Is Inpatient Drug Rehab an Option with No Insurance?


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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, and with unemployment at a record high, 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 through your job, 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.

Medicare and Medicaid

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% of the federal poverty 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. 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.

COBRA Health Benefits After Job Loss

As the rate of job loss continues to climb in this country, the number of people who are losing their employee-sponsored health insurance plan is also skyrocketing. However, the Consolidated Omnibus Budget Reconciliation Act, also known as COBRA, can provide you with the same insurance coverage you previously had, creating an opportunity to attend addiction treatment with insurance.

A word to the wise, however: you’ll be responsible for covering the entire cost of your insurance plan. Before, your company likely covered a percentage of it. This means, however, that’ll you’ll be able to see your same doctors as you were before you lost your job. And it means you can potentially have insurance cover at least some of the cost of your addiction treatment.

Mental health and substance abuse treatment are considered essential benefits with health insurance under the Affordable Care Act. Just make sure the program or facility you choose is covered by your insurance.

You can find out information about how COBRA works online, and you can also find out what your insurance covers by calling the number on your health insurance card.

Scholarships and Grants

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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).

Sliding Scale

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.

Financing: Get Treatment Now, Pay Later

One of the most straightforward such programs is a financing plan. 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.

Be considerate of interest rates, however, and only consider this way of payment if you can afford the monthly payments later.

Affording Inpatient Drug Rehab without Insurance

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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About The Contributor

Editorial Staff
Editorial Staff

Editorial Staff, American Addiction Centers

The editorial staff of Oxford Treatment Center is comprised of addiction content experts from American Addiction Centers. Our editors and medical reviewers have over a decade of cumulative experience in medical content editing and have reviewed... Read More