Healthcare costs can overwhelm, especially when you are trying to recover from addiction. You may already have financial troubles, extra bills to pay, and perhaps even court costs to cover. Often, one facing these financial troubles will avoid proper healthcare insurance to save money. This is a dangerous choice as addiction is a brain disease. You will need to learn proper coping techniques to get away from compulsive behaviors hard-wired in the neuropathways of the brain. To help with the costs associated with quality treatment to change these neuropathways, this guide will discuss how to choose an insurance plan that covers rehab.
Insurance Plan Basics
Insurance plans can be complicated. This guide will cover how to choose an insurance plan that covers rehab by explaining the basics of insurance coverage. The main areas of interest for those needing addiction treatment are benefits coverage, out-of-network coverage, deductibles (out-of-pocket payments), cost of the insurance plan, and how to specifically ask about addiction recovery benefits.
This list can seem overwhelming when considering how to choose an insurance plan that covers rehab. Don’t worry, it can be much easier than it seems. Let’s start with benefits coverage, also known as plan coverage.
Determine Your Current Insurance Plan Coverage
If you already have an insurance plan and need to check if it covers addiction treatment services, calling member services or checking your policy manual will determine coverage. If you wish to call, have your policy number ready and write the name of the representatives you speak with, and notes about your policy. Ask the following questions on your policy coverage.
- Are addiction services covered by this policy?
- If so, what levels of care are covered? (Ask specifically if assessment, detox, inpatient, outpatient, intensive outpatient services, residential, partial-hospitalization, hospitalization, and alternative therapies are covered.)
- Does the plan offer coverage for in-network and out-of-network providers? If so, what percentage of coverage is offered for each?
- What are the co-pays and deductibles for the plan? (Co-pays are a flat amount of money you pay for each service out of pocket. Deductibles are an amount of many you must pay out-of-pocket before insurance coverage will start.)
- Ask your insurance provider what your largest out-of-pocket costs are.
- Finally, ask what criteria your insurance company uses to decide medical necessity to make sure your treatment will be covered.
Keep a copy of these questions with you while speaking to the insurance representative so you don’t forget to ask any of these critical questions. If you need help to verify your insurance coverage, call us at (561)-770-6616. We will verify your benefits for free, saving you the hassle of calling.
How to Choose an Insurance Plan that Covers Rehab?
The list of questions you ask your current insurance company are the same you would ask a potential insurance company. But, you will also need a to ask about insurance premiums, or the monthly fee you pay to be insured.
It is typical that the higher monthly fee you pay for insurance will lower your co-pay and deductible payments. The premiums are categorized in “metal tiers” and can have various combinations of co-pays and deductibles available.
Bronze Plan: These plans have the lowest premium, or monthly cost. They cover 60 percent of necessary medical services. The remaining costs are paid by the policy holder as deductibles and co-pays. In 2014, the average deductible for a single person was $5,081 and $10,386 for a family. This is the amount a single person or family would need to pay before insurance would cover costs of healthcare.
Silver Plan: These plans have slightly lower deductibles and cover 70 percent of necessary medical expenses. The exchange is higher monthly payments for coverage. The average individual deductible for an individual in 2014 was $2,907 and $6,078 for families.
Gold Plan: These plans continue to lower the deductibles and cover 80 percent of necessary medical costs. Again, the monthly payment is higher to offset the lower deductibles. The average individual deductible in 2014 was $1,277 and $2,846 for families.
Platinum Plan: These plans have the lowest deductibles and cover 90 percent of necessary medical expenses. The monthly premiums for coverage are the highest, but or often shared by the employer. The average deductible for individuals in 2014 with this plan was $347 and $698 for families.
How to Know Which Metal Tier to Choose for Insurance Coverage?
There are many plans available and each insurance company will have variations of these plans. So how do you know which metal tier to choose? Consider these points:
- If you already have a medical condition that requires expensive treatment, consider a plan in the Gold or Platinum range. These plans will cover more of the out-of-pocket costs, saving you money in the long-run.
- If you are generally healthy or are financially challenged, you can consider one of the lower monthly payments associated with the Bronze and Silver plans. While these plans will lower your monthly payments while you are healthy if you become ill or have an accident the deductibles can challenge financially.
When considering how to choose an insurance plan that covers rehab, keep in mind the higher the monthly premium you can afford for insurance will equal the lower out-of-pocket expenses for treatment.
How to Choose an Insurance Plan that Covers Rehab as a Pre-Existing Condition?
It is common for people to look for insurance once a problem surfaces. With Obama Care, getting a policy with active addiction is possible. Pre-existing conditions, conditions that existed before purchasing insurance, are covered. The Trump Administration states that this provision needs to stay even if Obama Care is repealed, ensuring many Americans will still receive needed care for health conditions.
At the time of writing this guide on how to choose an insurance plan that covers rehab, your state’s Health Insurance Marketplace, part of Obama Care, may offer income-based subsidies that will lower the cost of your premium payment. Sometimes, these subsidies will lower the cost of out-of-pocket expenses too.
Need Help to Decide How to Choose an Insurance Plan that Covers Rehab?
There are many factors that determine the best insurance plan to cover rehab. Aside from the basics of finances, you will need to consider plans that may or may not cover certain addiction recovery treatments. While this can overwhelm, help is available to make the choice easier.
Northlake Recovery in Southern Florida has a team of addiction specialists who understand insurance coverage issues. We will work with your existing insurance to get the best coverage possible for your needs. Don’t let the process of finding and buying insurance keep you from getting the help you need. Call Northlake Recovery at (561)-770-6616.