Does Insurance Cover Rehab?

Insurance typically covers substance abuse treatment, including inpatient services, outpatient services, psychotherapy and counseling. For complete details regarding your coverage, call your insurance provider and ask about mental health and substance abuse treatment coverage.
Topics On this page
| | 18 sources

49 percent of drug rehab attendees used private insurance to pay for treatment in 2014.

The Mental Health Parity and Addiction Equity Act of 2008 stipulates that insurance companies cannot discriminate against or deny coverage to individuals with substance use disorders. In addition, the Affordable Care Act of 2010 classified mental health and addiction services as essential health benefits.

This means insurance companies have to treat mental health and substance abuse treatment similar to regular health treatment. Every insurance company has a different coverage plan that can be tailored to the individual’s needs.

How to Determine Your Coverage

Call your insurance provider and request information about mental health and drug addiction treatment. Every insurance provider is required to cover those services under the MHPAEA and the ACA. It is important to ask about copayments, deductibles and out-of-pocket maximums.

You can also call a rehab facility and ask an admissions representative to verify your coverage. Admissions representatives can give you an estimate of how much rehab will cost and how much your insurance will cover without requiring you to commit to treatment at their facility.

Robert Fishman of Advanced Recovery Systems discusses the convenience of having a rehab facility verify insurance coverage.

Find out if your insurance covers rehab:

Health Marketplace

The health marketplace follows the ACA; therefore, all health care plans must comprise essential benefits. Marketplace health plans cannot refuse to cover individuals with pre-existing mental health or substance abuse conditions.

Parity protection rules dictate that the financial, treatment and care management limits for mental and substance use disorders cannot be more than those placed on physical health treatment. The health marketplace insurance plan makes treatment for mental disorders and substance abuse more accessible.

Coverage includes:
  • Behavioral health treatment including psychotherapy and counseling
  • Mental and behavioral health inpatient services
  • Substance abuse treatment

Coverage for treatment of all pre-existing conditions starts on the first day that the individual receives treatment.


Medicaid champions the payment of mental health services in the United States. It also is a major contributor in reimbursing the cost of rehab. Medicaid varies from state to state, and it offers coverage only to low-income individuals, families, children, pregnant women, the elderly and people with disabilities.

Young nurse helping an elderly woman

Some states and special cases do not require any copayment or coinsurance, but some states require a premium. The mandatory benefits under Medicaid are required by federal law.

Nearly 12 percent of Medicaid beneficiaries 18 or older have a substance use disorder.

Medicaid coverage includes:
  • Inpatient hospital services
  • Outpatient hospital services
  • Mental health services
  • Home health services
  • Physician services
  • Transport to medical care

Coverage may start up to three months before the application month and stops at the end of the month when the individual is no longer eligible for Medicaid.


Medicare is available to people 65 or older and people with disabilities. In some cases, it also applies to those with end-stage renal disease. Medicare is divided into four parts: A (hospital insurance), B (medical insurance), C (Medicare Advantage) and D (prescription drugs).

Inpatient Services

Part A of Medicare covers all services required for the patient to be admitted to a hospital. This can either be in a regular hospital or psychiatric hospital. However, in cases of psychiatric hospitals, Part A only pays for 190 days of inpatient treatment per lifetime.
Part A Does Not Cover:
  • Private duty nursing
  • Phone or TV in room
  • Personal items
  • Private room — Exceptions for medical requirements

Outpatient Services

Part B of Medicare covers mental health services along with treatment with the following professionals:
  • Psychiatrist or other doctor
  • Clinical psychologist
  • Clinical social worker
  • Clinical nurse specialist
  • Nurse practitioner
  • Physician assistant
These medical visits are covered only if the providers are in agreement with Medicare to accept a payment that Medicare deems fair for the service.
Coverage includes:
  • Mental health services
  • Testing and evaluation
  • Psychiatric evaluation
  • Physician-administered prescription drugs

Partial Hospitalization

Part B covers partial hospitalization in some specific cases. Acting as an alternative to inpatient services, it is provided during the day without the requirement of an overnight stay. Partial hospitalization is covered if it is being provided through a hospital’s outpatient department or community mental health center. In certain cases, the patient may have coverage for occupational therapy as well as patient training and education about his or her condition. Similar to outpatient services, Medicare covers partial hospitalization only if the provider is in agreement that it will accept the payment Medicare deems right for the service and not charge the patient the surplus.
Part B Does Not Cover:
  • Meals
  • Transport
  • Support groups other than group psychotherapy
  • Testing or training for job skills
Medicare coverage begins on the first day of the month of the individual’s 65th birthday. Enrollment extends from three months prior to three months after the 65th birthday.

Private Insurance

Private insurance coverage varies per plan, but all insurance providers are required to cover substance use disorder treatment as an essential health care benefit. The plans are not allowed to deny coverage based on pre-existing mental health conditions, and they must cover preventative services such as depression screening for adults and behavioral assessments for children and adolescents.

Private insurance plans must also offer coverage for SUD services that matches coverage for treatment of other diseases. Many plans require prior authorization for services, but they cannot impose lifetime or annual dollar limits on coverage.

Will insurance cover rehab?Check your insurance coverage right now and get help today!


Tricare is the health care program for members of the U.S. military. It was previously called the Civilian Health and Medical Program of the Uniformed Services. With prior authorization, Tricare covers medical detox, inpatient rehab, outpatient therapy and family therapy.

Under Tricare, detox is covered for seven days, inpatient rehab is covered for 21 days, 60 outpatient group therapy sessions are covered and 15 outpatient family therapy sessions are covered per benefit period. Tricare covers three substance use disorder treatments per lifetime.

Medical Disclaimer: aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.

Sonia Tagliareni
Sonia Tagliareni is a writer and researcher for She is passionate about helping people. She started her professional writing career in 2012 and has since written for the finance, engineering, lifestyle and entertainment industry. Sonia holds a bachelor’s degree from the Florida Institute of Technology.

Was this article helpful?

How helpful would you rate this article?

    loading logo

    Thanks for helping us make our website better for visitors like you!

    View Sources

    Ready to make a change?

    Get cost-effective, quality addiction care that truly works.

    Start Your Recovery
    We're here to help you or your loved one.
    Question mark symbol icon

    Who am I calling?

    Calls will be answered by a qualified admissions representative with Advanced Recovery Systems (ARS), the owners of We look forward to helping you!

    Question mark symbol icon

    Who am I calling?

    Phone calls to treatment center listings not associated with ARS will go directly to those centers. and ARS are not responsible for those calls.