Does Anthem Insurance Cover Drug Treatment?
Anthem Health Insurance provides health insurance to more than 40 million people in the United States. Part of the Blue Cross Blue Shield Association, Anthem insurance offers plans that cover some or all of the costs of drug and alcohol rehab programs.
American Addiction Centers (AAC) is in-network with Anthem and provides Anthem rehab coverage for many of our facilities throughout the country. Depending on your policy/insurance plan and the state you live in, your drug and alcohol addiction treatment could be covered.
Anthem coverage is available in 14 states:1
- New Hampshire
- New York
If you have Anthem health insurance and are searching for a drug and alcohol treatment facility that is covered by your plan, we are here to help. You can call the number on the back of your insurance card to find out more information about what is covered under your specific plan. Or, you can call us at 1-888-851-2649 Who Answers? to speak with an admissions specialist who can work with you to determine what is covered while you’re on the phone.
Anthem Insurance Coverage
Anthem healthcare plans fall into 4 categories:2
- Platinum plans: With the highest monthly premiums and lowest deductibles and copays, platinum plans are best for those who routinely rely on medical care and need the most coverage. Approximately 90% of healthcare costs are covered by Anthem under platinum plans.
- Gold plans: Anthem gold plans have the highest monthly premiums, but offer lower deductibles and copays. Approximately 80% of healthcare costs are covered by Anthem gold plans. Individuals who visit the doctor frequently and/or have high medical needs and ongoing medication prescriptions may prefer the gold plans.
- Silver plans: Silver plans have moderate premiums and costs, with approximately 70% of costs covered. Silver plans are ideal for those who occasionally use their health insurance plans and prefer lower deductibles.
- Bronze plans: Bronze plans have lower monthly premiums but higher cost use (e.g., higher copays and highest deductible). Approximately 60% of medical costs are covered by Anthem with the bronze plans. If you are in good health, prefer lower monthly premiums, and are comfortable with higher deductibles, you may opt for the bronze plan.
The monthly premiums for each type of plan will vary, depending on your location and the number of dependents/covered individuals under the insurance plan.
If Anthem is your health insurance provider, your policy may cover the following for addiction treatment:
- Medical detox: Some drugs and alcohol can cause serious physical and mental withdrawals. For individuals who need assistance withdrawing from substances, medications are often used to help you safely detox from the substance(s). Anthem does cover medical detox when it is deemed medically necessary. In some cases, this may require a pre-authorization prior to coverage kicking in.
- Inpatient or residential rehab: These live-in treatment programs give an individual the opportunity to live at the treatment facility, generally for 15-30 days or more.
- Partial hospitalization programs (PHP): Sometimes referred to as “day treatment,” these intensive programs allow you to live at home and spend your days in treatment at a designated facility.
- Intensive outpatient (IOP): Ideal for individuals who have completed residential treatment, this type of program involves attending treatment approximately 3 evenings a week.
- Outpatient rehab/therapy: Patients live at home but attend the treatment center 10-12 hours a week to complete the program.
The Anthem health insurance plan you have impacts your total cost of drug and alcohol treatment, no matter what services you are accessing. Some parts of treatment may or may not be covered depending on your plan and tier level. Regardless, at least part of your treatment should be covered by Anthem. It’s important to check ahead of time to avoid any surprises.
Mental Health Coverage by Anthem
Many people who live with substance use disorder also have mental health conditions such as depression, anxiety, and mood disorders. These are referred to as “co-occurring disorders,” or dual diagnosis. According to the 2016 National Survey on Drug Use and Health, more than 8 million adults aged 18 or older have a mental health condition along with substance use disorder.3
It is imperative to treat co-occurring mental health and substance use disorders at the same time, as the conditions can often impact each other. Treating one will not have an effect on the other. Both disorders need to be treated at the same time in order for substance use disorder treatment to be most effective.
Mental health and substance abuse treatment are considered to be essential health benefits under the Affordable Care Act. As a result, all marketplace plans — including Anthem plans — must cover some of these costs for those who are seeking treatment.
According to the ACA, all health plans in the marketplace must cover behavioral health treatment (e.g., psychotherapy and counseling), mental health inpatient services, and substance use disorder treatment.4
Anthem Insurance Rehab Coverage Duration
Though everybody’s needs are unique, generally speaking, the longer a person is in treatment, the more effective it will be. A longer stay in rehab means less likelihood of a relapse and a greater chance for long-term sobriety.
The rehab facility you choose will work with Anthem to determine how long your stay will be covered by your particular plan. Factors that will be considered include:
- How long you or your loved one has been using the substance(s).
- Type of substance(s) being abused.
- Co-existing mental health diagnoses.
- Family history.
- Whether you’ve attended addiction treatment facilities in the past and what the outcomes were for prior stays/attempts at sobriety.
Research shows that 3-6 months of treatment with continuing care after completion — such as counseling and outpatient treatment — is associated with better treatment outcomes. According to a recent study, longer treatment (3-6 months) and structured continuing care (such as outpatient treatment and counseling) are associated with better treatment outcomes.5
There are many different policies and tiers of Anthem insurance coverage. As a result, the length of time covered by your particular policy is unique to your particular Anthem plan. Call the number on the back of your insurance card to learn more about what your specific plan covers for drug and alcohol rehab, including the length of time your stay will be covered by insurance.
Rehabs Not Covered by Anthem Insurance Policy
If your Anthem insurance policy does not cover rehab expenses, don’t let that hold you back from getting the help you need. The sooner you get treatment, the sooner you will be on a path to health, wellness, and sobriety. There’s no doubt about it: entering and completing treatment saves lives. Depending on the rehab center you choose, there are payment plans available for those without insurance and for those whose insurance does not provide enough to cover all expenses. Some rehab treatment facilities offer financing options or scholarships to help offset costs.
In-Network vs. Out of Network Rehab Centers
When researching which drug and alcohol rehab center to attend, you’ve likely come across a lot of “in-network” vs “out-of-network” language.
Anthem’s in-network facilities, or Anthem providers, have an agreement with the company to offer care at a lower rate than other providers. American Addiction Centers has a partnership with Anthem for many of our facilities throughout the United States.
Out-of-network facilities do not have an agreement with Anthem, so you may not be covered for any or most of the costs. If you choose an out-of-network facility, this will likely mean that you will have higher out-of-pocket costs, and you may need to pay for all services yourself.
It is best to choose an in-network facility when possible to help cover costs and keep your out-of-pocket expenses lower.
In some cases, Anthem may provide some out-of-network coverage. This may be the case for people who live in areas where there are no local treatment facilities.
Check Your Benefits
Before choosing the right rehab treatment center for you, check your Anthem policy benefits to determine which costs will be covered by your provider and which will be out-of-pocket for you. Call the number on the back of your insurance card or log in to your account on Anthem’s website to determine what deductible (if any) must be reached before coverage kicks in and what copays you will be responsible for.
American Addiction Centers can verify your insurance coverage for you. Complete the form below to enter your information to find out if the facility you are considering is in-network with Anthem. Or, you can call our helpline at 1-888-851-2649 Who Answers? to speak to an admissions specialist who can check your benefits with you while you’re on the phone.
Let’s verify your coverage for treatment at an American Addiction Centers location. Your information is always confidential.
 Anthem. (2021). Anthem Blue Cross and Blue Shield.
 Anthem. (2021). How to Choose a Health Insurance Plan.
 Center for Behavioral Health Statistics.SAMHSA – Substance Abuse and Mental Health Services Administration Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. (2017).
 Healthcare.gov (2021). Mental Health and Substance Abuse Coverage.
 Eastwood B, Peacock A, Millar T, et al. Effectiveness of inpatient withdrawal and residential rehabilitation interventions for alcohol use disorder: A national observational, cohort study in England. J Subst Abuse Treat. 2018;88:1-8. doi:10.1016/j.jsat.2018.02.001