Paying for detox

Most health coverage in the US includes some substance use treatment. Every ACA Marketplace plan must cover mental health and substance use disorder services as one of its 10 essential health benefits. Medicare covers inpatient hospital care and, since January 1, 2020, opioid treatment programs. Medicaid coverage of substance use services varies by state. And if you have no coverage, some programs charge on a sliding scale or nothing at all.

What’s covered, and where, differs by plan and by state. Call before you go, or have the program call for you.

Medicaid

States build substance use coverage into Medicaid in different ways: through their state plans, managed care, and Section 1115 demonstrations. Medicaid.gov notes that many states include behavioral health services for people with substance use disorders, but which withdrawal management settings are covered varies. We haven’t confirmed that every state covers every level of detox, so check yours.

Some things are set nationally:

Medication for opioid use disorder is a mandatory Medicaid benefit, and now a permanent one. The Consolidated Appropriations Act, 2024 (section 201) removed the benefit’s old end date of September 30, 2025. CMS explained this to states in a letter dated November 19, 2024. The benefit covers the medications and requires coverage of the counseling and behavioral therapy that go with them. A state can seek an exemption only for a documented shortage of providers.

The same law made permanent a state option (section 1915(l)) to cover certain people with substance use disorders in institutions for mental diseases (IMDs), facilities where Medicaid generally doesn’t otherwise pay. Whether your state uses this option is a question for your state Medicaid agency or the program.

If you might qualify for Medicaid but aren’t enrolled, ask the detox program whether they can help you apply.

Medicare

Part A covers inpatient services you get when you’re admitted to a general or psychiatric hospital. Part B covers outpatient substance use disorder services.

For opioid treatment programs (OTPs), the SUPPORT Act, signed October 24, 2018, created a Part B benefit for opioid use disorder treatment at OTPs, starting January 1, 2020. The bundle includes FDA-approved medications for opioid use disorder and giving them to you, plus substance use counseling, individual and group therapy, and toxicology testing. Medicare.gov lists methadone, buprenorphine and naltrexone, and says Part B also covers naloxone and nalmefene.

What you pay at an OTP: no copayments, but the Part B deductible applies. If you have both Medicare and Medicaid, you pay nothing for the services you get through your state Medicaid program.

Marketplace and other private insurance

HealthCare.gov lists “mental health and substance use disorder services, including behavioral health treatment” among the 10 essential health benefits Marketplace plans cover. Three other benefits often matter for detox: hospitalization, emergency services and prescription drugs.

Your plan decides which programs are in-network and when you need prior approval. Call the member services number on your card and ask:

• Is withdrawal management covered, and at which levels (inpatient, residential, outpatient)?
• Is this program in-network?
• Do I need prior authorization, and who requests it?
• What will my deductible, copay or coinsurance be?
• Are buprenorphine, methadone or naltrexone covered after detox?

Parity: where the rules stand as of October 2026

The federal parity law (MHPAEA) governs how health plans cover mental health and substance use benefits compared with medical ones. As of October 2026, its protections still apply, and so do the 2013 parity rules. The parts a 2024 rule added aren’t being enforced, and a replacement rule is pending. This may change, so check the Department of Labor’s parity page for the current status.

No insurance, or not enough

Some programs charge on a sliding fee scale, and some charge nothing. In our directory, look for the “Sliding scale or free” view on your state’s page. Start at /detox/ and pick your state, or search by ZIP in the finder. Listings come from SAMHSA data, explained on our data page. Call to confirm what the program charges you before you arrive, because fees and funding change.

SAMHSA’s National Helpline, 1-800-662-4357 (free, 24/7), refers callers to local treatment.

If you’re in danger now, cost comes second

Emergency services are one of the Marketplace essential health benefits. If someone is having a seizure, is confused or disoriented, or can’t be woken, call 911 and sort out payment later. The withdrawal guides explain the warning signs: alcohol, opioids, benzodiazepines.

Before you call

Find two or three programs near you in the finder. Call each one with your insurance card (or your income, if you’re uninsured) in hand and ask what you would pay. If you’re stuck, call 1-800-662-4357.

Sources

• HealthCare.gov, What Marketplace health insurance plans cover, accessed Oct 24, 2026
• Medicaid.gov, Substance Use Disorders, accessed Oct 24, 2026
• CMS, State Medicaid Director Letter SMD# 24-004, Extension of Medicaid Coverage of SUD Treatment in the CAA, 2024, Nov 19, 2024
• Medicare.gov, Mental health and substance use disorder coverage, accessed Oct 24, 2026
• Medicare.gov, Opioid use disorder treatment services, accessed Oct 24, 2026
• CMS, Medicare Benefit Policy Manual, Chapter 17, Opioid Treatment Programs, Rev. 13572, issued Mar 3, 2026
• U.S. Departments of Labor, HHS and the Treasury, Statement regarding enforcement of the final rule on requirements related to MHPAEA, May 15, 2025
• Joint Status Report, The ERISA Industry Committee v. HHS, No. 1:25-cv-00136 (D.D.C.), filed Sep 30, 2026
• SAMHSA National Helpline, last updated Jun 9, 2023