Guide to COBRA Insurance Coverage for Addiction Treatment

Last Edited: December 29, 2023

Author

Matt Esaena

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Clinically Reviewed

Jim Brown, CDCA

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All of the information on this page has been reviewed and certified by an addiction professional.

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Drug and alcohol dependencies and addictions affect individuals, their families and the community. It is vital, therefore, that help is found in the form of high quality rehabilitation treatment so that those with an addiction can start to heal and get recover. If you have COBRA insurance coverage, it is likely that they will at least pay for your detox services. Getting clean of substances always starts with a period of detox, which is the opportunity to rid your body of all the toxins and chemicals that you abused. Exactly what COBRA covers, and how much of it, can vary greatly, and it is important to look into that before you go to rehab.

COBRA Insurance Coverage for Drug and Alcohol Rehab

The COBRA plan that you have will give you exactly the same coverage as what you had when you were still in an employer-sponsored plan. If that covered rehab services, your COBRA plan will as well. However, no two insurance plans are exactly the same, and this is why it can be quite confusing to figure out exactly what you are and aren’t covered for. If you are dealing with a substance abuse problem, the last thing you need is to find yourself trapped in the world of insurance jargon. You just want to know whether your COBRA plan covers you or not, what types of facilities you can go to, and whether you need to be referred or not.

You can contact COBRA directly and find out what you are and aren’t covered for. Your policy documents will highlight all of this, and you can also check on their website. You can also ask a rehab facility that you are considering to perform an insurance check for you. This is all confidential and discreet and will give you a better idea of what you can expect. This is free and no obligation and it will not affect your premiums either.

One of the important things to look into when you do an insurance check, is how long you can stay in treatment. Because every story of addiction is unique for each individual, most insurance companies no longer put a maximum length of stay on their policies. However, if you do want to stay in rehab for longer than 30 days, then it is likely that you will have to demonstrate medical necessity for this. Should your COBRA policy not cover you for longer treatment, then it is possible that the rehab facility will offer you sponsorship or point you towards a grant. They may have payment plans in place, or you could be able to apply for a loan.

COBRA Insurance Coverage for Specialty Treatment

There are a number of luxury, executive, and private facilities that offer rehab treatment as well. These facilities often have a resort-like feel to them, usually located in secluded, beautiful environments and having luxury amenities in place. Some of these amenities are:

• Private rooms
• Spa treatments
• Upscale, relaxing settings
• Exclusive treatment plans, including one on one counseling
• Extended sober living programs
• Dedicated aftercare programs
• Family involvement
• Holistic therapies like massages, acupuncture, yoga, equine therapy, and so on.

Generally speaking, few of these extra amenities are classed as a medical necessity. This means that it is unlikely that your COBRA insurance policy will pay for them. However, they may pay towards the cost of the medically necessary treatment that is offered, leaving you to fund the rest out of your own pocket. What you should look for is the treatment that you feel will work best for you, placing financing this treatment in a secondary place. If you feel that yoga classes will make it more likely for you to achieve lasting sobriety, go ahead and try to find a center that offers this.

COBRA Insurance Coverage for Inpatient and Outpatient Treatment Services

It is quite common for health plans to treat inpatient and outpatient rehab facilities very differently; generally speaking, inpatient treatment is a lot more effective. However, it is also more expensive and not everybody is able to actually leave their homes behind for the duration of the treatment. Choosing between inpatient and outpatient rehab is a difficult decision to make, and one that you should take into very careful consideration. What matters is which treatment option will be the most likely to enable you to live a sober life. It is likely that COBRA will cover more outpatient treatment than inpatient treatment, simply because it is more affordable. However, that should not be your main factor of consideration when it comes to choosing between the two.

If you find that your COBRA plan does not cover the treatment that you are hoping for, there are other options out there as well. One popular option is the treatment loan, which is now offered by many banks. Payment plans with the rehab facility are also popular, particularly because they tend to be offered on a sliding scale, so that you only pay what you can afford.

It is certainly true that the world of health insurance is a confusing one. It is challenging to find out exactly what your plan does and does not cover. However, you can be free from drugs and alcohol by doing just a little bit of research.

COBRA is Here to Help

COBRA is a unique type of health insurance that has optional self pay coverage. It is designed for people who were in employment, but whose employment ended, and who want to continue to pay into their plan. The coverage you maintain at that point will be the same as the one you had when you were still working. Whether or not you are eligible for detox and rehab services, therefore, depends on the plan that you have chosen. Sometimes, 100 percent coverage is offered for treatment. At other times, there will be a deductible or copay to contend with. You will need to be medically evaluated in order to determine whether you’re eligible for treatment or not. This evaluation will also guide COBRA in terms of determining how much treatment you may need. By calling (866) 578-7471 you can determine what your insurance plan covers to make a decision on how you will proceed with your rehabilitation.