Illinois Insurance Options for Drug Rehab
If you or someone you love is suffering from drug addiction, you are not alone. According to the National Survey on Drug Use and Health (NSDUH), during 2016, approximately 28.6 million people over the age of 12 living in the United States said they had used some type of illicit drug within the 30 days prior to responding to the survey. Thousands of these people live in Illinois.
If you are in this category, do not wait to get treatment. The risk is too great. More than 5,500 Illinois residents die every year due to the use of drugs or alcohol. Thousands more die in accidental deaths related to drug or alcohol use. In fact, 5 percent of all deaths in the state are somehow related to drug or alcohol use.
Although the most commonly abused drug is marijuana, prescription painkillers come in second followed by other drugs such as methamphetamine, cocaine and heroin. Between 2000 and 2013, use of heroin in the U.S. quadrupled with nearly 45,000 deaths in 2013 attributed to a drug overdose.
You may be concerned that treatment is too expensive, but If you have state-funded health insurance or health insurance through your employer, it is likely your insurance will pay for all, or at least part, of your drug rehabilitation treatment. Federal and Illinois laws work together to require insurers who offer medical benefits to also offer drug abuse treatment under the umbrella of behavioral health benefits.
Illinois Law Relevant to Substance Abuse Insurance Benefits.
Substance abuse treatment is classified in health insurance policies under the heading of behavioral health benefits. Federal and Illinois state laws require a parity with medical benefits and behavioral health benefits. This essentially means fairness. Insurers have to have the same co-pays, deductibles, and out-of-pocket expenses for drug rehabilitation as they do for medical benefits.
On January 1, 2014, under the Affordable Care Act (ACA), insurance plans were required to provide coverage for substance abuse disorder treatment. Illinois has a stricter standard and mandates employers of more than 50 employees to provide minimum benefits for drug rehabilitation. It also requires:
- Employee health insurance benefits offered by state and local government to also provide drug rehabilitation treatment.
- Medicaid and CHIP plan to also cover drug rehab.
- Coverage for each calendar year to equal a minimum of 45 days of inpatient days and 60 days of outpatient days.
- People with an addiction problem cannot be denied insurance coverage or treatment.
- The law also prohibits insurers from having a different standard for determining “medical necessity” decisions other than those established by the American Society of Addiction Medicine.
There are other legal requirements that may be relevant for each individual or group plan. You need to check your policy carefully to determine what specific coverage you have.
Illinois Health Insurance Plans That Provide Drug Rehab Coverage
Most people obtain health insurance from their employer. Even if an insurer offers a plan through one employer, it may not be the same as the plan another employer provides that is issued by the same company. Employers of large companies often have policies with more comprehensive coverage than smaller groups since there are more people insured among which to spread the risk.
If your insurer is a Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO), you will likely be required to seek treatment at an in-network facility. Some exceptions may be made depending on the policy and your individual needs.
An overview of companies that provide medical and drug rehab benefits in Illinois include:
Aetna has at least 15 different health insurance plans available to those in Illinois. Aetna AARP provides coverage for those on Medicare; however, Medicare does not cover drug rehabilitation, but if you have a Medicare Advantage plan, it might provide coverage. Review your Advantage Plan benefits to find out.
Assurant is the parent company of Time and offers plans under both the Assurant name and the name Time. Plans are provided for employer groups, both large and small and for individuals and their families. Time also offers Short Term coverage for those who need comprehensive coverage for a short period of time.
This is the largest insurance company in the state. It offers group policies as well as individual policies. They generally offer good coverage for drug rehab.
This company concentrates on individual and family plans. The plans are not offered by employers.
CoventryOne/Group Health Plan Health Insurance
This company provides coverage for businesses, labor unions, and other organizations. It has some individual policies, but mostly group insurance. If you have insurance through your union, this is likely your insurer.
This is one of the largest insurance companies in the country. Although its focus is on group plans for employers, they also have individual policies.
John Alden Life Insurance
This company has been selling health insurance since 1961 and is part of Assurant. This company has individual plans as well as plans for small groups.
United Security Life and Health
You may have an individual plan through this company. Its plans are not offered to employers.
This provides group health coverage to employees. Under its Golden Rule Insurance Company, it also provides coverage to individuals and families.
World Insurance offers individual and family policies but does not sell group insurance to employers.
What Types of Coverage to Look For in Your Policy
Although the type and amount of coverage you have will likely influence your decision on the type of treatment you seek, you need to consider several other factors. Check your policy carefully to see if these treatments are covered and if so, are there any limits to how much coverage you have.
Some types of Illinois drug rehab include:
- Detox. This is a process, done under medical supervision, where your body is rid of all of its toxins and chemical substances leftover from the drug or drugs you were abusing. With medical care, withdrawal symptoms, such as sleeplessness, seizures, vomiting, and panic attacks, may be minimized or alleviated.
- Inpatient program. This is the highest level of rehab and involves a minimum of a 30-day stay at a rehab facility and may be up to six months or longer depending on the severity of your addiction. If your insurer provides coverage, Illinois law requires it to cover you for a minimum of a 45-day inpatient stay at a rehabilitation center.This is also referred to as “luxury care.” It is the most expensive, but includes everything from detox to rehabilitation, with care for medical, psychological and physical problems as well as providing a good peer support throughout treatment which may continue on after your discharge. It is often located in a peaceful, serene location and offers after-care support as well.
- Outpatient program. You will attend an out-patient program for a certain number of days a week for a certain number of hours each day. This may be for you if you hope to continue working while focusing on your rehabilitation. The drawback is that you will face greater temptation to begin using your drug when you are away from your support system and back in your home routine.
- Holistic care. Holistic care focuses on diet, exercise, meditation, and other modalities designed to discover the reasons for the addiction and treat the whole person, not just the addiction.
- Dual diagnosis treatment. If there is a mental health component to the addictive behavior, choose a program that will address both of your problems. This will make for a better outcome.
- Medication. Depending on the drug you are addicted to, there may be some medications that help in recovery and prevent relapses. They are primarily used for opioid or alcohol addiction. They are also used to treat a condition that is co-occurring with the addiction.
- Counseling. If the substance abuse issue was triggered by a traumatic event, either recent or sometime in the person’s history, or you have issues you need help with, counseling may be necessary.
Ultimately, of course, the decision of seeking Illinois drug rehab treatment and deciding on what the best treatment is for you is on your shoulders. Whether you are seeking help for yourself or for a loved one, you need to carefully review your insurance policy, or call your insurer, to determine exactly what is covered. Then, you will have a clearer picture of your options and be able to make an informed decision about your future.