Is Sober Living Covered By Insurance? Here’s What You Need To Know

Is Sober Living Covered By Insurance? Here’s What You Need To Know.

So, you’ve decided to go the sober living route and get your life together after years of substance abuse.

That’s awesome! Now you need to figure out how you’re going to afford it.

Is sober living covered by insurance? And if so, what kind of insurance?

Before we continue, please read;

The short answer to both questions is yes, but this article will get into the details of how to make that happen for you.

What is Sober Living?

If you or a loved one has struggled with addiction, one thing is for sure: You’re well aware of what insurance doesn’t cover. Often people in early recovery wonder about whether their addiction treatment and sober living programs are covered by their insurance.

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The short answer is maybe, but there are some key details that can affect your benefits. Read on to learn more about what a sober living home is, how it differs from other addiction treatment programs, and how insurance coverage can impact these treatment choices.

Is Sober Living Covered By Insurance?

Yes and no. There is a lot of confusion about whether sober living is covered by insurance, so let’s start with an overview of how private health insurance generally works in the US.

In short, people under 65 who buy their own health insurance policies usually pay a flat rate every month (called premiums), which they can use to access all kinds of care (from primary doctor visits to prescription drugs) from any provider.

People over 65 rely on Medicare, which covers all kinds of health care without copays or premiums—except for long-term services like rehab and nursing homes.

Why Insurance Companies Don’t Cover Sober Living

The Affordable Care Act mandates that insurance companies provide mental health treatment which can be the treatment of substance abuse disorders.

That said, sober living homes provide a safe place for people recovering from addiction to stay sober, but they are not a rehab facility.

Thus, they’re not covered by insurance. Insurance should cover treatment with therapists which patients need to continue even after rehabilitation.

How Does a Health Insurance Company View Sober Living Facilities?

If you’ve got a serious drug or alcohol problem, your health insurance provider may be hesitant to cover treatment at a residential facility. Many providers don’t consider inpatient and outpatient care medically necessary if it doesn’t directly relate to your substance abuse.

While your insurer might not cover rehab, there are some ways to work around their restrictions so you can get clean and sober safely. But it’ll take research on your part, as well as persistence and patience with healthcare professionals.

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Your best bet is to approach your provider directly about their coverage for residential addiction treatment. The more you know about coverage limitations up front, then better equipped you’ll be when you do have questions—and potentially run into roadblocks—along the way.

Do Health Insurance Companies Have to Cover the Cost of My Stay in a Rehab Facility or Sober Living Environment?

Many insurance companies cover addiction treatment, but make sure to call your provider and ask. Most health plans include coverage for inpatient alcohol and drug rehab treatment at specific facilities (this is called a carve-out benefit), but whether or not that includes intensive outpatient services or residential/inpatient care depends on each individual plan.

Be prepared to pay up front for any non-covered services (you’ll typically have a co-pay of around 20% to 40%).

Some common questions you can ask your health insurance provider include:

  • How much does outpatient detox cost?
  • Is short-term residential treatment covered by my plan?
  • Am I eligible for any special waivers or subsidies, like those offered by private insurers in Oregon, Rhode Island, and New York?

Why Don’t Health Insurers Offer Coverage For Long-Term Alcohol Rehab Programs (I.E. Intensive Outpatient Treatment)?

The answer to that question depends on who you ask. Some people say it’s because health insurers are greedy and don’t want to spend more money than they need to; others say it’s because insurance companies lack a unified vision of what long-term alcohol rehab programs should look like, which leaves them unable to provide any coverage at all.

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How Can I Finance My Stay at an Alcohol Treatment Facility Without Private Health Insurance Company Coverage?

Many people find themselves wondering how they will finance their recovery. While some facilities offer very affordable rates, many others do not.

If you don’t have private health insurance coverage, there are still financing options available to you – and finding those options can be a good first step in your recovery journey.

Most alcohol treatment programs require insurance verification prior to admittance and most major credit cards also require insurance verification for payments made out-of-pocket.

For these reasons, you will need an alternative solution that does not include insurance as a source of payment for your stay at an alcohol treatment facility.

Options such as CareCredit® Flexible Payment Plans or Secured Credit Cards are a great way to help finance your rehab without relying on insurance coverage or private health funding from family members.

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