Insurance Coverage for Gambling Addiction in 2024

Problem Gambling (also called gambling disorder, gambling addiction, and pathological gambling or compulsive gambling) is the uncontrollable compulsion to continue gambling despite the effects on an individual's life. Problem gamblers feel an urge to keep risking something they value for the expectation they will receive something of even greater value.

It affects millions of Americans and can lead to significant and negative consequences including mental health and behavioral disorders, relationship and emotional issues, and even financial problems such as debt, theft, crime, and imprisonment.

Understanding you may be struggling with gambling addiction is important. But individuals are often unsure where to get care once they come to that realization and just as importantly, do not know how to pay for gambling addiction treatment. Fortunately, there are a number of payment options when looking for covered gambling addiction treatment from Birches Health. Insurance is a central one, and here we will focus on which insurance payors may provide gambling addiction treatment coverage as well as what types of service they offer.

Cigna

A leading insurance company offering coverage for gambling addiction treatment is Cigna. Cigna is a global health service company that offers a wide range of health insurance plans, including behavioral health coverage. Cigna's behavioral health coverage includes treatment for gambling addiction, as well as other mental health conditions such as depression, anxiety, and substance abuse.

Cigna's behavioral health coverage for gambling addiction typically includes inpatient and outpatient services, such as counseling and therapy. These services may be provided by licensed professionals including therapists, counselors, gambling specialists, and other trained mental health providers.

Aetna

Another large insurance company that offers coverage for gambling addiction care is Aetna. Aetna is a leading health insurance provider that offers a range of plans, including behavioral health coverage. Aetna's behavioral health coverage includes treatment for gambling addiction, as well as other mental health conditions. Coverage can often include both inpatient and outpatient services as well as support services.

Blue Cross Blue Shield (including Anthem)

Anthem Blue Cross Blue Shield is another insurance company that offers coverage for gambling addiction treatment. Anthem Blue Cross Blue Shield is a health insurance provider that offers a range of plans, including behavioral health coverage. Anthem Blue Cross Blue Shield's behavioral health coverage includes treatment for gambling addiction, as well as other mental health conditions. Anthem Blue Cross Blue Shield's coverage for gambling addiction varies state by state but can include inpatient and outpatient services.

Medicaid and Medicare (CMS)

The topic of CMS (Centers for Medicare and Medicaid Services) covering problem gambling is a complicated one. Throughout the early two thousands, problem gambling coverage was scattered and just as often, at times non-existent. Now, thanks to the work done by providers and organizations focused on gambling addiction across the United States as well as internal allies at insurance payors themselves, coverage for problem gambling from the Centers for Medicare and Medicaid Services is starting to be approved state by state. Those of us in the United States began last year with a fantastic announcement: that the Centers for Medicare and Medicaid had officially approved Medicaid Reimbursement for Gambling Disorder Treatment Provided by Certified Programs. This had been a multi year exploration and push by a group of intertwined stakeholders, but in September 2022 there was a General Announcement via the New York State Medicaid Update Publication. Then in October 2022, Managed Care Plans were notified that this ruling was imminent through the New York State Department of Health Insurance Programs. Finally, as of January 1, 2023, coverage was announced!

Despite all this exciting news (and the future looking bright for Problem Gambling coverage across all fifty states), It is important to note that coverage for gambling addiction treatment may vary depending on the specific insurance plan and the state in which you live. In some cases, insurance companies may require pre authorization for treatment or may limit the number of sessions that are covered. It is always important to first understand what your insurance provider covers and determine what treatment may be covered or not.

If you or a loved one is struggling with a gambling addiction, it is important to seek help. Companies like Cigna, Aetna, United, Anthem Blue Cross Blue Shield, Medicaid and others, may offer coverage for problem gambling treatment. Gambling addiction can have serious consequences, including financial problems, relationship issues, and mental health disorders. With the right treatment and support, however, it is possible to overcome this addiction and lead a healthy, fulfilling life. Our knowledgeable team is able to offer insights into what exactly may or may not be covered. Often we are able to ensure care is fully reimbursed through a variety of funding sources - in fact more than 96% of Birches Health patients pay nothing for their care. If you'd like to have a free, confidential conversation with a Birches Health gambling specialist and better understand your options for treatment, reach out today.