If you and your partner are struggling with substance abuse, rehab is an important step in recovery. Rehabilitation or substance abuse treatment services use therapy, counseling, and complementary skills like emotional management, building coping skills, stress management, and building healthy routines to help people overcome not just their substance abuse but also the underlying problems that resulted in it in the first place.
If you’re with a partner who also has problems, getting couples drug rehab means you go together and often receive relationship and family therapy alongside drug addiction treatment to ensure you can rebuild your relationship on a healthy basis.
At the same time, drug addiction treatment is expensive. You want your insurance to pay for as much of it as-is possible. The question is, does your insurance pay for couple’s drug rehab? The answer is; that depends. We’ll go over the factors involved and how you can work to ensure you’re getting coverage for your program of choice – and what you need to do to ensure you get that coverage to begin with.
Your Insurance Covers Rehab
Your insurance plan is required to cover drug and alcohol abuse treatment. That’s the law under the Affordable Care Act (better known as Obamacare). You are legally entitled to rehabilitation or substance abuse treatment care under Federal law. This means that your insurance plan covers rehab. However, coverage offered can vary significantly per plan.
The good news is that, no matter what, you’ll get some coverage for your drug rehab. If you take a quick look at your plan, you’ll also see roughly what is covered. Usually you can expect 40-90% coverage depending on plan, although many providers have caps and custom options for inpatient treatment. Increasingly, insurance plans are rolling rehab under general clinic visits or specialty care, which means it might not always be straightforward to find rehab or substance abuse treatment on your plan. If you’re not sure, you can always call your provider for straightforward answers. That will also help you figure out if you have to go through a provider-sponsored treatment plan or assessment before you can get help – as some plans do require this.
What Your Insurance Plan(s) Cover
Insurance plans cover different things depending on the plan. Often, that’s equitable to the physical health coverage you have. For example, with a bronze plan you can normally expect to cover about 60% of total costs yourself and with a platinum plan that drops down to about 10% of total costs. That should remain roughly equivalent no matter what kind of treatment you’re looking for. Therefore, many insurance plans won’t care too much what kind of treatment you start, providing you pay the associated costs.
- What type of treatment is covered. E.g., inpatient or outpatient? Some plans require you complete an outpatient program before it will pay for an inpatient program
- Some plans have deductibles per day some plans have deductibles per treatment type
- Maximum coverage
- Maximum covered
- If deductibles change for inpatient vs outpatient care
For example, if you have a bronze plan, chances are very high that your insurance plan will attempt to cover the bare minimum. This means you might not get coverage for extras like couples’ rehab, unless that’s explicitly incorporated into mental health treatment and coverage.
You’ll also want to check whether:
- You both have the same insurance plan. If you’re both on the same plan, it will be easier to align treatment and get joint coverage. If you’re not, it may be much harder to do so.
- If you have different plans, your providers may work with a different network, which means it will be basically impossible to both get coverage from the same organization
- Couples rehab may be treated as “joint” therapy or as individual therapy for two people and the difference will matter a lot depending on your rehab program
Essentially, if you have to align two separate insurance plans, you may have more trouble getting insurance coverage. However, if you’re on a family plan together, it may be much easier.
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What Your Doctor(s) Recommend
It’s always important to start out any visit to rehab with a trip to your doctor. This is important because you’ll need a doctor’s recommendation into treatment in order to get coverage for your rehab at all.
Here, you’ll also want your doctor to specifically recommend couples rehab to you. This will greatly increase your chances that the rehab center covers the treatment without making a fuss.
- Research why you want to go to couples’ rehab, what are the benefits, what do you get out of it over individual treatment
- Check if treatment is broken down into rehab + mental health treatment or listed as one treatment. In most cases, with deductibles, a single treatment session is better. However, splitting them may make it easier to get coverage if you have a basic plan
In most cases, if you can present your doctor with a case as to why you want couples’ rehab, your doctor will be more than happy to recommend it. Those reasons can be as simple as:
- We want to learn how to support each other in staying clean and sober
- We want to undo the harm of substance abuse on our relationship and that means getting help together and getting family therapy alongside substance abuse treatment
- It’s important that we have perspective on the treatment the other has received so that we can live with and work with that in a healthy way after treatment
Essentially, there are plenty of reasons why couples drug rehab can be beneficial over both of you going to separate programs or even both of you going to the same program with no extra support for couples. Talking to your consultant about it and then taking that discussion to your doctor can mean you very easily get a recommendation into that treatment from your doctor. That’s also important because, without that recommendation, your insurance may not offer coverage.
Will Everything Be Covered?
Almost no insurance provider will cover every part of rehab. If you’re going to an inpatient program, you can expect higher deductibles, limits on coverage, and reduced coverage. If you’re going to an outpatient program, you can expect relatively low deductibles and copays. However, in most cases, you can expect a maximum coverage of about 90% even with the best plans. Basic plans usually won’t cover more than about 40% of your treatment – although that does vary quite a bit. The best option is to look at your plan, see what it covers, and figure out what your best option is within your insurance plan and budget.
Confronting your mutual substance abuse can be difficult. Sharing the burden, learning how to be better together, and learning how to support each other in that can be a powerful part of recovery. Getting couples rehab can very much be the right choice for many of us. Hopefully, you can easily get that treatment without worrying too much about what your insurance provider covers. However, the fastest and easiest solution is always to call your insurance provider, ask what their options are, and take steps from there. Chances are very high that a significant portion of your couples therapy will be covered by your insurance. Good luck getting treatment.
