Know What Treatments Your Health Insurance Covers
Does insurance pay for treatment?
Most health insurance plans cover treatment, but not all do and some will only cover certain levels of care.
Find out what your plan covers
To find out, call the phone number on the back of your health insurance card and ask:
- If they cover the type of treatment you want and at what rate.
- How much your co-pay and/or coinsurance is and how many appointments or days of treatment are covered per year. Learn about health insurance costs (PDF | 1.6 MB).
- For a list of preferred facilities or providers in your area. Choosing from this list can help prevent unexpected costs.
- If they have case managers (like a nurse or social worker) who can work with you for free. They can help you find options for your medical and financial needs.
You can also check your health insurance plan’s website to see the benefits they offer–you may have to log in to your account to do this.
It can take many calls to figure this information out and the conversation may be difficult. You can ask a trusted person for help. You may consider allowing your trusted person to make decisions for you. Ask your health insurance provider to help you authorize someone to speak about your coverage and care.
Know your rights to coverage
Private health insurance, Medicaid, Children's Health Insurance Program (CHIP), and Medicare plans that cover mental health, drug, and alcohol treatment, must pay for them at a comparable level to what they pay for medical and surgical care. Limits on getting these benefits must also be comparable.
Learn more about your rights to coverage (PDF | 2.2 MB) for mental health, drug, and alcohol treatment and how to make a complaint.
Does Medicare pay for treatment?
In most cases, Medicare will cover most of your treatment costs. Learn more about your coverage for:
- Outpatient mental health treatment
- Inpatient mental health treatment (staying overnight for treatment)
- Opioid use treatment
- Tobacco use treatment
- Alcohol misuse counseling
If you get Medicare benefits through a Medicare Advantage Plan (like an HMO or PPO) or other Medicare health plan, check your plan’s website, materials, or call the number on the back of your insurance card.
If you get your Medicare benefits through traditional Medicare (not a Medicare Advantage plan) and want more information, visit Medicare and Your Mental Health Benefits (PDF | 925 KB).
If you have more questions about coverage, call the number on the back of your Medicare card or contact your State Health Insurance Assistance Program (SHIP).
Do Medicaid and Children's Health Insurance Program (CHIP) pay for treatment?
Medicaid and CHIP cover some mental health, drug, and alcohol use treatment, but how much they will pay and the type of services they cover will depend on the state you live in. Many states have specialized programs and support for people using Medicaid and CHIP.
To learn more about your benefits, call the number on the back of your health insurance card or talk to your primary care provider.
Does Veterans Affairs (VA) Health Care cover treatment?
Yes. If you're a Veteran, you can get help, even if you aren’t part of VA Health Care. Learn more about VA coverage for:
Does TRICARE cover treatment?
Learn more about TRICARE coverage for mental health, drug, or alcohol misuse programs. Call the number on the back of your card or look online for your plan’s specific benefits to find how much it will cover.