CareFirst Insurance Coverage for Drug & Alcohol Treatment

Does CareFirst Cover Addiction & Drug Abuse Treatments?

All CareFirst plans are ACA-compliant and cover addiction and drug misuse treatments. CareFirst’s website outlines the best way to receive in-network treatment services, including these:

• Individual and group therapy
• Counseling services
• Community-driven addiction help
• Drug and addiction education for you and treatment providers

Verifying Your Coverage

The process of verifying your insurance coverage is typically similar regardless of the specific treatment provider or plan. 

First, find a treatment provider and determine if they are in your plan’s network. You can either ask them directly or look on CareFirst’s site for in-network treatment providers before selecting one. 

Once you know they accept your insurance, you can typically assume treatment will be covered as long as you go with the recommended treatment options. If you’re unsure, contact your insurance provider directly and ask about the treatment option you want to get covered. If you’re making this call, make sure to have as much information about the treatment provider available as you can.

Typical Cost of Addiction Treatment

The National Center for Drug Abuse Statistics (NCDAS) claims the average cost of drug rehabilitation per person is $13,475, although the cost per treatment episode varies widely depending on the type of treatment one engages in. It’s also worth noting several of their estimates are based on 2006 data, with costs then adjusted for inflation. However, the numbers they provide can be a helpful starting point, as estimating the typical cost of drug treatment is often difficult, and not much data is available on the topic.

These costs aren’t typically what a person would pay with insurance, as a significant portion of drug treatment can be covered as long as you’re taking advantage of your insurance plan. CareFirst provides a helpful treatment cost estimator through their account system to further refine what you can expect in terms of your treatment costs.

Plan Options

CareFirst offers health insurance plans using a similar system to the one used by many other insurance providers. Plan types include the following:

Health Maintenance Organization (HMO)

Plans of this type only cover services from in-network providers. Only out-of-network emergency services will be covered. The main benefit of these plans is usually a lower premium.

Preferred Provider Organization (PPO)

These plans are the most flexible CareFirst offers, allowing you to use in-network providers and out-of-network providers, at a higher but still covered cost. The main benefit of these plans is the ability to get out-of-network costs covered at least partially.

Catastrophic Plans

Catastrophic plans are low-cost plans with low premiums but high deductibles. While these plans can be useful for some individual medical needs, these are not generally a good option for the purpose of addiction treatment and similar service coverage.

Metal Tiers

CareFirst plans use the same metal system as most other insurance companies for rating the benefits a plan provides. 

Bronze plans offer a 40 percent coinsurance rate. They are generally the weakest plans on every metric except the premium to keep them active. 

On the opposite end of the spectrum are Platinum plans, which have the highest premiums but an excellent 10 percent coinsurance rate and the lowest deductibles. 

The best plan for you will depend on your medical needs, but many people can get most of what they need from Silver or Gold tier plans.

In-Network vs. Out-of-Network Coverage

In-network treatment is almost always cheaper than out-of-network treatment of the same level, even with a high-graded PPO plan. This makes logical sense. Insurance providers are able to provide better rates for treatment coming from providers who work with them and with whom they have developed a stronger business relationship. 

Because addiction treatment services can already be one of the more expensive types of treatment, it’s generally recommended that you stick with in-network providers unless you can afford it and have a specific reason for choosing an out-of-network provider. Even if your plan covers some out-of-network costs, staying in-network can often mean hundreds or thousands of dollars in savings.

Length of Treatment Covered

As long as your plan remains active, CareFirst plans should generally cover the entire length of any treatment they’ve already accepted as medically necessary and provided coverage for. 

Complications are possible with any insurance company, but addiction treatment is evidence-based and at least partially protected by the Affordable Care Act, with CareFirst openly discussing its importance on its website.

Covering Out-of-Pocket Costs

Even with good insurance coverage, addiction treatment can admittedly represent an unexpected expense. You may need to be strategic to lessen the financial burden. 

Some common strategies to help make care more affordable include the following:

• Get a loan from friends or family members.
• Get a medical loan or financing from a treatment provider or loan company. This allows you to pay treatment off gradually once you are firmly in recovery.
• Look for ways to reduce your monthly expenses to save money.
• Sell unneeded items around the house to raise funds.
• Start a GoFundMe or similar crowdfunding campaign. This approach is becoming more common for those seeking addiction treatment.