Most Inpatient Rehab Facilities Require PPO Insurance.
Here's What to Do if You Don't Have It.

The Insurance Gap in Addiction Treatment

Every year, millions of Americans who need inpatient addiction treatment discover a painful reality: their insurance won't cover it. According to SAMHSA's National Survey on Drug Use and Health, only about 10% of people with a substance use disorder receive any form of treatment — and lack of insurance or inadequate coverage is consistently cited as the top barrier.

The problem is straightforward. Inpatient residential rehab — the level of care most effective for moderate-to-severe substance use disorders — is expensive. A 30-day program typically costs $10,000 to $30,000. The facilities that provide this care need reliable reimbursement, which is why the vast majority accept PPO insurance but not HMO, Medicaid, or self-pay at reduced rates.

Why PPO Insurance Matters for Rehab

PPO (Preferred Provider Organization) plans are preferred by treatment facilities for a specific reason: they offer out-of-network benefits. This means a facility in Florida can treat a patient with a PPO plan from New Jersey without needing a direct contract with the insurer. The plan pays a percentage of the "reasonable and customary" charges regardless of network status.

HMO (Health Maintenance Organization) plans, on the other hand, typically require you to stay within a specific network and get referrals from a primary care physician. Most HMO networks do not include residential addiction treatment facilities. Medicaid, while covering substance abuse treatment in all 50 states, has reimbursement rates so low that many private residential facilities cannot accept it.

The result: if you need inpatient treatment and have an HMO, Medicaid, or no insurance, you face a significant access gap.

Your Options If You're Uninsured or Underinsured

Option 1: Enroll in a PPO Plan

If you can wait a few days for coverage to begin, enrolling in a PPO plan through the ACA marketplace or a private insurer is often the most cost-effective path to inpatient treatment. Monthly premiums for PPO plans with behavioral health coverage typically range from $300 to $800 depending on your age, location, and income level. Many people qualify for subsidies that reduce this significantly.

A licensed health insurance broker who specializes in behavioral health coverage can identify the fastest enrollment path — including Special Enrollment Periods you may qualify for even outside of the annual open enrollment window.

Option 2: State-Funded Treatment Programs

Every state receives federal block grant funding through SAMHSA to provide substance abuse treatment to uninsured residents. Wait times vary significantly — from days in some states to weeks or months in others. Contact your state's substance abuse authority or call the SAMHSA National Helpline at 1-800-662-4357 for referrals to state-funded programs.

Option 3: Facilities with Sliding-Scale Fees

Some treatment centers offer reduced rates based on your ability to pay. These programs typically require financial documentation and may have limited availability. Use the SAMHSA treatment locator at FindTreatment.gov and filter for "payment assistance" to find facilities near you.

Option 4: Medicaid + Supplemental Coverage

If you currently have Medicaid, you may be able to add a supplemental PPO plan during qualifying enrollment periods. This gives you access to the broader network of residential treatment facilities while maintaining your Medicaid benefits for other healthcare needs.

How Insurance Enrollment Works for Treatment

The process of getting insured specifically for addiction treatment is faster than most people expect. Here's what typically happens:

Step 1: Assessment. A licensed insurance advisor reviews your current coverage (if any), your state of residence, your income level, and any qualifying life events that might open a Special Enrollment Period.

Step 2: Plan selection. The advisor identifies PPO plans available in your area that specifically cover inpatient residential treatment, medical detox, and medication-assisted treatment. Not all PPO plans are equal — behavioral health benefits vary significantly.

Step 3: Enrollment. Once you select a plan, enrollment can often be completed the same day. Coverage effective dates depend on when in the month you enroll, but some plans offer coverage within 1-15 days.

Step 4: Verification. Before entering treatment, the advisor confirms your benefits directly with the insurer — verifying covered services, authorized duration, deductible status, and facility eligibility.

Questions to Ask About Your Insurance Coverage

Whether you already have insurance or are considering a new plan, these are the specific questions to ask about addiction treatment coverage:

Does the plan cover inpatient residential treatment, or only outpatient? What is the maximum number of covered days for residential treatment? Does the plan require pre-authorization for substance abuse treatment? Are there in-network residential treatment facilities near me — and if not, what are the out-of-network benefits? Is medication-assisted treatment (MAT) covered? What is my deductible, and has any of it been met this year?

If you're not sure how to get answers to these questions, our treatment advisors can run a free insurance verification for you, or you can speak with a licensed insurance broker for help understanding your options.