Most often, insurance will not cover the cost of a sober living home. Health insurance typically covers health-related services and treatments, while sober living is a type of rental housing.
That said, insurance policies sometimes cover eligible addiction treatment services, even when you are staying in a sober home. Sober living costs will need to come out of your pocket. The treatment insurance can help pay for will depend on your plan, your provider, whether the treatment is in-network, and whether the service is eligible under your benefits.
Below, we explain the differences between sober house and treatment insurance, the likely costs, and the things to consider when choosing one home over another in Orange County, CA.
Does Insurance Cover Sober Living Homes?
For the most part, insurance does not cover the costs of sober living homes. The reason is that health insurance typically covers medical services and treatments, not housing. That means that when asking, “Does insurance cover sober living,” the short answer is, “Probably not the bed, but potentially the treatment.”
The same goes for the question, “Does insurance pay for sober living homes.” The bed is usually yours to pay for, while the treatment you attend may be covered. Coverage differs from one plan to the next.
To understand why, let us differentiate between the two:
Paying for the sober home covers the room and the structure you are living in, as well as the rules and limitations that come with it.
Meanwhile, paying for treatment covers evidence-based care delivered by qualified addiction treatment professionals.
Insurance typically covers the latter category of services, not the former. Why is that the case?
Well, sober living communities offer a structured and supportive environment for people in recovery, but they primarily serve as housing. Clinical treatment services, on the other hand, are delivered by addiction treatment professionals and constitute health care services. That is also why the question “Does health insurance cover sober living” rarely has a simple yes or no answer.
While some sober homes partner with treatment facilities, the services they provide are typically separate from those offered by addiction treatment centers. Policies and programs vary, so the only way to be certain is to contact your insurance provider and ask them directly about your own plan.
Why Doesn’t Insurance Usually Cover Sober Living?
The difference between sober home and treatment insurance comes down to a simple fact. Sober living facilities offer housing and recovery support services, not health care services.
A sober living home is a type of residential facility where people in recovery from substance use disorders live. They typically pay rent for a room, and in exchange, they receive a structured environment that supports their sobriety. Some sober homes enforce strict rules, such as curfews and bans on drugs and alcohol. Others offer more flexibility. Residents also benefit from the support of others who are working on their own recovery.
Sober homes can be beneficial for many people, as they provide structure, accountability and help people avoid triggers. That said, sober homes typically do not provide clinical treatment themselves, and any treatment a resident attends is usually delivered elsewhere.
Meanwhile, clinical addiction treatment services are typically covered by insurance, as they are health care services. Insurance covers eligible health care services rather than room and board. Insurance coverage for sober living tends to follow the treatment, while the housing is typically not covered.
That is the simple reason insurance rarely pays the rent. The distinction is worth remembering. Sober living is housing and recovery support. Treatment is clinical addiction services.
What Addiction Treatment Can Insurance Cover While Living in Sober Living?
If the short answer to the question “Does insurance cover sober living?” is negative, many people assume that everything will have to come out of their pocket. That assumption is incorrect, as treatment services can sometimes be covered by insurance, even while you are in a sober home. Again, it depends on the policy.
Insurance typically covers addiction treatment services, including partial hospitalization programs, intensive outpatient programs, and outpatient treatment. Depending on the plan, these services may be partially or fully covered by insurance, which can significantly reduce out-of-pocket costs.
The extent of coverage will depend on your policy, benefits, and the terms of your plan. It will also depend on the level of care and whether it is in-network or out-of-network, so no plan should be assumed to cover every service.
The levels of care that insurance typically covers include:
Partial Hospitalization Program (PHP)
A partial hospitalization program is a type of intensive day treatment for people with substance use disorders. People in PHP spend several hours per day at the treatment facility and return home or to a sober living home in the evening.
Therefore, a person in a sober home may be able to access PHP while continuing to live in the sober home, depending on their treatment plan and the rules of the house.
Intensive Outpatient Program (IOP)
Intensive outpatient programs deliver structured addiction treatment services while allowing people to continue with their daily lives. Unlike PHP, IOP does not require people to come to the facility every day. Instead, they attend treatment on a weekly basis, following a carefully designed schedule.
Sober home living can be combined with intensive outpatient treatment, as the house provides a structured recovery environment outside of treatment hours.
Outpatient Treatment
Outpatient treatment services are the most flexible form of addiction treatment. They can be scheduled to accommodate the individual’s needs, and they allow people to continue with their daily lives while receiving treatment. For people in sober homes, outpatient treatment can offer a great deal of flexibility. Again, not every plan covers every service, and treatment coverage will depend on the plan.
Does Insurance Cover Sober Living in California?
The sober home and treatment coverage rules that apply everywhere else also apply in California. In other words, if you are wondering, “Does insurance cover sober living in California?” the answer is the same as elsewhere: probably not the home, but potentially the treatment.
The specifics, however, can differ from person to person, depending on the following factors:
- Your insurance provider
- The plan you are on
- Whether the treatment is in-network or out-of-network
- Your deductible
- Your copay or coinsurance, if applicable
- Whether prior authorization is required
- Whether the plan covers the level of care you need
- Whether the medical necessity criteria are met
These factors can combine in many different ways, which is why two people with similar plans can have vastly different coverage. Two people attending the same program can end up paying very different amounts. The same applies to sober homes in Orange County. Anyone looking into sober living Orange County insurance will find the same rules and similar costs to the ones elsewhere in the state.
It is always a good idea to check your benefits before treatment starts rather than after. Most treatment facilities have billing and insurance departments that can help you determine your benefits and coverage.
What Does Sober Living Cost Without Insurance?
When asking, “Does insurance cover sober living homes?” most people are really asking about costs. After all, the question is typically asked when a person is looking into enrolling in a sober home.
Sober living costs typically come out of one’s pocket, as most insurance policies do not cover these costs. The costs can vary significantly from one facility to another, but they typically include the following:
- Rent (can be private or shared)
- Security deposit
- Fees (move-in, application, etc.)
- Meals and groceries (can be included or not)
- Transportation (can be included or not)
- Personal expenses
- Other household costs and utilities
Most sober homes charge a weekly or monthly rent that covers room and utilities based on the services included. Additionally, most require a security deposit, which is typically returned when the resident leaves the facility, so long as they comply with the rules. Other costs may apply as well, depending on the facility and the level of service.
The costs will depend on a few factors, including the following:
- The location (costs tend to be higher in desirable areas)
- Whether the room is shared or private
- Whether meals and other amenities are available
- The level of structure and staffing
- The policies and what they entail
A private room in a structured and desirable sober home will typically cost more than a shared room in a less desirable sober home. Everything is relative, so it is essential to determine what level of service you need and what you can afford.
Keep in mind that these costs are separate from the cost of clinical addiction treatment. The rent pays for the home, while insurance, where it applies, goes toward the treatment. For more on the housing side locally, see How Much Does Sober Living Cost in Orange County?
Can You Use Insurance for Treatment While Living in a Sober Home?
In most cases, yes. As mentioned above, insurance typically does not cover the costs of sober homes. That said, many insurance plans do cover some types of addiction treatment services. Sober living insurance coverage depends on the plan you are on, but the following services are typically covered:
- Partial hospitalization program
- Intensive outpatient treatment
- Outpatient treatment
These types of treatment services can be combined with sober living, as they require you to spend only a portion of your day at the facility. The sober home provides the structure and accountability outside of treatment hours, while the treatment provider delivers the clinical care.
Two things are worth confirming before you commit to either. The treatment provider needs to accept your plan and agree that the level of care is appropriate. The sober home needs to allow the schedule your treatment requires, as some houses have curfews or commitments that have to be worked around.
Again, it depends on the policy. Some plans cover more of the treatment than others, and some require prior authorization before treatment begins. It is always a good idea to check with your insurance provider to determine what services are covered, and to do it before you move in rather than after.
Choosing Sober Living in Orange County
Sober homes are not all the same, so it is worth looking closely at one before moving in. The things to check include:
- Clear house rules
- Sobriety requirements and how they are enforced
- Drug and alcohol testing
- House management and who is on site
- Safe and appropriate living conditions
- The accountability expected of residents
- Whether the house works with your job or school
- Whether you can attend treatment while living there
- Transparent pricing, including what rent covers
- A recovery-focused environment
A home that is clear about all of the above is usually easier to settle into, as you know what is expected of you from the first day. Sober living also works best when the house and the treatment schedule fit together. If you plan to attend PHP, IOP or outpatient treatment while living in a sober home, ask the house about it before you sign anything.
Anchored Recovery Community in Orange County offers sober living in Orange County as an option for people looking for structured sober home living that complements outpatient treatment. Our sober living option is ideal for people who wish to continue their outpatient treatment while benefiting from the structure and support of a sober house environment.
Final Thoughts
Insurance typically does not cover sober home living, as it is a type of rental housing. However, insurance may cover some of the costs associated with treatment, depending on the plan. By choosing sober home living, you agree to pay rent for the services rendered, while treatment insurance can help pay for some of the treatment services rendered, depending on the plan.
When choosing between sober living facilities, it is important to understand the costs involved, as well as the services included. When choosing between treatment facilities, it is important to make sure that your insurance covers the services and that the services are appropriate for your level of care.
If you are looking for a sober living program that offers structured, supportive services alongside outpatient treatment, the team at Anchored Recovery Community can talk you through the options.