Rehab Centers That Accept COBRA Insurance
Inpatient rehab programs help individuals overcome addiction and other issues in order to rebuild their lives. The intensive nature of the programs, and the deep healing and growth individuals achieve during treatment, is reflected in the cost.
The cost of a rehab program is one of the biggest factors which keep people from seeking addiction treatment. For many, this cost can be greatly reduced or completely covered by private insurance plans.
For individuals who may have recently lost insurance coverage and who are considering a rehab program, this can cause some stress. One of the ways to get rid of this stress and cover addiction treatment at such a difficult time is through the use of COBRA insurance coverage.
What Is COBRA Health Insurance?
COBRA insurance is actually a continuation of a person’s individual healthcare plan. COBRA stands for Consolidated Omnibus Budget Reconciliation Act of 1985, a law passed by Congress.
This law holds that employers offering group health plans to employees must continue to offer coverage for individuals who would not be normally be covered due to situations of job loss or change.
Such situations can include layoffs, changes to employment status (such as from full-time to part-time), or termination (being fired).
How COBRA Insurance Coverage Works
Almost all group health plans are covered by COBRA. This means if you have or had healthcare coverage through a group plan offered by your employer, you are likely eligible to use COBRA.
However, COBRA does have an expiration date. Most coverage offerings range from 18 months to 36 months.
Individuals can use COBRA to cover healthcare costs, including addiction treatment, during a layoff, while looking for a new job, or during other personal situations which affect employment status and benefits.
For those looking to enter addiction treatment, COBRA provides a way to still focus on health needs even if employment has ended or changed.
While employers with 20 or more employees are obligated to offer COBRA coverage for individuals who qualify, they are not obligated to pay the employer portion of the insurance premium they would for full-time, qualifying employees.
In other words, if you lose your insurance coverage and elect to use COBRA, your monthly premium will likely be higher than it was before you lost coverage.
Once you lose your insurance benefits with your employer, they must provide you with notice of a 60-day period to elect COBRA coverage if you so choose.
Does COBRA Insurance Cover Alcohol And Drug Rehab?
COBRA Insurance covers healthcare costs to the same extent as your private insurance plan. Due to the Mental Health Parity and Addiction Equity Act of 2008, most group health plans cover addiction treatment.
If your private health insurance plan covers substance abuse treatment, then COBRA will cover the cost of your rehab program.
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Which treatments will be used during an individual rehab program depend on the rehab center a person chooses to attend and which services they need. Addiction treatment needs are typically determined by a clinical assessment prior to the start of treatment.
COBRA Eligibility Requirements
To be eligible for COBRA, an individual must have been eligible for insurance coverage on the day before a qualifying event ended their coverage.
Qualifying events for COBRA coverage include:
- resigning (quitting)
- being fired
- being laid off
- reducing work hours
Qualifying events count so long as the person did not leave their job for reasons of gross misconduct.
All individuals covered under the health insurance plan before the qualifying event will be eligible for COBRA coverage. This includes the employee, employee’s spouse, and the employee’s dependent child(ren).
Individuals whose spouse lost coverage for other reasons, such as they became eligible for Medicare, may also qualify for COBRA. Children who lose dependent child status (age out of the plan) may also be eligible.
Remember, employers are only obligated to offer COBRA coverage if they have 20 employees or more at least 50 percent of their business days in a given calendar year.
How To Use Your COBRA Insurance To Pay For Rehab
Using COBRA insurance coverage to pay for rehab can help alleviate many of the stressors associated with treatment costs.
This is especially true if you have lost a job and are dealing with the stress of that as well. In many cases, COBRA insurance will completely cover the cost of addiction treatment.
Before heading to treatment, it’s important to get a full clinical assessment to determine treatment needs. This will help treatment specialists work with you to design a rehab program that meets your individual needs.
Once you know which services you will be receiving during your rehab program, you can coordinate with your insurance provider or a treatment specialist to identify which are covered by COBRA, which are not, and what your out-of-pocket cost will be.
Many rehab centers will work with you to determine a payment plan that fits your financial situation. Some may offer plans which lift financial burdens, such as sliding scale fees.
Does COBRA Cover The Cost Of Inpatient Drug And Alcohol Treatment?
If your private insurance plan covered inpatient treatment for drug and alcohol abuse, then these rehab programs will be covered by your COBRA insurance as well. Commercial health plans differ widely, so you will need to determine exactly what was covered by your former insurance plan.
In general, private insurance plans cover anywhere from 40 to 80 percent of residential treatment costs for addiction. This means you may still have a copay. For inpatient treatment, copay amounts are usually determined by a daily fee, as in COBRA insurance will pay a certain amount per day and you will be responsible for what’s left.
The length of treatment programs covered by COBRA will also be determined by your health insurance plan. Some insurance policies will only cover short-term rehab programs, or up to 30 days of treatment.
With other plans, such as Gold tier plans, you may be able to get long-term inpatient treatment covered as long as you continue to show medical need.
Does COBRA Cover The Cost Of Outpatient Addiction Treatment?
Outpatient rehab programs are covered by COBRA insurance at the same rate as your private insurance plan. There are many different types of outpatient treatment for addiction, and coverage greatly varies among commercial insurance plans.
COBRA coverage for outpatient rehab programs may depend on whether you can meet certain requirements, such as:
- showing proof of medical need
- showing ability to participate in outpatient care without need for 24-hour medical supervision
- outpatient treatment program meets your insurance policy’s rehab program eligibility guidelines
Insurance carriers may require that outpatient programs be a certain number of hours per week and take place for a minimum number of days per week.
Many commercial health insurance providers also ask for prior authorization for treatment. This includes a medical/clinical assessment that shows the need for drug or alcohol treatment and a referral from a physician. To qualify for COBRA coverage, policyholders must meet the same requirements outlined by their former insurance plan.
Does COBRA Cover The Cost Of Partial Hospitalization Programs?
Partial hospitalization programs (PHP) provide the most intensive form of outpatient treatment for addiction and are covered by COBRA insurance. PHPs tend to occur 4 to 5 days per week, for 20 hours or more per week.
Your COBRA insurance coverage will pay for partial hospitalization if it was covered by your insurance plan. However, the PHP must qualify with your former plan. This could include being in-network with the plan, which could exclude partial hospitalization programs with certain treatment providers.
You could also be responsible for out-of-pocket costs, such as medication or other copay amounts.
Does COBRA Cover The Cost Of Intensive Outpatient Programs?
COBRA insurance covers intensive outpatient programs (IOP), which are the next level of care for addiction treatment following partial hospitalization. IOPs offer similar treatments to PHPs, such as counseling and behavioral therapy, but occur less frequently.
COBRA coverage for intensive outpatient treatment depends on your insurance policy’s coverage for IOPs. If your insurance policy requires that you have prior authorization and only attend in-network rehab centers, for example, then COBRA coverage will follow these same guidelines.
As with other rehab programs, intensive outpatient programs covered by COBRA may come with copays. Many rehab centers work with addicted individuals and their families to find payment options that meet their needs.
Does COBRA Cover The Cost Of Suboxone?
Medication-assisted treatment (MAT) involves medication to treat withdrawal symptoms, counseling, and therapy. Suboxone is used in medication-assisted treatment programs for opioid addiction and can be covered by COBRA insurance plans.
MAT programs offering Suboxone therapy can be both inpatient and outpatient, as Suboxone is often intended for long-term use of up to several months, a year, or longer if needed. To understand whether COBRA will cover Suboxone, you’ll need to review your health insurance plan’s pharmacy benefits (prescription coverage).
Does COBRA Cover The Cost Of Methadone?
Methadone is another medication used in medication-assisted treatment programs that can be covered by COBRA insurance. This medication helps curb opioid withdrawal symptoms and can help people seek long-term recovery.
As with Suboxone, methadone can be involved in both outpatient and inpatient rehab programs. Prescription coverage through COBRA will be determined by your individual plan. For this reason, it’s crucial to see which medications are covered and what your out-of-pocket expenses will be before you enter this type of program.
Does COBRA Cover The Cost Of Sober Living?
If sober living costs are covered by your commercial health plan, they will also be covered by COBRA. With some private insurance plans, transitional living facilities are a covered benefit.
Sober living homes can be covered by COBRA as a form of outpatient treatment, but coverage may depend on the state you live in.
For any questions about your COBRA insurance coverage, you can talk to a customer support representative from your insurance carrier. If you need help verifying coverage or feel overwhelmed by the process, you can also talk to one of our addiction treatment specialists who can handle this task for you.
Finding A Rehab Center That Accepts COBRA Insurance
It’s always important to have insurance figured out before heading to addiction treatment, but it’s an especially good idea to know what’s covered when using COBRA coverage.
Due to the nature of COBRA and how a person qualifies for this type of insurance, it’s best to ensure that coverage is well-established and treatment costs are covered before beginning a rehab program.
In this way, you can avoid any unnecessary stress that comes with the cost of addiction treatment, affording you the opportunity to focus instead on your recovery.
Learn more about rehab centers that accept COBRA insurance coverage by contacting us today.
Updated on July 27, 2020
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- U.S. Department of Labor — COBRA Continuation Health Coverage FAQs