February 26, 2024

Getting Addiction Treatment with a High-Deductible

The high out-of-pocket costs can be a significant barrier to accessing the treatment needed to achieve recovery.

Getting into Addiction Treatment with a High Deductible

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Table of Contents

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Susana Spiegel

Recovery Writer and Advocate

Last Update on February 29, 2024

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Individuals with high-deductible health insurance plans face considerable challenges when seeking addiction treatment. The high out-of-pocket costs can be a significant barrier to accessing the treatment needed to achieve recovery. However, there are strategies for managing deductibles and finding affordable care. Understanding one’s insurance coverage, evaluating financial options, and tapping into assistance programs can make treatment possible, despite the obstacles.

Understanding High-Deductible Health Plans (HDHPs)

High-deductible health plans require the policyholder to pay a specified amount out-of-pocket before insurance coverage for services kicks in. Deductibles typically range from $1,400-$7,000 per individual. The policyholder must pay medical expenses out-of-pocket until they meet their annual deductible. HDHPs often have lower monthly premiums but lack first-dollar coverage offered by traditional insurance plans.

About 30% of Americans insured through their workplace have enrolled in HDHPs. These plans can impact one’s decision and ability to pursue needed care due to high initial out-of-pocket costs. When it comes to addiction treatment services, failing to access care can have devastating personal and societal consequences.

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How Common Are High Deductible Health Plans?

Up to 30% of Americans with employer-based insurance are now enrolled in High-Deductible Health Plans (HDHPs), a dramatic increase in the last decade, presenting new challenges for affording care

Evaluating Addiction Treatment Options

Addiction treatment services range from outpatient counseling to luxury residential rehabilitation programs. Depending on medical necessity criteria outlined in one’s health plan, treatment options may include:

  • Detoxification: Medically managed acute withdrawal under the supervision of addiction specialists, offered in hospitals, detox centers, or residential programs.
  • Inpatient Rehab: Short to long-term residential treatment including medical care, therapy, counseling, and recovery education.
  • Intensive Outpatient Programs (IOPs): Structured therapy 3+ hours/day multiple times per week while living at home.
  • Outpatient Counseling: Individual and group therapy 1-2 hours per week in an outpatient setting.

Assessing the right level of care requires balancing treatment needs with insurance limitations. Choosing an in-network facility when possible is wise. Still, higher quality care may exist out-of-network, so comparing all options is important, taking into account varying deductibles for each tier.

Financial Strategies for Managing High Deductibles

Those with HDHPs can take proactive financial steps to prepare for meeting higher deductible requirements:

  • Calculate Anticipated Costs: Understand expected out-of-pocket costs for the treatment option(s) selected based on insurance coverage details.
  • Budget & Save: Based on quotes from treatment providers, develop savings goals and budgets adjusting living expenses if possible.
  • Leverage Accounts: Fund Health Savings Accounts (HSAs) or Flexible Spending Accounts (FSAs) to reserve pre-tax money for healthcare costs.
  • Explore Direct Payment: Discuss cash pay discounts or payment plans offered by the treatment facility to manage out-of-pocket costs.

Navigating Insurance and Treatment Costs

Work closely with your insurance provider and the treatment facility’s finance department to navigate coverage details. Be an empowered, informed consumer by:

  • Verifying Benefits: Confirm coverage amounts for services at in and out-of-network facilities.
  • Negotiating Rates: Compare pricing and discuss fee reductions or sliding scale options at given providers.
  • Appealing Denials: If certain services are denied, work with providers to submit additional info to justify medical necessity.

Looking Beyond Insurance

Several resources exist for financial aid including scholarships, charity care programs, private grants, and government funding sources:

  • State Funding: Medicaid, mental/behavioral health programs
  • Federal & Non-Profit Grants: SAMHSA, Recovery Resource Hub, Shatterproof
  • Hospital Charity Care: Income-based fee reductions offered by some hospital systems.

Exploring these options takes effort but can significantly offset out-of-pocket treatment costs.

Practical Steps to Begin Treatment

To expedite accessing addiction care with a high deductible:

  • Verify Insurance Benefits & Out-of-Pocket Projections
  • Communicate with Loved Ones About the Treatment Plan
  • Contact Facilities to Explore Financing Options
  • Schedule Assessments & Pre-Admission Testing
  • Request Time Off Work and Make Care Arrangements for Dependents

Entering treatment is a challenging time. Seeking support from others and creating organizational and self-care strategies can ease the stress.

Pursuing Treatment Through Financial Barriers

The obstacles posed by high-deductible insurance for addiction treatment may seem overwhelming. However, taking strategic financial steps and utilizing available resources can significantly minimize out-of-pocket expenses. Facilities like Cornerstone Healing Center offer customizable treatment programs while working with patients on managing costs through payment assistance. Most importantly, one’s health and life depend on obtaining quality, timely treatment. By persevering through the financial roadblocks, with the help of treatment providers, achieving recovery is possible.

Navigating addiction treatment costs is complex, but support exists. Taking an informed, proactive approach, aided by treatment centers focused on affordability and financing options, clarifies the path to access care and maintain recovery goals.

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Author & Reviewers

susana spiegel recovery writer and SEO expert
RECOVERY WRITER & ADVOCATE

Susana is a recovery writer and advocate with over 8 years in addiction recovery. She is passionate about sharing accurate and helpful information about mental health, addiction, and recovery. She holds a Bachelor’s in Christian Studies from Grand Canyon University and has over 7 years of working in the addiction field. 

lionel estrada lisac clinical director
CLINICAL DIRECTOR & REVIEWER

Lionel is the Clinical Director of Cornerstone’s Scottsdale treatment facilities. He has had over 4 years at Cornerstone. He is personally in recovery and passionate about helping others overcome substance abuse and mental health challenges; he is trained as an EMDR, adopting a trauma-informed approach to treat the underlying issues.

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