Does Anthem Blue Cross Cover Drug and Alcohol Rehab?

Quick answers

The short version, before the detail below:

• Does Anthem cover substance use treatment? Anthem's consumer information lists substance abuse treatment, which may include rehabilitation programs or counseling, among the mental health benefits discussed for Marketplace plans. Details depend on the plan.
• Who manages the behavioral health side? Anthem's materials reference Carelon Behavioral Health, which publishes medical necessity criteria and provider resources.
• Which criteria apply to addiction treatment? Carelon says ASAM criteria are used for substance use treatment services unless custom criteria apply, and that criteria vary by state, contract, and member benefit coverage.

Anthem's plan types and why they differ

Anthem's pages describe several different markets, and each has its own rules.

• Individual and family (Marketplace) plans. Anthem's page on mental health in ACA plans says the Affordable Care Act requires Marketplace insurers to cover mental health benefits, and lists substance abuse treatment, which may include rehabilitation programs or counseling, as part of what's available. It advises reviewing each plan's network to see whether it includes the provider a person wants. It also mentions virtual mental health visits through a mobile app offered through an arrangement with Carelon's digital platforms.
• Employer group plans. Anthem markets behavioral health programs to employers, with different options depending on company size.
• Medicaid plans. Anthem operates state Medicaid programs, which follow state-specific rules.

Because the plan type controls the rules, knowing which one applies is the first step. It's usually printed on the member card or named in the plan's benefits summary.

Anthem employer programs

Anthem's large-group behavioral health page describes two tiers of programming. Behavioral Health Advantage is offered to companies with fewer than 12,500 employees and includes, in Anthem's words, advocacy programs and targeted support for people facing substance use disorders. Behavioral Health Resource is designed for companies with 12,500 or more employees and adds a 24/7 resource center. Anthem's page also states that its behavioral health network is backed by "the power of the Blues network" and that it continues adding Carelon Behavioral Health providers to it. And it describes a behavioral health case management program that coordinates between the medical and behavioral health teams. These are descriptions of programs an employer can choose to purchase, written by Anthem. Which of them an individual employer has, if any, is a plan-specific matter. An employee at one company may have access to programs that an employee at another doesn't.

Carelon Behavioral Health and the criteria it uses

Carelon Behavioral Health publishes medical necessity criteria for providers. For substance use treatment, its page says ASAM criteria are used for substance use treatment services, unless custom criteria apply. Custom criteria take precedence where they exist, and the page uses New York's LOCADTR as an example. For substance use laboratory testing, it points to a different criteria set, InterQual. It also states that criteria vary according to state and contractual requirements and member benefit coverage. That line is as useful for readers as the ASAM statement: the same insurer can apply different criteria in different states or under different contracts. For families, the connection to ASAM is the part worth remembering. When a program describes itself as a certain level of care, that framing usually comes from the ASAM Criteria. Our levels of care guide explains those levels in plain language.

Employer funding and who sets the rules

For employer plans, how the employer funds the plan matters. The Department of Labor's annual report on self-insured group health plans explains that sponsors of self-insured plans pay covered health expenses directly as claims arise, while sponsors of fully insured plans generally pay premiums to an insurer that takes on responsibility for paying claims. It also states that state insurance laws generally don't apply to self-insured, ERISA-covered plans. So a person with an Anthem card from a self-funded employer may be under a different set of legal rules than a person with a fully insured Anthem plan. The plan documents show which applies.

Federal parity law

The Mental Health Parity and Addiction Equity Act requires plans that cover mental health and substance use disorders to do so in a way similar to medical and surgical benefits, according to the Department of Labor. The Department says most plans can't charge higher copays for mental health providers than for medical or surgical providers, and that visit limits for mental health benefits can't be more restrictive for most plans. Parity doesn't require coverage of any specific treatment, and the Department's wording applies to "most" plans. The Department's parity page links to current enforcement and news updates.

Where treatment fits

Addiction care ranges from medically managed withdrawal to residential programs, partial hospitalization, and outpatient care. The directory lists medical detox centers, inpatient rehab centers, and residential rehab centers. A qualified healthcare professional can say which setting fits a person after a clinical assessment.

What facilities report about insurance

In our analysis of SAMHSA's 2024 survey, 78.3% of 15,953 facilities reported participating with private insurance, with wide variation by service and state; the full breakdown is in our insurance access analysis. It's a self-reported snapshot, it doesn't name insurers, and reported participation isn't network status for any particular Anthem plan. Anthem also operates under the Blue Cross and Blue Shield name in some states; our BCBS page explains how that system is organized.

Questions to ask a facility

These questions help when comparing programs directly with a facility:

• About the program: Is the facility licensed by the state? FindTreatment.gov states that all facilities it lists are state-licensed.
• Which level of care does the program offer, and who completes the clinical assessment?
• Accreditation can be one additional factor to consider alongside licensing, staffing, services, and other program details.
• Some facilities are equipped to address polysubstance use, while others may have narrower capabilities, so this is worth confirming directly.
• If the facility publishes outcome or completion statistics, ask how those figures are defined, measured, and over what time period.
• About intake and payment: What is the facility's current intake availability?
• What does the intake process involve?
• Does the facility currently have openings for this level of care?
• What payment options does the facility offer, and what payer participation does it currently report?

A note on insurance and payment

Payment options and payer participation vary by facility. Reported payer participation does not guarantee coverage for a specific plan. Coverage, network status, authorization requirements, deductibles, and copays vary by plan. Plan-specific information should be confirmed directly with the insurer and facility.

Finding treatment programs

FindTreatment.gov, SAMHSA's locator, lets you search by location and filter by type of care. The SAMHSA National Helpline, 1-800-662-HELP (4357), is free, confidential, and open 24 hours a day; it provides referrals but not treatment. The directory can be browsed by state and city. If someone is in immediate danger, call 911. For suicidal thoughts or emotional crisis, call or text 988.

About this page

This page is for educational purposes only and isn't medical, legal, or insurance advice. It can't determine what any plan will cover or the level of care any individual needs; a qualified healthcare professional can assess the latter. Treatment Locators is an information resource and is not a treatment provider, insurance verification service, or admissions service.