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Paying for treatment: insurance, Medicaid, self-pay — and what to ask

Most people pay for treatment with more than one source. Insurance and Medicaid must cover substance use treatment under federal law. Medicare, cash, sliding-scale fees, and payment assistance can fill the rest. Ask a facility what it accepts and what you would owe before you agree to anything.

There is rarely just one way to pay

Most people use more than one source to cover treatment. That is normal, not a sign something is wrong.

The six routes below are the ones this directory tracks. A single facility can accept several at once.

Six ways people pay for treatment, compared
RouteWho it is forWhat to check first
Private insuranceAnyone with an employer or marketplace health planWhether this facility is in your plan's network
MedicaidPeople who qualify by income or disability in their stateWhether this facility accepts your state's Medicaid plan
MedicarePeople 65 or older, or with certain disabilitiesWhether the facility takes Medicare assignment
Cash / self-payAnyone, with or without coverageThe full price, and whether a payment plan exists
Sliding-scale feesPeople whose income is limitedHow the facility sets the scale, and what proof it needs
Payment assistancePeople who cannot cover the gap another wayWhat the assistance covers, and for how long

Private insurance

Marketplace and most employer health plans must cover substance use disorder treatment. It is one of the ACA's essential health benefits. HealthCare.gov: mental health and substance abuse coverage.

A separate federal law, the Mental Health Parity and Addiction Equity Act, limits how a plan can restrict that coverage.

MHPAEA says a plan cannot set stricter limits on substance use or mental health benefits than on medical benefits. CMS: Mental Health Parity and Addiction Equity Act.

That covers things like visit limits, prior authorization, and copays. It does not guarantee zero cost.

Being in-network still matters. An out-of-network facility can cost far more, even under a compliant plan.

Medicaid

Medicaid covers substance use disorder services. States build the exact benefit into their own Medicaid plans. Medicaid.gov: substance use disorders.

What is covered, and which facilities take it, can differ by state. Ask the facility directly rather than assuming.

MHPAEA's parity protections apply to most Medicaid managed care plans too, not only private insurance.

Medicare

Medicare covers substance use treatment for people who are 65 or older, or who qualify by disability.

Not every facility accepts Medicare. Ask whether this program takes Medicare assignment before you commit.

Cash and self-pay

Paying cash works with or without insurance. Some people self-pay to avoid a claim on their insurance record.

Ask for the full price in writing, and ask if a payment plan is available. A real number beats a vague estimate.

Sliding-scale fees

A sliding scale sets your price based on income. Lower income usually means a lower fee.

Ask how the scale is set and what proof of income it needs.

Ask whether the lower fee is fixed, or whether it can still change later.

Payment assistance

Some facilities offer their own assistance, a discount, or a scholarship-style fund for people who cannot cover the gap.

Ask what the assistance actually covers, whether it is a one-time reduction, and how long it lasts.

How many facilities accept each route

The counts below come from our own directory. They are read from the database when this page loads.

These counts are read from our directory when the page loads. The read did not come back this time, so the table is not shown. Nothing is substituted for it. Reload in a moment, or search the directory directly.

A facility can accept several payment types at once, so the rows do not add up to the total.

Cash, private insurance and Medicare are the most commonly accepted routes in the directory today. Sliding-scale fees are the least common.

Questions to ask before you say yes

  • What does this cost me, after insurance or Medicaid?
  • Are you in network with my specific plan, not just my insurer?
  • Do you accept Medicaid or Medicare, and does that cover this service?
  • Is a sliding scale available, and how is it calculated?
  • Do you offer payment assistance, and what does it cover?
  • Can I get the total price and any payment plan in writing?
  • Who do I call if a bill does not match what I was told?

A program that cannot answer these clearly is worth a second look before you commit.

If you need help right now

Call or text 988 for the Suicide and Crisis Lifeline. It is free, confidential, and runs all day, every day.

Call the SAMHSA National Helpline on 1-800-662-4357 for free, confidential treatment referral, in English or Spanish.

If someone is unresponsive or cannot breathe, call 911.

Money should never be the reason someone waits to get help. Ask about payment options before you rule a place out.

How this site is paid for

Facilities pay a flat listing fee to be listed here.

The fee does not change what you see, or the order you see it in.

Nobody pays us for a referral, and nobody pays us when a person is admitted.

That is a legal line, not a preference. Federal law makes paying for a treatment referral a crime.

Common questions

Does insurance have to cover addiction treatment?

Marketplace and most employer plans must cover substance use disorder treatment as an essential health benefit under the ACA.

What is parity, and why does it matter?

Parity means a health plan cannot apply stricter limits to substance use or mental health benefits than it applies to medical and surgical benefits. It is required by federal law.

Can I use Medicaid and pay cash for the rest?

Yes. Many people combine sources. Ask the facility what each option covers and what would be left for you to pay.

What if I have no insurance and cannot pay cash?

Ask about sliding-scale fees and payment assistance. Some facilities offer both. The SAMHSA National Helpline, 1-800-662-4357, can also point you toward options.

Does aSoberBed get paid when I contact a facility?

No. Facilities pay a flat listing fee. The fee does not change what is shown, or the order it is shown in. Nobody pays us for a referral or an admission.

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Written by Brett Spain. Founder of aSoberBed. He built the treatment directory and writes the code behind it. He is not a clinician.