Treatment options for addiction recovery have grown with the increased awareness of mental health needs and the passing of the Affordable Care Act (ACA), which mandates that insurance plans cover mental and behavioral health treatment. This makes using insurance for online rehab and therapy more accessible.
With the ACA in place, insurance companies will now cover both in-person addiction treatment and online programs, opening the doors for everyone to receive the care they need to achieve sobriety.
Now that the doors are open for treatment, understanding how insurance works for you can be the next best step toward sobriety.
Key Facts
- Most insurance plans cover online addiction treatment programs, with specifics varying between policies.
- The Affordable Care Act mandates that all insurance plans cover mental and behavioral health treatment, and the new telehealth parity laws now require virtual and in-person treatment to be charged and reimbursed at the same rate.
- Choosing an in-network provider for your insurance plan will help reduce treatment costs.
- Medicaid and Medicare will often cover online treatment with virtual state-run programs.
- All types of online treatment should be covered by insurance, including IOP, Tele-MAT, individual and group therapy.
Is Online Addiction Treatment Covered by Insurance?
Most health insurance plans will cover online rehabilitation services. However, the extent of the coverage varies between policies, providers and regional telehealth regulations, so be sure to call your insurance company to confirm the coverage available to you.
The Affordable Care Act and Telehealth Parity
When the Affordable Care Act (ACA) was passed, mental health and substance use disorders were listed as essential health benefits, and a specific mandate was created that barred insurance companies from denying coverage for addiction treatment.
The “telehealth parity laws” were also passed, adding a requirement that insurance companies reimburse virtual care at the same rate as in-person medical care, thereby expanding treatment options for those in need.
In-Network vs. Out-of-Network Virtual Providers
As with any insurance, choosing providers and treatment options within the plan’s network is often required for reducing costs associated with treatment.
Using an in-network telehealth platform for virtual rehabilitation centers means that your insurance plan is contracted with them. Essentially, your insurance will recognize them as a healthcare provider and will cover the cost of treatment, drastically decreasing your out-of-pocket expenses.
The amount the insurance will cover depends on the specific details of your individual insurance policy.
Choosing an out-of-network provider likely means that your services will not be covered by your insurance. Any treatment you receive will either require a higher coinsurance payment or be fully self-pay.
Medicare and Medicaid Coverage for Virtual Care
If you are insured with Medicare or Medicaid, options for virtual addiction treatment have expanded with online state-run facilities. Medicare Part B offers specific coverage for virtual outpatient substance use disorder treatment, and many Medicaid programs now cover telehealth visits with zero out-of-pocket expenses.
What Types of Online Rehab Does Insurance Cover?
Insurance companies traditionally contract with online treatments that mirror traditional in-person options. Meaning, the treatment offered online is of the same caliber and modality as those you’d find in person. The providers of these online treatment programs are licensed professionals, and all treatment is done using evidence-based methods.
Virtual Intensive Outpatient Programs (vIOP)
Insurance will cover virtual intensive outpatient programs (vIOPs), often requiring 9 hours of online therapy a week and follow the same objectives as the ones used for in-person treatment.
Before beginning treatment, prior authorization may be required from your insurance provider. Be sure to contact them for the specifics for your plan.
Tele-MAT Cost and Insurance Coverage
Medication assisted treatment encompasses the whole person, where medication, counseling, and behavioral therapies are used together to offer stronger outcomes.
With tele-MAT, treatment emphasizes care of the whole person, but does so virtually with secure video appointments for counseling and medication management, such as Suboxone.
Many commercial insurance plans and Medicaid cover the cost of Tele-MAT, thereby significantly lowering the overall tele-MAT cost for you.
Online Individual and Group Therapy
With the ACA mandate for mental health, standard outpatient care, both in person and virtually, is highly likely to be covered by insurance. One-on-one virtual counseling and digital group therapy are typically covered by the behavioral health benefits in your insurance plan.
Privacy expectations are consistent across all provider platforms, and HIPAA compliance is mandated for video platforms. If HIPAA regulations are not met, insurance providers will not approve or reimburse the therapy sessions.
How Much Does Online Rehab and Addiction Treatment Cost?
The cost associated with online addiction treatment depends heavily on the level of care you require and whether you are using insurance benefits or paying privately. Researching options and understanding your personal budget will aid in making the best decision for your needs.
Average Online Drug Rehab Cost (With and Without Insurance)
The average cost of online addiction treatment varies depending on the payer, whether that be insurance or self-pay. For those pursuing a standard virtual outpatient option, each session ranges from $100 to $500, whereas vIOPs may cost between $250 to $350 per day.
If you are using insurance with in-network options, your financial responsibility is often reduced to the standard specialist copay for your plan.
Copays, Coinsurance and Deductibles for Telehealth
As with most insurance, the plan’s deductible will need to be met before insurance will begin covering the cost of treatment. Once the deductible is met, insurance will pay a percentage of the treatment, depending on how your individual plan is arranged.
Once the out-of-pocket maximum is met for the year, insurance will cover all treatment at 100%.
Anyone seeking treatment will most likely be responsible for a per-session co-pay or a percentage-based coinsurance fee for telehealth visits.
This remains consistent for all levels of coverage, no matter how great the insurance plan.
How to Verify Your Telehealth Rehab Benefits
To fully understand your benefits and avoid unwanted fees, it is crucial that you contact your insurance provider and thoroughly discuss your coverage details. Confirming complete benefits before committing to a digital treatment program will help you avoid unexpected medical bills.
Steps to Check Your Virtual Care Coverage
Confirming your coverage details can be done by calling the member services number on the back of your insurance card and specifically asking about your policy’s coverage for telehealth for behavioral health and substance abuse.
You may also ask for a specific online rehab facility’s admissions team to perform a free verification of benefits (VOB) on your behalf.
Insurance for Online Rehab FAQs
Most insurance plans have strict geographic restrictions for coverage and usually require your virtual provider to be actively licensed in your home state to cover the treatment.
Yes, you are able to receive Suboxone prescriptions and medication management online with tele-MAT providers. These providers are permitted to legally prescribe Suboxone, and most insurance policies cover both the cost of the virtual doctor visit and the pharmacy prescription.
Telehealth parity laws require online and in-person treatment options to be charged the same amount, yet online treatment offers a reduction in overall cost, as the virtual nature of treatment eliminates costs associated with travel, lodging and facility fees.
This decrease in expense makes online treatment an appealing option for many.
Find Treatment Near You
If you’re ready to begin recovery but aren’t sure where to start, call
800-985-8516
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today to talk to someone about your treatment options and see if your insurance will cover rehab.
You can also use the online directory to help filter facilities by location, level of care, insurance and special programs.
Healing is just one step away. Reach out today to get started.
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