When to Go to Rehab to Maximize Your Insurance Benefits

If you’re thinking about getting sober, one of the first factors to consider is the cost. Most programs offer financing options, and many accept insurance to help cover payment. If the facility you’re considering falls into this category, it’s wise to plan when to go to rehab around whether or not you’ve met your deductible — often at the end of the year. 

Navigating insurance can be tricky, though, as the process isn’t always easy to understand and often leaves you with more questions about your policy than answers. In this post, we break down everything you need to know about meeting your deductible to maximize your insurance benefits and minimize the amount you pay out of pocket.

How to Meet Your Deductible

Meeting your deductible is a key part of maximizing your insurance benefits for drug rehab or any healthcare service. Here’s how it works and what to keep in mind:

1. Understand the Deductible

Your deductible is the amount of money you must pay out-of-pocket for covered healthcare services before your insurance begins to share the costs. For example, if your deductible is $2,000, you’ll need to pay that amount for your rehab treatment services before your insurance starts covering a percentage of the costs.

2. Track Your Costs

Each time you pay for medical services, the amount you pay counts toward meeting your deductible. This can include things like doctor’s visits, lab work, or medication costs related to your treatment. It’s important to keep track of what you’ve already paid, as this will determine how much more you need to pay before insurance starts covering more.

3. Choose In-Network Providers

Insurance plans often have different deductibles for in-network and out-of-network providers. To make meeting your deductible more manageable, choose in-network treatment centers. These providers have agreements with your insurance company to offer services at a reduced rate.

4. Confirm Coverage with Your Insurer

Contact your insurance provider to confirm how your payments for drug rehab services will apply toward your deductible. This can help you ensure that everything you’re paying for is counted appropriately.

5. Monitor Your Progress

You can reach out to your insurance provider to get updates on how much of your deductible has been met. This will help you manage any further costs and ensure you’re on track to have more costs covered by insurance.

Do I Have to Meet My Deductible Before Treatment?

You don’t necessarily have to meet your deductible to get insurance to help pay for your treatment, but it depends on your insurance plan. Once you pay the amount of your deductible, your insurance will typically start covering a percentage of the remaining treatment costs. 

Here’s how it typically works if you haven’t met your deductible before entering treatment:

• Pay the Deductible: You pay the full cost of your treatment until you’ve met your deductible amount. 
  • Example: If your deductible is $2,000, you’ll pay that $2,000 out-of-pocket for your treatment.

• Insurance Kicks In: After you meet your deductible, your insurance will begin to cover a percentage of the remaining treatment costs. This is referred to as coinsurance. 
  • Example: If your plan covers 80% of the cost, you would pay 20% of the remaining costs after your deductible is met.

• Continued Coverage: Your insurance will continue to cover that percentage (e.g., 80%) until you reach your out-of-pocket maximum, at which point it would typically cover 100% of the costs for the rest of the year.

What if You Meet Your Deductible Before Treatment?

If you’ve already met your deductible before entering treatment, the process is different because your insurance will start covering a larger portion of your treatment costs. Here’s what happens:

Insurance Pays a Larger Share

Once you’ve paid enough to meet your deductible, your insurance will begin to pay a higher percentage of your treatment costs. 

Using the previous example: If your deductible is $2,000 and you’ve already met it, your insurance might start covering 80% of any further costs, leaving you responsible for only the remaining 20% — this is your coinsurance amount — until you reach your out-of-pocket maximum.

Once you’ve paid your coinsurance up to your out-of-pocket maximum (the total amount you’re responsible for in a year), your insurance will typically cover 100% of the costs for any remaining treatment for the rest of the year.

What This Means For Your Treatment Timeline

If you’ve met your deductible, starting rehab sooner rather than later is wise because the deductible resets at the start of the new year. This means you’ll either have to pay the amount of your deductible — so in the example, paying an extra $2,000 — or have to meet it again to pay less out of pocket. By starting treatment now, you can take advantage of your insurance benefits before they reset.

Remember: The deductible amount we’re using ($2,000) is just an example, not an estimate. Your deductible may be higher or lower depending on your plan. Check your insurance plan to determine how much your deductible is and what services count towards meeting it.

Seek Addiction Treatment Today

If you’ve already met your insurance deductible, now is the best time to consider going to rehab. By starting treatment before the deductible resets, you can save money and make the most of your insurance benefits. 

Don’t wait until next year — take advantage of the timing and get the help you need today. At Northpoint Recovery, we offer personalized inpatient addiction treatment that is in-network with a variety of insurance plans. We’ll work with you to coordinate with your insurance and provide support during the financial planning process. 

Recovery is possible, and we’re here to help you reach it. Contact us today to learn more about our treatment options and costs.