Blue Cross Blue Shield Insurance Coverage for Drug & Alcohol Treatment

Blue Cross Blue Shield insurance plans cover drug and alcohol addiction treatment, as do most standard insurance plans. The BCBS network is also quite extensive within the United States, with over 90 percent of doctors and hospitals in their network.

Does BCBS Cover Addiction & Drug Misuse Treatments?

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 plan to offer coverage for any evidence-based treatment appropriate to your needs, as determined by a medical professional. Your plan will likely cover the following:

• Outpatient therapy
• Partial hospitalization treatments
• Detox treatments
• Residential or inpatient treatment

Verifying Coverage for Addiction Treatment

It can initially be confusing to understand what is and isn’t covered through a BCBS plan, as Blue Cross Blue Shield is actually an association of independent companies, all of which carry the BCBS moniker. You can click here to better understand your benefits through a helpful interactive search tool provided by the association. 

You can also use their Find a Doctor tool to look for treatment providers within your network. While some plans allow you to get coverage for providers outside your network, this will almost always cost more than staying in-network. This tool is broadly useful for finding any kind of medical care you might need, but you can also specifically look for addiction treatment providers. 

From there, you can talk with an available provider to confirm they can take you as a patient and will accept your insurance. They can answer questions about your insurance, although you may need to contact your insurance provider directly for some queries.

The Typical Cost of Treatment

Finding the “typical” cost of addiction treatment options is fairly difficult. 

An article from Georgetown University exploring the cost of drug addiction and treatment 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. 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 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 health care 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.

Length of Treatment Covered

Your insurance should usually cover the full length of your treatment, as long as you continue to use evidence-based treatments from in-network providers and are following the recommendations of medical professionals. 

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.

References

Blue Facts. Blue Cross Blue Shield Association.

Find a Doctor. Blue Cross Blue Shield Association.

Healthcare FSA Vs. HSA—Understanding The Differences. (July 2021). Forbes.

Member Services. Blue Cross Blue Shield Association.

Substance Abuse: Facing the Costs. Georgetown University.

Supporting Your Journey to Recovery. Blue Cross Blue Shield Association.

The Affordable Care Act Transformation of Substance Use Disorder Treatment. (January 2017). American Journal of Public Health.

Understanding Your Costs. Horizon Blue Cross Blue Shield of New Jersey.