TRUSTED CONTENTCoverage Checker by Plan Type
See what your plan typically covers for addiction treatment, what you can expect to pay, your rights, and the exact questions to ask your insurer.
What's typically covered
Your chosen level of care
Your likely cost exposure
Your rights and protections
Questions to ask your insurer
Pages for your plan
Free help understanding your coverage
The SAMHSA National Helpline offers free, confidential support 24/7 and can explain your options in English and Spanish: call 1-800-662-HELP (4357). In crisis? Call or text 988.
Browse coverage and care options
By carrier: all insurance, Aetna, Cigna, Blue Cross Blue Shield, Anthem, Kaiser Permanente, Medicare, Medicaid and TRICARE.
By level of care: detox, residential, PHP, IOP, outpatient, medication-assisted treatment and sober living, plus veterans' care.
Important: This tool provides general coverage information for planning, not a quote, a guarantee of coverage, or financial advice. Plans and state programs vary, and only your insurer can confirm your specific benefits. Always verify directly with your plan and the treatment facility.
What Different Plans Cover for Addiction Treatment
Almost every type of health coverage in the United States pays for addiction treatment, but how much they pay, and what you owe, varies a great deal by plan. The checker above gives you a tailored answer; this guide compares the major plan types side by side so you know what to expect before you ever pick up the phone.
The most important thing to know: substance use treatment is an essential health benefit, so all Affordable Care Act plans must cover it, no matter the metal tier. Across Bronze, Silver, Gold, and Platinum, the services covered are the same. What changes between tiers is not whether you are covered, but how the costs are split.
Marketplace Metal Tiers Compared
Marketplace plans are grouped into four tiers by actuarial value, which is the share of costs the plan pays on average across a standard population. A higher tier means the plan pays more and you pay less when you need care, in exchange for a higher monthly premium.
| Metal tier | Plan pays on average | Best suited for |
|---|---|---|
| Bronze | About 60% | Lowest premium; a safety net if you rarely need care |
| Silver | About 70% | Mid-range; can add cost-sharing reductions if income qualifies |
| Gold | About 80% | Higher premium; expect to use care regularly |
| Platinum | About 90% | Highest premium; lowest costs when you need care |
Share of costs the plan pays, by tier
These are averages across a standard population, not your exact bill. Whichever tier you choose, your in-network costs for covered care are capped for the year. Source: HealthCare.gov.
The Cap That Applies to Every Tier
No matter which marketplace plan you hold, federal law limits what you can pay in-network for covered care in a single year.
2026 individual cap on in-network out-of-pocket costs, across every metal tier.
2026 family cap, after which the plan covers 100% of covered in-network care.
Every tier covers the same essential health benefits, including addiction treatment.
Beyond the Marketplace: Other Plan Types
Employer plans and public coverage each have their own rules. Here is how the other major plan types handle addiction treatment.
| Plan type | What it typically covers | Your likely cost |
|---|---|---|
| Employer | Detox through outpatient plus MAT, with parity | Varies by plan; capped in-network |
| Medicaid | Detox, outpatient, MAT; inpatient in most states | Zero or very low |
| Medicare | Inpatient, outpatient, MAT, and medications by part | Deductibles and coinsurance vary |
| TRICARE | Full continuum for service members and families | Low; often zero for active duty |
| Uninsured | Self-pay, with Medicaid and sliding-scale options | Varies; often reducible |
Check your carrier: Aetna, Cigna, Blue Cross Blue Shield, Anthem and Kaiser Permanente.
Medicare, Medicaid and TRICARE, plus the full insurance directory.
Matching Coverage to Your Level of Care
Most plans cover the full continuum of care, though the more intensive levels usually require pre-authorization, meaning the plan approves the stay in advance. Here is what to expect.
| Level of care | Typically covered? | Pre-authorization? |
|---|---|---|
| Medical detox | Yes, widely | Often |
| Residential | Yes, most plans | Usually |
| PHP | Yes | Typical |
| IOP | Yes | Sometimes |
| Outpatient | Yes, most widely | Rarely |
| MAT | Yes | Sometimes |
| Sober living | Often self-pay | Not applicable |
Your Rights: Parity and Appeals
Whatever your plan type, the federal Mental Health Parity and Addiction Equity Act requires most plans that cover addiction treatment to do so on terms no more restrictive than they apply to medical and surgical care. Your deductible, coinsurance, and visit limits for substance use treatment cannot be harsher than those for a comparable physical condition. If a claim is denied, you have the right to a written explanation and to appeal, first internally with your plan and then through an independent external review. Many denials are overturned, so a first no is rarely the final answer. Your provider’s billing team can often help build the appeal.
How to Confirm Your Coverage
Identify your plan type
Your plan type and metal tier are listed on your insurance card and your plan documents. Knowing whether you hold an employer, marketplace, Medicaid, Medicare, or TRICARE plan tells you which rules apply. Enter it into the checker above for a tailored summary.
Confirm the facility is in-network
Network status is the single biggest cost lever. An in-network facility keeps your costs lower and capped. Ask your insurer directly, or compare carriers on our insurance directory.
Ask about pre-authorization
For inpatient, residential, or PHP, confirm whether the plan needs to approve the stay in advance. Skipping this step is a common reason claims are denied. The facility’s admissions team usually handles it, but verify.
Find Covered Treatment Near You
Networks and providers vary by area, so the best next step is to compare programs near you and verify them against your plan. RehabSeekers lists treatment across the country and is adding new areas regularly. Browse by region below.
Northeast
Explore New York, New Jersey, Massachusetts and Pennsylvania. In Philadelphia, see Center City, Fairmount and Manayunk, or browse Worcester.
South
Browse Florida, Georgia, Texas and Tennessee. In Atlanta, see Buckhead and Virginia-Highland; also Nashville, Houston and Louisville.
Midwest
Find care in Illinois, Ohio and Michigan. In Chicago, see Lincoln Park and West Loop; in Columbus, see German Village and Upper Arlington.
Southwest & West
Browse Arizona, Colorado, Nevada and California. See Scottsdale, Phoenix, San Diego and Los Angeles.
International
Coverage and self-pay options are also listed in London and across Spain, including Marbella, with new regions added regularly.
Specialized Coverage
Tailored care for veterans and military, young adults and professionals.
Dual diagnosis care treats addiction alongside anxiety and depression.
Frequently Asked Questions
Does a cheaper plan mean less addiction coverage?
No. A Bronze plan covers the same addiction treatment services as a Platinum plan. The difference is your cost share: lower-tier plans have lower premiums but you pay more when you use care, up to your out-of-pocket maximum.
Does Medicaid cover rehab?
Yes. Medicaid covers substance use treatment in every state, including detox, outpatient, and medication-assisted treatment, with inpatient and residential covered in most states. Costs are typically zero or very low for those who qualify.
What if I have no insurance at all?
You still have options. You may qualify for Medicaid, can enroll in a marketplace plan during an enrollment window, and many providers offer sliding-scale fees, scholarships, and payment plans. The free helpline below can point you to low-cost programs.
Free help understanding your coverage
The SAMHSA National Helpline offers free, confidential support 24 hours a day, 365 days a year, including referrals and guidance in English and Spanish: call 1-800-662-HELP (4357). If you are in crisis or having thoughts of self-harm, call or text 988.
The figures and explanations here are general 2026 information for planning purposes, not a quote, a guarantee of coverage, or financial advice. Coverage, networks, and costs vary by plan, state, and individual circumstances. Always confirm details directly with your insurer and the treatment facility.
References and Citations
HealthCare.gov. Health plan categories: Bronze, Silver, Gold, and Platinum (actuarial value). healthcare.gov
HealthCare.gov. Out-of-pocket maximum/limit (2026 plan-year figures). healthcare.gov
HealthCare.gov. Mental health and substance abuse coverage (essential health benefit and parity). healthcare.gov
SAMHSA National Helpline, 1-800-662-HELP (4357). samhsa.gov/find-help
