The success rates of addiction treatment programs in helping people to achieve and maintain sobriety are well documented. The majority of people who enter residential treatment programs will achieve sobriety and complete the program while remaining sober.

However, the battle to control addiction is a continuous one, and overall relapse rates are high.1 Addiction treatment specialists are continually looking for ways to decrease the likelihood of relapse. One way of doing this is to encourage people to enter a structured sober living facility after treatment.

Understanding Structured Sober Living

Structured sober living facilities provide a supportive environment to people in recovery who are transitioning back to a productive life after completing a residential treatment program. Structured sober living facilities assist residents in getting involved in community activities outside the residence. These activities may include finding a job, enrolling in an educational or vocational training course and attending support meetings. This involvement provides a way for people to add routine, structure and connections to the community to their daily lives.2

Will My Insurance Cover Structured Sober Living?

There isn’t always a simple answer to the question of whether your insurance will cover a structured sober living program, as it depends on many factors. These programs are often composed of both treatment and non-treatment services. Many basic medical insurance plans offer only primary care, which essentially covers you for doctor and hospital bills. Both treatment and non-treatment services may be excluded from basic health insurance coverage.

The Mental Health Parity and Addiction Equity Act of 2008 mandates that, if a group health insurance plan offers mental and behavioral health coverage, it must be offered at comparable coverage levels as other medical benefits. The Affordable Care Act amended the Patient Protection and Affordable Care Act to apply this parity to individual plans in addition to group plans.

While non-treatment services generally aren’t covered by insurance, this legislation makes it likely that most plans will provide coverage for the treatment services provided within the program. You will need to check your insurance details to see exactly what is covered. If you have an HMO plan, you may have to ensure that the program is considered in-network, while PPO plans generally offer you the flexibility to choose your own health care provider.

Asking Your Insurer

You can carefully examine your insurance documents to see if structured sober living is covered. If you don’t have a copy of the documents, ask your insurer to send you the details. You can also call your insurance provider to find out whether structured sober living is covered under your plan. Another option to find out if your insurance covers structured sober living costs is to contact the program.