Does insurance cover addiction treatment in Kentucky?

Addiction treatment is covered by insurance companies as an essential health benefit. The Affordable Care Act mandates that any insurance sold on the public exchange and government insurance programs must cover substance abuse treatment.

While every policy is different, insurance usually covers most or all of your treatment. You may be responsible for additional fees, like copays, deductibles and fees for filling prescriptions.

The quickest way to find out what your specific policy covers is by calling the customer service phone number on the back of your insurance card.

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Kentucky Addiction Treatment Coverage for:
Medicaid | Medicaid Eligibility | Anthem | Blue Cross Blue Shield | United Behavioral Health | Cigna | Optum | Outpatient | Costs | Best Options in KY

Does Kentucky Medicaid cover rehab?

Yes, as government-backed insurance, Medicaid covers drug and alcohol treatment. But, there are limitations.

• Only a handful of rehabs in KY accept Medicaid (JourneyPure is one of them). You can find a searchable list of Medicaid providers at Findtreatment.gov. Type in your zip code and filter the search results for Medicaid.
• Kentucky Medicaid pays for your inpatient therapy and treatment, but not room and board. People who use KY Medicaid for residential treatment may be responsible for additional room and board fees.
• Medicaid facilities sometimes have waitlists because of high demand.

Does Medicaid cover outpatient in KY?

Outpatient treatment, where you attend sessions a few times per week but still live at home, is covered under Medicaid. Medicaid covers 80% of outpatient treatment costs, with the remaining 20% passed onto the patient.

Kentucky Medicaid also covers prescription medications used during outpatient treatment:

1. Buprenorphine (film)
2. Buprenorphine (tablets)
3. Naltrexone – also known as Vivitrol.
4. Methadone

Does Medicaid cover Suboxone in Kentucky?

Yes. Suboxone (buprenorphine naloxone) is covered under Kentucky Medicaid.

Suboxone is on the preferred drug list for most Kentucky Medicaid policies, so costs are low (under $15).

To use your prescription benefits for Suboxone, you must meet the following conditions:

• You must be enrolled in substance use disorder counseling, or have proof that you have previously attended counseling.
• After six months of treatment, the max dose of buprenorphine is 24 mg per day.
• Patients must be tapered to the minimum dose of buprenorphine after eight months of treatment
• Prior authorization is required. You may need to wait a few days after seeing your doctor until you can fill your prescription.

How do I know if I’m eligible for Medicaid?

Medicaid eligibility is based on your income. According to Benefits.gov, Single adults in Kentucky are eligible if their income does not exceed $17,131 (before taxes).

From there, the income maximum increases when you have more earners in your household.

If you are disabled, pregnant, or a caretaker, you may be eligible regardless of your income. Income maximums are based on the Federal Poverty Level.

You can apply for Medicaid through kynect, Kentucky’s health insurance marketplace.

Does commercial insurance cover rehab in Kentucky?

Yes, private insurance policies, which are the kind you get through your employer, cover addiction treatment, including:

• Medical detox
• Inpatient/Residential Treatment
• Outpatient Rehab
• Prescriptions medications that help with cravings

Commercial or private insurance plans aren’t subject to the same regulations as state policies, so what is covered will vary between policies.

Here are the top 5 insurance providers in Kentucky:

Anthem

Yes, Anthem covers residential or inpatient treatment in Kentucky, as well as a variety of mental health services for co-occurring disorders.

Blue Cross Blue Shield (BCBS)

Yes. Blue Cross Blue Shield covers drug treatment and a full slate of drug rehab services.

Blue Cross Blue Shield policies are some of the best out there when it comes to addiction treatment. If there are any out-of-pocket costs, they are usually low compared to other insurance companies.

United Behavioral Health

United Behavioral Health covers drug and alcohol rehab.

Cigna

Yes, Cigna plans include substance abuse benefits. Depending on the policy, your treatment may be covered in full.

Optum (United Health Group)

Substance abuse treatment is covered by UHC Optum plans. Since every policy is different, the best way to find out exactly what your plan covers is to call the customer service number on the back of your insurance card.

Does insurance cover Vivitrol?

Yes, Vivitrol is covered by commercial insurance and state Medicaid policies.

Vivitrol is an injectable form of Naltrexone that blocks the opioid receptors in the brain. If someone who has taken the Vivitrol shot tries to use opiates, the medication will block the opiate drug from reaching the receptors and the drug will have no effect.

Vivitrol works because it reduces the incentive to get high. The injection is administered in a doctor’s office and lasts 30 days. 

The downside of Vivitrol is that it’s expensive. Even if you are covered, you may have to pay a copay out of pocket. The average cost is about $1400-$1500, and copays can be hundreds of dollars. 

Some people get the Vivitrol shot every month, but it’s best used as a preventative measure given before the patient leaves inpatient treatment.

Is outpatient rehab covered by insurance?

Yes, insurance covers outpatient rehab. In fact, outpatient therapy is more likely to be covered in full than residential treatment, and for a longer period of time.

Most commercial insurance providers cover both residential and intensive outpatient programs (IOP), allowing patients to transition to outpatient care after they complete inpatient rehab. Going to outpatient treatment after inpatient is proven to increase your chances of staying sober.

How much will I have to pay out of pocket?

Out of pocket costs are based on 1. the type of rehab you go to, 2. your insurance deductible, and 3. co-pays or co-insurance.

Level of care

The level of addiction care that you get is the number one factor that influences pricing. Inpatient programs are more expensive than outpatient options because they require 24-hour staffing and a medical team.

Deductible

A deductible is a set amount of money that you have to pay before your insurance coverage kicks in. If you have already met your insurance deductible paying for other health services, your insurance may cover drug treatment in full.

If you haven’t met your deductible for the year, you’ll be responsible for your payment up to the deductible amount. Usually, you’ll hit your deductible with treatment, which will reduce healthcare costs for the rest of the year.

Copays & Coinsurance

Most insurance plans require copays, which is a fixed amount that you pay for a medical service on top of what your insurance company pays. Like deductibles, copay amounts vary from policy to policy. Policies with higher deductibles usually have lower copays.

Out-of-Pocket Maximum

If your plan has an out-of-pocket maximum, insurance will cover treatment 100% after that maximum is met.

Make sure you understand the costs and how much you will need to pay out-of-pocket when you make arrangements for treatment. Costs will fluctuate depending on which medications you take during your stay.

What are the best rehab options in Kentucky?

There are plenty of great options for treatment in Kentucky. As you review your options make sure that you know:

• If the program accepts your insurance policy
• How much you will have to pay out-of-pocket
• If they offer residential treatment, outpatient treatment or both
• If they treat co-occurring mental health disorders

Don’t limit yourself to treatment centers in your local area. Travelling a few hours to get the best care is well worth it, especially for inpatient and residential programs. Owensboro, for example, has very few options within city limits. However, there are plenty of great treatment centers just a short drive from the city, outside of Daviess county.

JourneyPure offers in-network inpatient addiction treatment in Kentucky as well as outpatient services in Louisville, Lexington, Bowling Green, Elizabethtown and Paducah.