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Does Blue Cross Blue Shield Insurance Cover Heroin Rehab?

If you or a loved one is dealing with heroin addiction, you may worry about the cost of rehabilitation. Often, heroin treatment is covered by your insurance, so you can get the help you need without paying the full cost out-of-pocket.

Blue Cross Blue Shield is one of the most widely used insurance companies. They have many available plans to help you start your recovery. Over 90% of doctors accept BCBS across all 50 states, which means that you can usually find a treatment location that takes your insurance and can give you information on your specific coverage.1, paragraph 2

Many BCBS plans and coverage levels include heroin rehabilitation treatment. To make sure your rehab center is covered by BCBS, ask the center directly. They will request some basic insurance information and can tell you whether your coverage includes their heroin treatment program. You can also call the number on the back of your insurance card to speak directly with a BCBS representative for more information on your policy.

What Will Blue Cross Blue Shield Cover?

Blue Cross Blue Shield has 36 member companies that offer coverage by state. What your BCBS insurance covers depends on your plan and the treatment you seek for heroin addiction. BCBS coverage comes in 3 tiers2, Coverage and costs, Payments and out-of-pocket costs

  • Bronze: This plan comes with lower monthly payments but with higher out-of-pocket costs. It usually covers about 60% of your health costs.
  • Silver: The Silver plan costs more than Bronze but less than Gold when it comes to both monthly payments and out-of-pocket costs. You can expect it to cover about 70% of your healthcare costs. With this plan, you may qualify for a cost-sharing subsidy based on your income to help pay for your treatment.3, What is a subsidy? 
  • Gold: Gold comes with the highest monthly payments and the lowest out-of-pocket charges. It covers around 80% of your healthcare costs.

Most Blue Cross Blue Shield insurance plans cover some level of heroin rehab services. However, the costs vary based on factors like your state, treatment center, and the length of your treatment. You can use the three-letter prefix on your insurance card to determine whether you have Blue Cross Blue Shield substance abuse treatment coverage.

Because BCBS is available in all 50 states, your coverage will vary. For example, if you live in Massachusetts, you will have a Blue Cross Blue Shield of Massachusetts plan. That plan will cover inpatient, outpatient, intensive outpatient programs, and partial hospitalization programs.

Since BCBS is a national network, you are not limited to seeking heroin rehab in your home state. That means that rehabs in Florida that accept Blue Cross Blue Shield can give you treatment, even if you live in Georgia or even farther away. You get to choose the facility that offers the best resources for your situation.

BCBS also offers specialized plans for federal employees. The Federal Employee Plan covers inpatient and residential heroin rehab as well as outpatient rehab and therapy. In these cases, the plan pays for 30% of the expense, though the deductible varies based on whether you have a Self Only, Self+One, or Self+Family policy. 4, table, Hospital Care section

Does Blue Cross Blue Shield Insurance Cover Mental Health Care?

The Affordable Care Act mandates that all insurance providers must offer mental health coverage. However, your level of coverage depends on your Blue Cross Blue Shield plan and location.

When it comes to treating heroin addiction, it is important to treat co-occurring disorders along with it. These disorders often contribute to drug addiction and providing comprehensive treatment can help people avoid using again in the future.

According to the National Institute on Drug Abuse, co-occurring substance abuse disorders often arise with mental health disorders like anxiety, depression, schizophrenia, ADHD, and others. 5, 2nd paragraph Heroin addiction can occur without other mental health disorders, too, but when they present together, acknowledging and treating beyond the addiction itself becomes important to recovery.

The National Institute on Drug Abuse states that people with anxiety disorders are twice as likely to develop a drug use disorder6, pg. 2, “How Common Are Comorbid Drug Use and Other Mental Disorders?” There are similar statistics available for other mental health disorders, making the percentage of co-occurring disorders with substance abuse even higher than the occurrence of substance abuse by itself.

Treating co-occurring mental health disorders can help patients feel supported throughout the heroin rehab process. Because many substance abuse problems stem from underlying mental health disorders, we make it our goal to get to the root of the issue and provide support so that the person no longer turns to substances in place of getting help. We must recognize drug addiction as a mental health disorder and treat it as such. Understanding the full problem allows the person to get the full scope of the help they need.

Blue Cross Blue Shield mental health coverage includes detox and rehab if deemed necessary, such as with opiates like heroin. Mental healthcare is not usually fully covered under any insurance policy, so you will still pay a portion out-of-pocket.

Your coverage matters when it comes to choosing your rehab facility. A Preferred Provider Option (PPO) allows you to receive care at more facilities, while a Health Maintenance Organization (HMO) limits your options more. You can find your benefits in your MyBlue account, under the “Plan Benefits” tab. 7, “Show Me My Mental Health Benefits” There, you can select a mental health service and view your coverage for that type of treatment, including BCBS drug rehab.

How Long Does Blue Cross Blue Shield Insurance Cover Rehab?

The length of your Blue Cross drug rehab coverage varies based on your plan. You may be able to get coverage for a month or a year, depending on your treatment needs. BCBS often covers several types of heroin rehab services, including: 8, “What Types of Treatments Are Available?”

  • Inpatient.
  • Outpatient.
  • Interim.
  • Telemedicine.
  • Medication-assisted treatment.

Longer treatment times often work better to treat heroin addiction and lead to an increased rate of abstinence and continued progress after finishing treatment9, Key Results Longer rehab treatment time offers more support, the ability to create a routine, and more mental health and informational resources.

Blue Cross Blue Shield has several coverage types available, whether you need treatment short-term or need a longer stay at a facility.  You can find your plan information by calling the BCBS phone number on the back of your insurance card or logging onto your MyBlue account to check your plan benefits. You can also speak with a representative at your chosen rehab center and they can find this information based on the information you provide.

What if My Blue Cross Blue Shield Policy Does Not Cover Heroin Rehab?

Many heroin rehab facilities offer assistance with financing. Some even have scholarship options to help you afford the treatment you need.

If your BCBS insurance does not cover heroin rehab, don’t wait to get help. Just like with any physical illness, prolonging the time before you get treatment can make it more difficult to recover later. Even if you’re not sure what you can do to get help, you can contact your treatment center to ask what resources and financial assistance they can give you.

BCBS also offers services to all members through Team Blue. Team Blue can help you find mental health care and connect you with Care Managers who can work with your specific situation.

In Network vs. Out of Network Rehab Centers

An in-network provider accepts your health insurance coverage. That means they have agreed to the amount that BCBS charges for a particular service, which is usually lower than what the practice charges out-of-pocket.

Out-of-network providers don’t have that agreement with BCBS. In these cases, you will likely pay more than you would with an in-network provider. An HMO policy only gives you access to in-network providers. A PPO gives you the option to see out-of-network providers, but at a higher cost. With a PPO, BCBS will still pay a percentage of your care10, PPO vs. HMO section However, that percentage is lower, so you pay more out-of-pocket while still paying less than you would if you had no insurance coverage at all.

Check Your Benefits

American Addiction Centers can help you verify your insurance coverage and help you get the heroin rehabilitation treatment you need. We work with many people to help them find the right facility and policy for heroin rehab treatment. We can do the same for you.

When you call our helpline, a representative will help you verify your insurance coverage while you’re on the line and let you know where you can get treatment in your area. Call our helpline today at 1-888-496-8059 Who Answers? to speak to a representative and get started with your recovery.


  1. Blue Cross Blue Shield. (2021). Coverage that goes where you go: Travel worry-free with Blue Cross Blue Shield.
  2. Blue Cross Blue Shield of Michigan. (2021). What’s the difference between bronze, silver, and gold plans?
  3. Blue Cross Blue Shield of Michigan. (2021). Am I eligible for a health insurance subsidy?
  4. Blue Cross Blue Shield. (2021). FEP Blue Focus benefits.
  5. National Institute on Drug Abuse. (2020). Common comorbidities with substance use disorders research report, part 1: The connection between substance use disorders and mental illness.
  6. National Institute on Drug Abuse. (2010). Comorbidity: Addiction and other mental illnesses.
  7. Blue Cross Blue Shield. (2021). Show me my mental health benefits.
  8. Substance Use Resource Center (2021). Find treatment and support.
  9. Wakeman, S.E.; Metlay, J.P.; Chang, Y.; Herman, G.E.; & Rigotti, N.A. (2017). Inpatient addiction consultation for hospitalized patients increases post-discharge abstinence and reduces addiction severity.  Journal of General Internal Medicine 32, 909-916.
  10. Blue Cross Blue Shield of Michigan. (2021). What’s the difference between in network and out of network?

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