Can I Go To Rehab On My Parent’s Insurance?

It may be possible for you to receive addiction treatment on your parent’s health insurance plan. Millions of Americans today are living with a substance use disorder (SUD), and many use private or public health insurance plans to cover their treatment costs. This includes many children, teens, and young adults who have coverage under their parents’ private insurance plans.

When substance abuse goes untreated, it leads to increased negative mental, physical, and psychological effects, especially in young people whose brains and bodies are still developing. The good news is, many children, teens, and young adults up to 26 years of age are eligible to go to rehab on their parent’s insurance. This includes outpatient and inpatient treatment options.

Below we’ll explore the requirements for going to rehab on a parent’s insurance plan, the types of treatment services covered under insurance, some of the limitations of using insurance to pay for treatment, and alternative ways to pay for addiction care.

Eligibility For Going To Rehab On A Parent’s Insurance

The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that in 2022, the age group experiencing the highest number of SUDs was 18- to 25-year-olds, or 9.7 million people, while adolescents aged 12 to 17 have the third-highest number, with 2.2 million.

However, many people in the age group most affected by addiction, 18 to 25, may be attending college or finding their first job, which may not include benefits like health insurance. Young people still listed as dependents on their parent’s health insurance can often access those benefits to receive needed care.

Coverage Age Limit

The Affordable Care Act (ACA), passed in 2010, expanded mental health coverage for all Americans, including younger people. Under the ACA, adolescents, teenagers, and young adults can remain on their parent’s health insurance plan until they turn 26. So as long as someone is under 26, they may access mental health and substance use treatment through their parent’s policy. Once someone turns 26, they typically need to transition to their own health insurance plan.

Qualifying As A Dependent

Qualifying as a dependent under a parent’s health insurance plan allows young adults to access coverage for a range of medical needs, including treatment services for substance use and mental health issues. In most cases, there’s no requirement for proof of financial or housing dependency upon the parent to stay on their plan until age 26. As long as they are under 26 and legally their parent’s child, stepchild, or eligible foster child, they are able to be listed as a dependent and can receive insurance benefits.

State Regulations

State regulations can impact health insurance coverage for treatment services, including eligibility for young adults on a parent’s plan. While the ACA provides federal guidelines, states may have additional requirements or extended coverage options. For instance, some states allow adult children with disabilities to remain on a parent’s insurance beyond the standard age limit of 26.

Other states might mandate specific coverage minimums for mental health and substance use treatment, ensuring that more treatment services are accessible through insurance. Certain states also have stricter rules for in-network versus out-of-network coverage, which can affect the range of treatment options a person can choose under their insurance.

Types Of Rehab Services Covered Under Health Insurance

Health Services Research published an article in 2020 that looked into public and private health insurance expansion and adolescent SUD treatment, finding that many private carriers are providing more treatment than ever for younger people with SUDs. Someone interested in going to rehab on parent’s insurance should also consider what type of treatment program they require and if their insurance covers it. Depending on someone’s severity of SUD and their insurance coverage specifics, they may choose from one of many treatment options.

The three most common types of substance abuse treatment programs are:

• detoxification programs
• residential treatment programs
• outpatient rehab programs

Below we’ll explore the differences between these types of care and how likely it is that insurance will cover each type.

Detoxification

For many people, the recovery journey begins with detox. Detoxification programs provide withdrawal symptom management in a safe, secure setting. These programs tend to last only as long as withdrawal lasts, which is typically three to seven days, but in some cases two weeks. They also serve to prepare clients for the next steps in treatment, because detox alone is not considered complete treatment. Many insurance plans will fully or partially cover the cost of a detox center stay.

Live-In Treatment Options

The most sought-after type of addiction treatment is residential treatment. During these programs, clients live on site, with round-the-clock structure and support and a variety of treatment options available, such as counseling, group therapy, medication-assisted treatment (MAT), and psychoeducation. Many also feature alternative treatment methods, such as wilderness or sound therapy. Some treatment facilities also offer top-of-the-line amenities, such as gyms, spas, private rooms, and chef-prepared meals.

Residential treatment provides the most intensive and supportive environment for seeking addiction recovery, including room and board. Because of this, it’s typically the most expensive option. Public programs like Medicaid typically only cover treatment costs at less-costly facilities that feature fewer amenities. Private insurance providers may cover the cost of luxury facilities, but only for a certain amount of time.

Another live-in treatment option is inpatient treatment. This type of treatment also requires clients to live on site, but where residential treatment focuses on a client’s whole recovery experience, inpatient treatment tends to focus more on the early stages of recovery, such as detoxification and introducing clients to therapy practices. Inpatient treatment generally runs shorter than residential treatment and has fewer offerings, so it can cost less. Many insurance plans fully or partially cover inpatient treatment.

Outpatient Treatment

Outpatient treatment includes several options, and many people with SUDs receive some form of outpatient treatment during their recovery journeys. Since clients don’t live on site and fewer treatment approaches are provided, such as counseling, therapy, or group activities, the cost of outpatient treatment is less than live-in options and detoxification programs. Insurance plans, both private and public, tend to cover the full cost of outpatient treatment programs. This goes for both standard outpatient treatment (OP) and intensive outpatient programs (IOP).

Partial hospitalization programs (PHP), the most intensive form of outpatient rehab, tend to cost more because more sessions and services are provided. However, many insurance carriers will also cover the cost of PHP.

Common Challenges And Limitations

Utilizing a parent’s health insurance for addiction treatment comes with potential challenges and limitations. Young people who plan to pay for rehab this way should be ready to work within the boundaries of the provider or have other resources to get the appropriate treatment.

Pre-Authorization

Pre-authorization, sometimes called prior authorization, is a process where health insurance providers require approval before covering certain treatment services. This step is intended to ensure that treatment is medically necessary and aligns with the insurer’s coverage policies. For addiction treatment, pre-authorization may involve a review by the insurance provider to confirm that the services requester, such as a residential or outpatient program, meets the criteria for coverage.
The pre-authorization process can be complex and lengthy, often requiring detailed information from a healthcare provider, including treatment history, diagnosis, and service recommendation. This process can delay the start of treatment, but failure to obtain pre-authorization can result in partial or full denial of coverage, leaving people responsible for significant costs.

Out-Of-Network Restrictions

Out-of-network restrictions refer to limits placed by health insurance providers on coverage for services received outside their approved network of providers and facilities. For addiction treatment services, these restrictions mean that if a chosen treatment center isn’t in the insurer’s network, the coverage may be reduced or not available at all. Typically, in-network providers have pre-negotiated rates with insurers, making services more affordable. However, out-of-network facilities, while potentially offering specialized care, don’t have these agreements, which often results in higher costs. Insurance providers might still offer partial coverage for out-of-network services, but it usually comes with higher deductibles, copayments, or coinsurance.

Out-Of-Pocket Expenses

Out-of-pocket expenses are the costs people pay directly for healthcare services that aren’t covered by insurance. These expenses can include deductibles, copayments, and coinsurance fees.

• The deductible is the amount one must pay before the insurance begins to cover treatment costs.
• Copayments are set fees paid for each service or visit.
• Coinsurance is the percentage of costs that a client shares with the insurance provider once the deductible is met.

Addiction treatment, especially for substance use or mental health issues, can lead to high out-of-pocket expenses due to people needing many different types of treatment over a long period of time. Out-of-network facilities typically result in higher out-of-pocket costs, as they aren’t included in pre-negotiated rates with insurers.

What Happens If I Can’t Go To Rehab On My Parent’s Insurance?

A specific type of treatment program a younger person needs may not be covered by their parent’s insurance plan. This doesn’t mean that treatment cannot be obtained. There are several alternatives to using insurance for payment, including government funding, payment plans, and loans. Read on for more information about alternative payment options.

Government Assistance Programs

State and federal governments offer people with limited incomes, disabilities, and older and younger people help with obtaining health services, including addiction treatment. For example, Medicaid and Medicare plans offered through the government are accepted at many rehab facilities, making treatment free or very low-cost. However, the government also provides millions of dollars of funding in the form of grants. State-funded rehab centers are often fully funded by the government, offering free services for eligible clients.

Payment Assistance

Many treatment facilities realize that people with SUDs may be experiencing financial hardship or live on limited incomes. For these individuals, a facility may offer a sliding fee scale based on income level or a payment plan. Sliding fee scales mean that people who earn less pay less for treatment, while payment plans spread out the cost of treatment over a long period of time, allowing a person to get the treatment they need when they need it but not have to pay for it all up front.

Loans

Another option for younger people is seeking loans from parents or friends and family willing to help financially support their recovery. Though you will have to pay them back later on, it allows you time to focus on sobriety today, and time is of the essence when it comes to addiction recovery, helping you avoid further financial and health issues down the road. Also, loved ones often don’t charge interest, while other lenders will.

Addiction Treatment For Young Adults At Spring Hill

Spring Hill Recovery Center in the beautiful mountains of Ashby, MA, offers a healing oasis for adults of all ages seeking recovery from addiction. Through group therapy, peer support, outdoor recreation, healthy meals, and so much more, you or your loved one can find the tools and support needed for long-term recovery. We also offer fast and free health insurance verification. Please call today to learn more.