For those who struggle with an alcohol or drug addiction, worrying about the cost of the treatment can be stressful. It can be difficult enough to ask for help, let alone having to worry about whether you can afford to get that help.
The good news is there are ways to fund treatment. HealthPartners of Minnesota is a nonprofit healthcare provider that offers individual and family plans for Wisconsin and Minnesota. They also offer employer health insurance, prescription coverage, Medicare, and Medicaid (MinnesotaCare) plans.
Affordable Care Act
The Affordable Care Act has designated plans on the Health Insurance Marketplace must offer mental health and substance abuse services as essential health benefits. Those include:
- Behavioral health treatment (psychotherapy, counseling)
- Mental and behavioral inpatient health services
- Substance use disorder treatment
Pre-existing conditions are also covered, and no spending limits are allowed. The Affordable Care Act also says “parity” protections are necessary, where mental health and substance use coverage must be equal to medical or surgical benefits.
As a result, everyone should have coverage. Exactly how much coverage a person will have, and what the copays and deductibles will be, and their in-network options will vary by plan.
It’s a good idea to check with your insurance provider beforehand to find out what services are covered and what the costs will be.
Health Partners of Minnesota Levels of Care
HealthPartners plans cover preventive care as well as other essentials including mental health and addiction treatment.
What you will be responsible for will depend on your plan. Most plans on the health insurance marketplace (including HealthPartners offerings) have varying “metal” levels of coverage:
- Bronze plans have high deductibles (often several thousand dollars) and lower premiums. Copays and coinsurance might run about 30%, but some plans may charge zero dollars for services once the deductible is met.
- Silver plans have medium deductibles and medium premiums. Coinsurance obligations and deductibles tend to be smaller than bronze options. Plans with a health savings account can have lower coinsurance, even as much as zero.
- Gold plans have the highest premiums but the lowest out-of-pocket costs (including deductibles).
People who qualify for a tax credit to help pay premiums can apply on MNsure.org (for Minnesota residents) or healthcare.gov for Wisconsin residents.
Drug and Alcohol Rehab
Does HealthPartners cover drug and alcohol rehab? Addiction treatment is covered, often under behavioral health. That can include several treatments, including detoxification, inpatient care, psychotherapies, counseling, residential hospitalization, and more. Often many procedures will need prior authorization for insurance to pay their portion.
How much HealthPartners will pay will depend on the plan you have. Gold plans mean less out-of-pocket for services rendered, while Bronze plans usually work in reverse, usually with treatment not being covered until the deductible is met.
Length of Treatment
The length of addiction treatment HealthPlan allows may vary.
The National Institute on Drug Abuse (NIDA) recommends considering a number of factors when prescribing a treatment plan. Those factors include the patient’s history of substance use, what they’ve used, for how long, if they have any co-occurring disorders, age, gender, and more. NIDA also says a longer treatment stay is recommended for better results. At least three months is best.
Rehabs also work with insurance companies, too, to seek additional treatment time for the patient when needed or preferred.
Does HealthPlan also cover mental health? Mental health care is an essential service, according to the Affordable Care Act. HealthPlan does offer mental health treatment coverage. Because mental health and substance use disorders frequently overlap, getting mental health care can be very good for patients.
Mental health care may include office visits for therapy and counseling, visits to psychiatrists for medication and monitoring, inpatient and outpatient treatment, to help a person manage their condition.
The exact costs, what’s allowed, and where a person may go, or what treatments they can get will vary by plan.
HealthPlan inpatient rehab involves checking into a facility to get 24-7 treatment. Inpatient rehab can last from 30 days to 90 or more days. Sometimes longer.
At the facility, the patient will be treated for their substance use disorder and any co-occurring mental health issues. Inpatient treatment occurs in several stages, including:
- Assessment: The staff examines the patient for a mental and physical health diagnosis. That helps develop a treatment plan.
- Detoxification. Many patients need to undergo detox before treatment. In this stage, the body is rid of alcohol or drugs (or both). Medication may be given to reduce the painful side effects of withdrawal like vomiting, insomnia, and anxiety. Medication-assisted treatment (MAT) keeps the patient stable and safe since some substances (like alcohol and opioids) should not be quit cold turkey, especially if a strong dependence has set in.
- Treatment. Treatment often includes therapy. A popular one is cognitive-behavioral therapy, where the patient works with a counselor or therapist to analyze and grow aware of their negative thinking and shift their attitude and approaches so problems are solved in more productive ways. Other therapies (including group), medication (for any co-occurring mental health disorders), and other activities make up treatment.
- Aftercare. Staffers ready the patient for life after rehab. Ideally, they’ll be armed with coping mechanisms, contacts for counseling and support groups, and possibly plan to make regular check-ins with the rehab. The goal is to prevent relapse.
HealthPartners outpatient services can be an extension of inpatient care or a replacement for it.
For intensive outpatient programming, the patient will visit the clinic a few times a week, usually a few hours at a time. They’ll engage in counseling or therapy and work on ways to prevent relapse.
Some patients may transition from inpatient care to a nearby sober living center, and IOP serves as a transitional phase between residential treatment and independent living.
Suboxone is often used as part of medication-assisted treatment (MAT), particularly to treat opioid use disorder. It has two drugs, buprenorphine, and naloxone. (Buprenorphine-naloxone is the generic version of suboxone.).
MAT blends behavioral therapies and medication to help treat addiction. Suboxone gives many of opioids’ effects as it reduces the intensity. That can help ease burdensome withdrawal symptoms and prevent relapse?
Does HealthPartners cover suboxone treatment? Suboxone is not covered on HealthPlan individual and employer plans, but the generic buprenorphine-naloxone version is a covered drug. There may be dosage limits and restrictions, however.
Medicaid may allow suboxone in some cases or may prescribe the generic instead.
Methadone is also used to treat opioid use disorder, also as part of medication-assisted treatment (MAT).
Methadone helps lower opioid cravings and reduce withdrawal symptoms by preventing the highs and lows that accompany some opioids. That can make it easier to stop using and prevent relapse.
Does HealthPartners cover methadone treatment? It is one of the drugs on HealthPartners’ list of approved prescription drugs. It will require prior authorization.
Paying for Rehab
Addiction rehab can quickly turn expensive. Fear that it will be costly or that insurance won’t cover treatment can make some people shy away from even considering rehab. Insurance can ease the burden, however. Coverage, approval of care, and seeking treatment in-network can drive costs down.
Deductibles and coinsurance are unavoidable. Bronze plans have smaller monthly premiums but you’ll pay more out-of-pocket, especially at first. Gold plans have higher monthly premiums, but the out-of-pocket costs will be much lower. Silver plans fall in between Gold and Bronze, usually.
Getting treated by a facility that’s within your insurance network can save you a good amount of money. HealthPartners can provide its subscribers with a lot of information about costs and what needs approval. Addiction centers can also answer a lot of questions.
When paying for services not covered by HealthPartners insurance policy, rehab centers can sometimes work out a billing plan, and financing may be an option, too.
- healthcare.gov – Mental health & substance abuse coverage
- drugabuse.gov – Principles of Effective Treatment
- drugabuse.gov – Types of Treatment Programs
- nami.org – Buprenorphine/Naloxone (Suboxone)
- samhsa.gov – Methadone
Sunshine Behavioral Health strives to help people who are facing substance abuse, addiction, mental health disorders, or a combination of these conditions. It does this by providing compassionate care and evidence-based content that addresses health, treatment, and recovery.
Licensed medical professionals review material we publish on our site. The material is not a substitute for qualified medical diagnoses, treatment, or advice. It should not be used to replace the suggestions of your personal physician or other health care professionals.