also a federally funded public insurance program, are eligible for public insurance plans to help them seek treatment for their addiction.

Note that even though covered by a private or public insurance plan for addiction treatment, the percentage paid by an insurance carrier may vary according to each state, the plan, and the treatment center. Also, some plans may cover the entire bill after deductibles, while others will only pay for part of the treatment.

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