A free tool for people looking for treatment
What will rehab cost me? Work it out from your own plan.
With insurance, your share of rehab is the deductible you have left, then a copay or coinsurance for each day of treatment, and never more than the out-of-pocket maximum you have left this year for covered in-network care. Type in your plan's numbers and the program's daily rate, and see your estimated share for IOP, PHP and residential treatment, with every step of the math.
- Nothing you type leaves your computer
- Free, no sign-up, no email
- Every number is one you enter
More free tools: Insurance call script for rehab · All free tools
Nothing you type leaves your computer. The math happens in this page. Nothing is sent to us or anyone else, and nothing is saved: close the tab and it's gone.
Your estimate
An estimate from the numbers you entered, not a quote or a promise of coverage. Your plan decides what it covers after the program asks for approval, and it pays only for days it agrees are medically necessary.
How the math works
Programs bill each level of care by the day: a daily rate for each day you attend residential, PHP or IOP. Your plan sets what it allows for that day, and your share of it follows the same steps your plan uses for any covered care:
- Count the days. Days a week times weeks. Three days a week of IOP for 8 weeks is 24 days.
- Add up what the plan allows. Days times the daily rate. Your deductible, coinsurance and copays are figured on the plan's allowed amount, not on the program's list price.
- Deductible first. If the deductible applies, you pay the allowed amount until the deductible you have left reaches $0.
- Then your share of each day. Coinsurance is a percent of the allowed amount after the deductible; a copay is a flat amount for each day. Some plans charge one, some the other, some both, and some charge a copay with no deductible at all. Your plan's Summary of Benefits and Coverage says which, under "inpatient" and "outpatient".
- Stop at the out-of-pocket maximum. What you pay toward the deductible, coinsurance and copays all counts toward it. Once you reach it, the plan pays 100% of covered in-network care for the rest of the plan year.
| Term | What it means for rehab |
|---|---|
| Deductible | What you pay for covered care before the plan starts to share the cost. Under the federal parity law it's the same deductible as your medical care, so a doctor's visit or surgery earlier in the year counts toward it. |
| Coinsurance | Your percent of the plan's allowed amount, after the deductible. At 20%, a day the plan allows at a given rate costs you a fifth of that rate. |
| Copay | A flat amount for each day or visit, sometimes charged before the deductible is met. |
| Out-of-pocket maximum | The most you pay in a plan year for covered in-network care. Premiums don't count toward it, and neither do out-of-network care or charges your plan doesn't cover. For 2026, a plan's in-network limit can be no more than $10,600 for one person and $21,200 for a family. |
| Allowed amount | The most your plan pays for a covered service. In network, it's the rate the program agreed to with your plan. |
Steps from one level to the next share one plan year. Many people start in residential treatment and step down to PHP, then IOP. The deductible and out-of-pocket maximum count across all of them, so the calculator also adds the levels up one after another: once residential has used your deductible, PHP starts with none left, and nothing more is owed once you reach the out-of-pocket maximum.
An example
Made-up, round numbers, to show the steps. A plan with $900 left on the deductible, 20% coinsurance after the deductible for outpatient care, no copay, and $3,520 left on the out-of-pocket maximum. The program is in network, and its rate with this plan is $500 a day for IOP.
- IOP 3 days a week for 8 weeks: 24 days.
- 24 days times $500: $12,000 allowed.
- The first $900 is the deductible. 20% of the other $11,100 is $2,220.
- Total: $900 + $2,220 = $3,120. That's under the $3,520 left on the out-of-pocket maximum, so the estimate is $3,120.
The same plan with 10 weeks of IOP (30 days, $15,000 allowed) comes to $900 + $2,820 = $3,720, but the out-of-pocket maximum stops it at $3,520.
Where to find each number
| Number | Where to get it |
|---|---|
| Deductible left, out-of-pocket maximum left | Your plan's member website or app, or the member services number on your card. Ask for the in-network and out-of-network amounts, for you and for the family. |
| Coinsurance or copay for each level | Your plan's Summary of Benefits and Coverage (inpatient for residential, outpatient for PHP and IOP), then confirm it on the phone, since substance use benefits can be managed by a separate behavioral health company. |
| Daily rate | The program. Ask what your plan allows them for a day of that level, or their self-pay rate and whether they have a sliding-scale fee. |
| Days a week and weeks | The program, after its assessment. Your plan approves days in blocks and reviews progress, so the weeks you're approved for can change. |
Our insurance call script for rehab walks you through getting each of these on the phone, with space to write the answers.
What the estimate leaves out
- Days your plan doesn't approve. Intensive care usually needs prior authorization, and approval isn't a promise to pay. Days the plan doesn't cover don't count toward your out-of-pocket maximum. See prior authorization.
- Out-of-network billing. An out-of-network program can bill you the difference between its charge and what your plan allows, on top of your share.
- Things billed separately, such as doctor visits, lab tests and medication, which can carry their own copays.
- A new plan year. If treatment runs past the date your plan year resets (January 1 for many plans), the deductible and out-of-pocket maximum start over for the days after it.
- Your premiums, which you pay whether or not you use care.
Medicare and Medicaid work differently. Original Medicare Part B covers IOP and PHP: after the Part B deductible ($283 in 2026) you generally pay 20% of the Medicare-approved amount, and Original Medicare has no out-of-pocket maximum. Texas Medicaid members don't pay copays for covered care. See what you pay, by coverage.
Questions to ask your plan
Call the member services or behavioral health number on your insurance card. Tick each one off and write the answer down. Have your member ID, the program's name and address, and the level of care in front of you.
Next steps
- IOP vs PHP cost in Texas: what each level costs your plan and you, by coverage.
- Does insurance cover rehab? What private plans, Medicaid, CHIP, Medicare, TRICARE and the VA pay for, and what to do if your plan says no.
- Texas treatment programs by insurance plan: which programs list your plan.
- IOP vs PHP vs outpatient care: which level fits.
- No insurance? Ask programs about a sliding-scale fee, and for a written Good Faith Estimate. Texas also pays for treatment for people whose income qualifies: call 2-1-1 and ask for your local OSAR.
If you need help now: call 911 in an emergency. In a mental health or substance use crisis, call or text 988, any time. SAMHSA's National Helpline, 1-800-662-4357, is free, confidential and open 24/7.
Questions
How much does rehab cost out of pocket with insurance?
For covered, in-network care, no more than the out-of-pocket maximum you have left this plan year. For 2026 a plan's in-network out-of-pocket maximum can be no higher than $10,600 for one person, and many plans set it lower. Below that, it's your deductible left plus your copay or coinsurance for each day. Out-of-network care and days the plan doesn't approve aren't capped by it.
How much does rehab cost per day?
There's no single price. Each program has its own daily rate for each level, and in network your plan pays the rate it agreed with that program. Your cost for a day is your copay or coinsurance on that rate, after any deductible. Ask the program what your plan allows them for a day, and put it in the calculator.
How much does a month of rehab cost?
Multiply it out: the days you'd attend in a month (about 30 for residential; for IOP or PHP it depends on the schedule, for example 12 days at 3 days a week or 20 at 5 days a week), times your share for a day, until you reach your out-of-pocket maximum. Put 4 weeks in the calculator for the level you're looking at.
Is there a separate deductible for rehab?
Generally no. The federal parity law requires a plan's deductible and out-of-pocket maximum to count medical and substance use care together, so treatment counts toward the same deductible as your other care, and care earlier in the year counts too.
What if I don't know the program's daily rate?
The calculator can still tell you the most you'd pay: your out-of-pocket maximum left, for covered in-network care. A copay with no deductible needs no rate at all. For a closer number, ask the program what your plan allows them for a day, or its self-pay rate.
Is what I type private?
Yes. The calculator works in your browser and sends nothing anywhere. Nothing is saved: close the tab and it's gone.
Sources
- CMS: Uniform Glossary of Coverage and Medical Terms (deductible, coinsurance, copayment, allowed amount)
- HealthCare.gov: Out-of-pocket maximum/limit (2026 limits, and what doesn't count toward it)
- HealthCare.gov: Summary of Benefits and Coverage
- CMS: The Mental Health Parity and Addiction Equity Act (deductibles and out-of-pocket maximums count medical and substance use care together)
- HealthCare.gov: Preauthorization and Medically necessary
- Medicare.gov: Intensive outpatient program services, Partial hospitalization and Medicare costs (Part B deductible $283 in 2026)
- Texas HHSC: Summary of Texas parity findings (no Medicaid copays)
- CMS: Your rights under the No Surprises Act (Good Faith Estimates for self-pay patients)
General information, not insurance, legal or medical advice. Your plan's documents and your plan's answers decide what you pay.