Blue Cross Blue Shield Insurance Coverage for Drug & Alcohol Treatment

Does Blue Cross Blue Shield Insurance Cover Alcohol and Drug Rehab?

Blue Cross Blue Shield is required, as are all private insurance providers, to cover at least some level of addiction treatment by the Affordable Care Act (ACA). States can also impose further requirements on the coverage insurance companies must provide. 

Generally speaking, you can expect your BCBS plan to offer coverage for drug and alcohol rehab, though the extent of coverage may vary depending on your specific plan. Your Blue Cross Blue Shield plan will likely cover: 

• Outpatient treatment 
• Medical detox 
• Residential or inpatient treatment

At Boca Recovery Center, we accept a variety of Blue Cross Blue Shield plans. Contact us to check the details of your specific coverage.

To What Extent Does BCBS Insurance Cover Drug Rehab?

Blue Cross Blue Shield insurance plans provide at least partial coverage for drug and alcohol addiction treatment services, and some may fully cover treatment, depending on the setting. 

Some plans may cover the entirety of an outpatient treatment program and half of an inpatient program, while others may cover a full 30-day stay at a residential facility. 

Verifying Your BCBS Insurance Coverage

There are a few ways to verify your BCBS insurance coverage for addiction treatment, including:

• Call the number on the back of your insurance card to talk to a representative who can discuss your plan details with you
• On the BCBS website, enter the 3-letter prefix before the ID number on your member card to check your coverage
• Fill out our insurance verification form to check your BCBS insurance coverage

PPOs vs. HMOs

Keep in mind, when comparing drug and alcohol rehab options, you’ll want to consider whether you have a PPO (Preferred Provider Organization) plan or HMO (Health Maintenance Organization) plan. 

If you have an HMO through BCBS, your plan will only cover treatment at HMO-contracted addiction treatment facilities. Meanwhile, PPO plans give you a broader range of treatment options and you can also choose to see an out-of-network provider for a higher cost.

What Addiction Treatment Services Does BCBS Cover?

Blue Cross Blue Shield insurance plans cover a wide variety of addiction treatment services, including:

• Medication-assisted treatment: Medications for addiction treatment, such as methadone, naltrexone, and Suboxone, may be covered by your insurance plan on an ongoing basis.
• Outpatient treatment: You may receive full or partial coverage for outpatient treatment or continuing care in which you attend counseling at a facility during scheduled meetings.
• Intensive outpatient programs: Your BCBS plan may cover intensive outpatient programs in which you attend between 9 and 20 hours of care per week.
• Partial hospitalization programs: Your plan may cover partial hospitalization programs where you attend up to 30 hours of treatment throughout the week and return home in the evenings.
• Inpatient drug rehab: You may receive partial or full coverage for a stay at an inpatient rehab program, where you reside for the duration of care, receiving 24/7 support.
• Medical detox services: Medical detox may be covered if medically necessary, such as for an addiction to opioids, alcohol, or benzodiazepines.
• Therapy and counseling: You can attend ongoing therapy and counseling for substance abuse, mental health disorders, or co-occurring conditions.

How Long Will BCBS Insurance Cover Drug and Alcohol Rehab?

Much like the addiction treatment services covered, the length of time your Blue Cross Blue Shield insurance will cover drug and alcohol rehab largely depends on your specific plan. 

The amount of time covered under your plan may depend on your doctor’s recommendation, whether your treatment was deemed medically necessary or not, the particular program, and beyond.

Blue Cross Blue Shield Tiered Plans

Blue Cross Blue Shield insurance plans vary from state to state but generally, the tiered plans include: [2]

The Typical Cost of Treatment

Finding the “typical” cost of addiction treatment options is fairly difficult since treatment prices can range considerably from $0 to tens of thousands of dollars.

An article from Georgetown University notes that outpatient treatment for cocaine or heroin costs about $3,100 a year according to one study, and that residential treatment for cocaine cost $12,500 a year. [3]

Other research indicates a yearly cost of $1,000 to $5,000 for outpatient treatment, which equates to about $19 to $96 per week. [4] 

And the average one-year cost of methadone maintenance for opioid addiction is about $4,700 per person. [5]

While costs can be highly variable, these numbers make adequate benchmarks to compare the costs quoted from different treatment providers you may talk to. 

Remember that costs can also vary greatly by area, so the providers near you may offer significantly better or worse rates depending on many different factors. Luxury treatment options can cost significantly more, often tens of thousands of dollars or even more per year. Luxury options can vary even more in cost and likely won’t be covered by your insurance plan.

Understanding Different Plan Options

While you should always read and fully understand a plan’s explanation of benefits (EOB) before choosing a plan, there are five key factors most people focus on when choosing a Blue Cross Blue Shield plan.

1. Monthly Premium

Your monthly premium is the amount of money your plan will cost you each month, which can sometimes be lowered further if you qualify for certain low-income benefits. Plans with lower deductibles and better coverage generally cost more each month, although they may cost you less overall if your yearly medical costs tend to be high.

2. Deductible

A plan’s deductible is the amount of money you need to pay out of pocket in a given year before you can benefit from your insurance. As you pay medical costs from different sources, as long as you’re paying for in-network treatment, those payments will build up and you will eventually meet your deductible and receive the full benefits your plan provides.

Some plans can have deductibles in the thousands of dollars, others may be in the hundreds of dollars. High-premium plans may have no deductible at all.

3. Coinsurance

Coinsurance is the amount of money you will pay out of applicable medical costs once you meet your deductible. Coinsurance rates are typically between 40 percent for lower-tier plans to 10 percent for high-tier plans. 

As an example, if someone has a coinsurance of 20 percent and has met their deductible, a medical bill of $1,000 would be 80 percent covered by their insurance. They would pay $200 rather than the full cost.

4. Copayments

Copayments are fixed costs associated with certain healthcare services, and they can vary by the service. For example, you may need to spend $10 when you see a doctor. Copayments costs will generally be listed on your insurance card. 

The copayment required to see a specialist or out-of-network will typically be higher than seeing a generalist. You will likely need to speak to a specialist for at least some parts of an addiction treatment plan.

Maximum Out-of-Pocket Amount

A plan has a maximum out-of-pocket amount, which is the total amount of relevant costs you have to pay, at which point you no longer will need to pay your deductible, coinsurance, or any copayments for applicable medical costs. 

In-Network vs. Out-of-Network Coverage for Addiction Treatment

BCBS has a very large network, with more than 90 percent of doctors and hospitals nationwide partnered with the association. To get the full benefits of your plan, you’ll want to find an addiction treatment provider within this network currently taking in patients. Because of the scale of the network, it usually isn’t hard for people to find a treatment provider near them that takes their insurance and is in the BCBS network.

The cost of using treatment providers out-of-network may or may not be covered by your plan. If it is covered, you will generally not be able to get the full benefits associated with your plan. Costs associated with using an out-of-network provider for medical emergencies are usually still covered, even if they normally wouldn’t be.

Covering Out-of-Pocket Addiction Treatment Costs

You have a few options to help cover your out-of-pocket treatment costs.

The ideal option when available is generally to get a loan from family or friends, as these people will usually provide a loan at no or minimal interest, and they can be paid back on a flexible schedule.

You can also try getting a loan from a third-party company or potentially financing directly with the treatment provider if they have that as an option. Many companies provide reasonable loans at low rates for those who qualify.

One way to broadly keep your costs down is through flexible spending accounts (FSAs) and health savings accounts (HSAs). These are special types of accounts you can use on medical expenses, including for addiction treatment, where the money put into them isn’t taxable. 

While it’s important to research these options yourself, and it is often best done with the help of a financial adviser, these are easily accessible options that many people don’t take advantage of that can potentially save significant amounts of money on medical costs.

Frequently Asked Questions About BCBS Insurance Coverage