Does Insurance Cover Detox?
The short answer is: often yes. Most insurance plans are required to cover substance use disorder treatment, which can include detox. Here is what you need to know.
Understanding Insurance Coverage for Detox
The Mental Health Parity and Addiction Equity Act (MHPAEA) and the Affordable Care Act (ACA) together require most health insurance plans to cover substance use disorder treatment — which includes detox — at the same level as other medical conditions.
That means if your plan covers hospital stays for medical conditions, it must also cover inpatient detox at a comparable level. If it covers outpatient doctor visits, it must similarly cover outpatient substance use disorder services.
Plans That Typically Cover Detox
- Employer-sponsored private health insurance
- Individual plans purchased through the ACA marketplace
- Medicaid (most states)
- Medicare Part A (inpatient) and Part B (outpatient)
- Medicare Advantage plans
- TRICARE (military)
Coverage varies by plan. Your actual benefits depend on your deductible, copay, network, and whether prior authorization is needed.
Not sure what your plan covers? We can help you find out. Complete the insurance verification form or call us and a specialist will help you understand your specific coverage.
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Frequently Asked Questions
The Mental Health Parity and Addiction Equity Act (MHPAEA) and the Affordable Care Act (ACA) together require most health insurance plans to cover substance use disorder treatment at the same level as other medical conditions. This includes detox as part of the treatment spectrum.
Medicaid generally covers substance use disorder treatment, including detox, in most states. Medicaid expansion under the ACA has extended this coverage to more people. Coverage details vary by state.
Medicare Part A may cover inpatient detox in a hospital setting if it is medically necessary. Medicare Part B may cover outpatient substance use disorder services. Medicare Advantage plans may have additional coverage.
Some insurance plans require prior authorization — approval before you receive treatment — for detox to be covered. Programs we work with are familiar with this process and can often assist with authorization.
Ready to Check Your Coverage?
Call us or complete the insurance verification form. We can help you understand your options quickly.