Paying for treatment
Cost is one of the biggest reasons people put off treatment, and it’s often more manageable than they think. Here’s how coverage works in Florida, and how to find out exactly what you’d pay.
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Most health plans cover at least part of drug and alcohol treatment. What you actually pay depends on your plan, whether the program is in your network and which level of care you need.
How coverage works
- The Affordable Care Act makes mental health and substance use treatment an essential health benefit for marketplace and most individual and small-group plans.
- Federal parity law says plans that cover addiction treatment can’t make it harder to get than medical or surgical care, for example with stricter visit limits or higher copays.
- Medical necessity decides how much is covered. Insurers usually rely on the ASAM Criteria to approve a level of care, and may review progress every few days or weeks.
- Prior authorization is common for detox, residential and PHP. Programs usually handle it for you.
What to expect by plan type
| Plan type | What to expect |
|---|---|
| PPO | Most flexibility. Out-of-network programs may be partly covered, at a higher cost to you. |
| HMO or EPO | Usually in-network programs only. Some HMOs need a referral. |
| Marketplace plans | Cover substance use treatment as an essential benefit. Networks can be narrow, so check first. |
| Florida Medicaid | Covers many services, including medication for opioid use disorder, through managed care plans. Program choice depends on your plan. |
| Medicare | Covers inpatient and outpatient treatment, methadone through opioid treatment programs, and intensive outpatient care. |
| No insurance | State-funded programs, sliding-scale clinics and payment plans. See below. |
The numbers that matter
- Deductible: what you pay before your plan starts paying
- Copay or coinsurance: your share of each visit or day of care
- Out-of-pocket maximum: the most you’ll pay in a year for in-network care. After that, covered care is paid in full.
If you’ve already had big medical bills this year, you may be closer to your out-of-pocket maximum than you think. That can make this a good time to start.
Questions to ask your insurer
- What are my in-network benefits for detox, residential, PHP, IOP and outpatient care?
- Do I have out-of-network benefits, and at what rate?
- How much of my deductible and out-of-pocket maximum is left?
- Which levels of care need prior authorization?
- Are medications like buprenorphine and naltrexone covered?
Or let us make the call. We check benefits for free and explain them in plain English.
If you don’t have insurance
You still have options. Florida funds treatment through regional managing entities; in Miami-Dade, that’s Thriving Mind South Florida. Federally qualified health centers and many clinics charge on a sliding scale, and some programs offer payment plans. You can also search FindTreatment.gov or call the SAMHSA National Helpline at 1‑800‑662‑4357.
Check your coverage
Share a few details and we’ll call or text you back with what your plan covers and what you’d likely pay. It’s free, and there’s no obligation.
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Questions people ask us.
Don’t see yours? Call or text (305) 701‑0439. There are no wrong questions, and nothing you tell us leaves the call.
Will my employer find out if I use my insurance for rehab?
Your employer doesn’t see your medical claims. Health plans must keep that information private under HIPAA, and substance use treatment records have extra federal protection. If you take leave, the paperwork only needs to show a serious health condition.
What if my insurance denies coverage?
Ask for the denial in writing and the reason. You have the right to an internal appeal and, if that fails, an independent external review. Treatment programs often help with appeals.
Can I get insurance now if I don’t have it?
Possibly. Losing other coverage, moving or certain life changes open a special enrollment period on HealthCare.gov. Otherwise, open enrollment usually runs from November 1 to January 15. You may also qualify for Medicaid.
How much does rehab cost without insurance?
It varies widely: from free or low-cost state-funded programs to tens of thousands of dollars for private residential care. We’ll help you find options that fit your budget.
Related guides
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Medication-assisted treatmentMedication (MAT)Buprenorphine, methadone, naltrexone and more, alongside counseling.
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For familiesHelping someone you loveWhat to say, what to avoid, and what to do if they say no.
Read moreTalk it through with someone who knows Miami’s programs.
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