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Substance abuse is expensive, whether in terms of money diverted to fund a habit, lost productivity, or how much it costs to get treatment. Most individuals and their families cannot afford rehabilitation out of pocket, and with more and more people having to forego insurance, there is a tangible fear that paying for addiction treatment might be a bridge too far. Inpatient drug rehab is an option with no insurance, and individuals in need and their families should be aware of what is required to qualify for the appropriate plans and programs.
Even for people who had insurance plans before the drug addiction took hold, policies may expire (or be outright canceled) after job loss, criminal conviction, bankruptcy, or other problems directly caused by the excesses of the addiction. This still leaves a heavy financial burden on a family trying to pay for the best care they can get for their loved one; fortunately, there are many different ways to afford treatment without a health insurance plan, and it may even be possible to combine different strategies. Most treatment centers have a financial counselor on staff who can work with clients and their families to determine the best kind of payment program, and to set up a system whereby payments can be reliably and regularly made.
One of the most straightforward such programs is a financing plan, a simple “get treatment now, pay later” system. For people who need immediate treatment, this gets them in the door, and it gives them (and their families) time to come up with the necessary funds. This entails the treatment facility retaining the client’s financial information, to pull the prearranged amount directly from the client’s bank after a set period of time. The exact amount can be decided through a repayment plan, which is designed to fit the client’s budget after treatment has been completed.
In most financing plans, clients are given a grace period of about six months after treatment; the idea is that they can use this time to find a job and rebuild their savings, so that when the payments kick in, they have a foundation on which they can continue to pay the treatment center while still making ends meet.
Another option to pay for inpatient drug rehabilitation without insurance is through scholarships and grants. The Substance Abuse and Mental Health Services Administration offers grants that patients and their families can apply for that will fund an inpatient treatment stay if the patient or their family doesn’t have any insurance or any other option to pay for the help. Scholarship funds usually come from a foundation or nonprofit organization, and some treatment facilities offer scholarships themselves. This kind of money comes through fundraising events and donations.
Various scholarships and grants are made available to certain at-risk populations and demographics, such as women, pregnant women, children, low-income families, families from ethnic minority backgrounds, etc. These lines of funding may also be available for people who have demonstrated a willingness to sincerely work on their sobriety, but who struggle because of socioeconomic problems that make consistent treatment more difficult. As with all forms of funding rehab treatment, there is a lot of paperwork, so it is important for a prospective client to research if they can qualify for certain grants and applications; that information is usually made available online (e.g., through the Substance Abuse and Mental Health Service Administration’s website and/or through the treatment center).
It is no secret that inpatient drug rehab can be very expensive, and many addiction treatment centers are sensitive to the financial needs of their clients. The sliding scale system is a fee structure that is based on the patient’s ability to pay; based on an evaluation, the patient will be required to pay only what they can reasonably afford. The evaluation will examine the patient’s expenses, household size and income, as well as any outstanding debts or loans that have to be repaid. Patients with a significant financial burden, or those who qualify as low-income, will not be expected to pay as much as patients who have more assets and savings.
The evaluation conducted by the center’s financial counselor will also determine if clients qualify for a loan or line of credit that is specifically designed for mental health treatment; this can offer additional opportunities to help clients pay for their treatment.
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Government programs, like Medicaid and Medicare, exist on the federal and state level to provide free or low-cost addiction treatment for patients who do not have their own insurance programs. Each program has its own requirements for eligibility, and they may cover all of the treatment costs or only part of the total fee. The policies and rules for Medicare and Medicaid differ across state borders, and coverage guidelines can change every year. Some people who were turned down for either program may find themselves eligible in the future.
Medicaid is the public insurance system for low-income families (defined by a specific income bracket). The Affordable Care Act of 2010 added basic drug and alcohol rehabilitation to Medicaid coverage. While this means that many people are eligible to get an inpatient stay through Medicaid, not all treatment facilities will accept Medicaid to cover their services. The Substance Abuse and Mental Health Services Administration has a list of which rehabilitation centers across the country are compatible with Medicaid. Under the terms of the Affordable Care Act, a person has to earn less than 133 percent of the federal poverty level ($24,600 for a family of four in 2017) in order to qualify for Medicaid coverage. A patient who earns above the federal poverty level can still receive government insurance coverage, depending on their income bracket.
The Medicare program is available to anyone 65 and older and/or who has a disability. There is a monthly premium that comes with Medicare, which is based on the patient’s income; like a sliding scale, it requires reduced payments from someone who earns less (again, based on their income bracket and other necessary expenses). As with Medicaid, Medicare is set up to cover the costs of inpatient drug rehabilitation. The program comes in four parts, and the first part specifically addresses insurance for hospital stays. Medicare Part A covers 60 days of treatment without a co-insurance payment; patients using their Medicare coverage must pay a deductible. Medicare covers 190 days, and no more, of inpatient care across a patient’s entire life.
Parts B, C, and D of Medicare address outpatient care, private insurance, and prescription medications, respectively.
Even beyond these options, there are a number of different ways to afford inpatient drug rehabilitation without insurance. In the age of social media, some people have crowdfunded their mental healthcare; per Glamor magazine, a woman told the story of her post-traumatic stress disorder and anxiety online, and “received 134 donations from friends, family, and complete strangers,” enough to fund the Eye Movement Desensitization and Reprocessing and neurofeedback treatment she needed for recovery. The president and CEO of the Brain & Behavior Research Foundation told the magazine that the crowdfunding success story hints at the “very big problem with access to care” that millions of people face. Insurance companies often put up barriers to treatment; the level of care may be beyond what the companies are willing to cover, or the reimbursement may be too low, and families and patients are left to shoulder the financial burden themselves.
Advocates hope that crowdfunding therapy, while still in its infancy, will also help to erode the stigmas that still exist toward substance abuse, mental health therapy, and the “low-income” tag. A psychiatrist and professor at Harvard Medical School said that it is “overall terrific that people who need help can use crowdsourcing to collect the resources that they need financially,” but cautioned that for patients struggling with self-esteem issues, exposing their vulnerabilities to the online world could be a double-edged sword. In general, however, being honest with close friends and loved ones is healthier than to “suffer in silence alone,” and a crowdfunding campaign can dispel some of the latent shame that comes from having to ask for financial help. One woman who went public about her need for therapy raised over double her requested amount; another raised $13,000 after her story was shared over 2,000 times.
The topics of money and insurance when discussing inpatient drug rehab can seem like an insensitive distraction; the substance abuse of a loved one is a delicate subject to begin with, and issues related to affording treatment can make a difficult process exponentially more heartbreaking. It is all too easy for people to avoid rehabilitation entirely because they have no insurance, and even treatment facilities have, in the past, been slow and hesitant about starting the conversation about payment. However, dealing with the financial realities of inpatient drug treatment is important – not only to ensure that treatment is properly settled, but also for the peace of mind and empowerment that come from taking care of a big first step in recovery.
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