Will Insurance Cover an Addiction Caused Hospital Trip?

Will Insurance Cover an Addiction Caused Hospital Trip?

Typically, health insurance covers any hospital or medical emergency

There are numerous insurance options available to those seeking treatment for their addiction to drugs, alcohol, or even specific behaviors such as gambling and shopping addiction. Both public and private health insurance cover a portion of the expense of outpatient or inpatient treatment for virtually any type of addiction. Typically, health insurance covers any hospital or medical emergency with the standard co-pays and out of pocket costs associated with any other necessary medical emergency.

Today’s society has come to understand addiction as a treatable disease. Insurers have also grasped the understanding that addiction, over an individual’s lifetime, can cost tens of thousands of dollars more than the cost of addiction treatment. Without helping cover addiction treatment costs, insurers would have to help cover numerous emergency services costs, psychiatric visits, and long-term medical care for physical and emotional damage caused by the addiction. Insurers now look at addiction treatment as a necessary medical cost and provide rehab insurance coverage.

Types of Insurance and Addiction Healthcare Costs

Individuals should contact their health insurance provider directly to figure out if any or all of their addiction treatment and specific rehab programs or services are covered. Due to the costs of treatment, knowing whether or not addiction treatment is covered is an important concern to many addicts.  There are two different forms of insurance: Private insurance and public insurance

Private health insurance is typically offered through an employer or other type of organization.  Some employers may only offer one type of health insurance while others allow the individual to choose from numerous plans. Buying health insurance individually, instead of purchasing it through an employer, typically costs more because the individual is paying for the plan individually rather than sharing the cost with the employer. Some insurance plans work with specific health care providers and facilities in their network, and by offering this, they are able to provide healthcare at lower costs, which is referred to as managed care. There are numerous different kinds of managed care plans: [1]

  • Health maintenance organizations (HMOs) – HMO plans pay only for medical care within their network of health care providers. Because of this, these plans typically cost less than other plans that offer choices of providers.
  • Preferred provider organization (PPOs) – These plans cover more of an individual’s medical care costs if treatment is sought within the network of care providers. They still also cover some costs for care sought outside the network.
  • Preferred provider organizations (PPOs) – These plans let the individual choose between the HMO and PPO each time they seek medical care. These plans offer more flexibility when choosing both doctors and hospitals.

Public health insurance is often also referred to as government insurance, or insurance that is issued by the government and not a specific employer or company. The plans offered through the government are Medicaid and Medicare. Medicaid is a state run and funded insurance program that helps individuals with lower incomes pay for costs associated with medical care, which can include emergency visits, inpatient and outpatient addiction treatment, and counseling. Medicaid pays the health care provider directly.  Medicaid is only available to those who meet the income restrictions and may have restrictions on what medical costs are covered.

Medicare is also a state funded government health insurance provided only for those individuals 65 and older or those individuals who have certain disabilities or long-term or chronic health problems. Similar to Medicaid, this plan covers some but not all medical costs for those individuals who qualify for it.

Ultimately, if you want to know if your insurance covers any form of addiction treatment such as inpatient, outpatient, residential, or counseling, you should directly contact your insurer and discuss your options.

Drug Addiction Treatment

If you or someone you love is concerned about addiction related healthcare costs, please call our toll-free helpline today. Our highly trained and professional counselors are available to answer your addiction questions as well as help you find the best treatment available for your condition. It only takes one call to save a life, so call us today!


[1] http://www.webmd.com/health-insurance/tc/undertanding-health-insurance-types-of-health-insurance, Understanding Health Insurance-Types of Health Insurance, WebMD, 12/13/15.

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