Blue Cross Blue Shield Drug Rehab

Blue Cross Blue Shield is an association of independent, community-based companies that is collectively one of the largest health insurance providers in the United States. BCBS offers a range of health plans to make medical care, including treatment for substance use disorders, accessible and affordable for Americans.

Blue Cross Blue Shield health plans cover addiction treatment and mental health services. Your exact coverage will depend on the specific Blue Cross Blue Shield health plan you hold. However, since these medical services are categorized as essential health benefits in the United States, all BCBS insurance plans cover addiction treatment and mental health care at least partially, if not fully.

Blue Cross Blue Shield: Company Overview

Since 1929, Blue Cross Blue Shield has been an industry pioneer in providing Americans with access to high-quality, affordable healthcare. ^[1] Blue Cross began when hospital administrators at Baylor University decided to do something to make healthcare affordable for their patients, many of whom were public-school teachers. The first plan they offered required members to pay 50 cents a month as a premium in exchange for up to 3 weeks of hospitalization per year. The plan was a success, and they soon began enrolling people from other professions.

Blue Shield evolved from Blue Cross when employers began to organize plans for loggers and miners in the Pacific Northwest struggling with occupational illnesses. The two companies unified in the 1940s to provide better services to their 24 million members. Further consolidation led to the formation of the Blue Cross Blue Shield Association in 1982. By the early 2000s, the company became synonymous with quality healthcare and had a membership base of 100 million Americans. Today, 1 in 3 Americans is insured by Blue Cross Blue Shield.

Blue Cross Blue Shield Addiction Resources

Blue Cross Blue Shield is dedicated to supporting its members in recovery. To this end, the company operates a publicly available national Substance Use Resource Center for people seeking information and guidance on addiction treatment. This resource is available to every American regardless of their insurance status. Friends and family members of individuals struggling with substance use disorders can connect with the Substance Use Resource Center to find appropriate resources to help their loved ones. Besides national resources, you can also use the center’s website to find additional support services in your state and the local area.

To help members find nationally accredited addiction-treatment facilities, BCBS has a provider directory of Blue Distinction Centers for substance use treatment and recovery. You can use this directory to find providers within your Blue Cross Blue Shield plan network. Providers with this distinction have a proven track record in offering improved outcomes with patient-focused and evidence-based care for substance use disorders.

Types of Addiction Treatment Available

Treatment options for substance abuse vary based on the severity of the addiction and the specific needs of the individual, including the presence of co-occurring mental health conditions like anxiety, depression, bipolar disorder, or PTSD. A clinical assessment is necessary to determine the recommended treatment for a person’s addiction. However, in general, the following types of treatment are covered by Blue Cross Blue Shield health insurance plans:

Withdrawal management: Also called detox, this is typically the first phase of addiction treatment and includes evaluation, stabilization, management of withdrawal symptoms, and preparation for the individual’s entry into a recovery program. 

Interim care: Sometimes a patient may be unable to enter addiction treatment immediately due to a waitlist or lack of availability of appropriate rehab programs. Interim care provides emergency counseling and medication management for such patients to tide them over until they can enter a formal rehab program.

Outpatient care: Clients attend appointments at a treatment facility several times a week and receive multiple hours of individual and group therapy while continuing to live at home.

Residential care: Patients receive 24/7 monitoring and care from a team of healthcare professionals in a rehab facility where they reside for several days to weeks. Some residential treatment programs can be longer-term and involve stays of several months or a full year.

Sober living homes: This is a temporary living arrangement for patients who are transitioning from intensive addiction treatment back to living independently in the community.

Medication-assisted treatment (MAT): Some types of drugs, such as opioids, can be treated effectively with MAT, which involves using FDA-approved medications to treat substance use disorders. 

Telemedicine: Treatment and counseling for addiction and mental health conditions are delivered remotely over the phone or internet to people who live in areas where substance abuse treatment services are not readily available. This service allows members the opportunity to achieve successful addiction recovery in the privacy and security of their homes. ^[2]

Blue Cross Blue Shield Health Plans

If you are shopping for health coverage, Blue Cross Blue Shield offers a range of plans with varying benefits and monthly premiums. To make comparison easier, BCBS has divided its healthcare plans into metal tiers, ranging from bronze to silver to gold.

The Affordable Care Act requires that each health plan cover a certain percentage of your medical expenses. The coverage you receive with a BCBS health plan is as follows:

• Bronze plans cover approximately 60% of medical expenses, and you are responsible for the remaining 40%.
• Silver plans cover roughly 70% of healthcare costs (you may be eligible for a cost-sharing reduction).
• Gold plans cover about 80% of medical costs.

Monthly premiums are highest for gold plans, but out-of-pocket expenses are the lowest if you need health care. On the other hand, bronze plans have the lowest monthly payments but higher out-of-pocket costs should you experience a medical event.

Silver plans are designed a little differently. Depending on your income, you may qualify for a cost-sharing subsidy. This can reduce your out-of-pocket expenses and may include the deductible, co-pay, and coinsurance which add up to your out-of-pocket maximum. If you are eligible for a subsidy on a silver plan, your coverage could extend up to 94% of your medical costs. ^[3]

Another way to save money is by linking your metal tier Blue Cross Blue Shield plan to an HSA or health savings account. This is a bank account that’s used exclusively to pay the cost of medical care. Any money you put into this account is tax-deductible or tax-free, so having an HSA is a way to save money on taxes.

How Do Deductibles, Co-Pays, and Coinsurance Work?

If you need any health care, such as addiction treatment, and you have a Blue Cross Blue Shield plan, you and BCBS are jointly responsible for your medical expenses. Understanding some of the terms used in your policy document can help you know how much you’ll pay for substance use disorder treatment.

The monthly premium is the amount you pay for health coverage from Blue Cross Blue Shield. You have to pay this monthly amount whether you avail of health care services or not. If and when you need medical care, you will incur additional costs depending on the deductible, co-payment, and coinsurance in your plan.

The deductible is a fixed dollar amount that you must pay before Blue Cross Blue Shield will begin to pay. If your plan’s deductible is $2,000, you will pay 100% of your medical costs in a policy year until your bills total $2,000, after which BCBS will start sharing the cost with you.

The coinsurance is a percentage amount charged for services. For example, if your plan’s coinsurance is 15% and you’ve already met your deductible, when you go to see a doctor and the visit costs $100, you’ll pay $15 and BCBS will pay $85.

The co-payment is a fixed amount you pay that varies by service. Your plan may include a co-pay before or after you’ve finished paying your deductible.

Choosing the Right BCBS Health Insurance Plan

Blue Cross Blue Shield offers a range of health plans to meet the needs of every American. However, it can be confusing to choose the right plan for you and your family. Although gold-tier plans offer a lower cost-share in case of a medical event, you pay a higher monthly premium. Bronze-level plans incur a lower monthly premium, but your cost-share is higher if you need healthcare services. Even though the gold plan is more expensive, it doesn’t necessarily mean it is the best plan for you. The best plan depends on your individual needs and circumstances.

What if your BCBS plan doesn’t cover addiction treatment

If you discover that your plan won’t cover addiction treatment, other options may be available. Some facilities offer a sliding-scale cost for treatment depending on your income. Others offer scholarships or payment plans.

If you do have large out-of-pocket expenses for drug treatment, don’t use it as an excuse not to get well. Consider treatment as an investment in your future and well-being. After all, how much money have you spent on drugs or alcohol? Think of the money you will save once you finally get clean.

Last updated: March 9, 2023