Does Insurance Cover Gambling Addiction Treatment?

The DiagnosisGambling disorder is a billable condition

Gambling disorder is a mental health diagnosis, not a character flaw. The American Psychiatric Association's DSM-5 places it with the behavioral addictions, citing its similarity to substance-related disorders. A clinician diagnoses it when someone meets four or more of nine criteria within 12 months, such as repeated failed attempts to cut back, or going back another day to get even after losing.

On an insurance claim, the diagnosis travels as ICD-10-CM code F63.0. New York's addiction agency tells certified programs to use F63.0 on gambling-only claims, and Oregon's Medicaid guidance lists it first among the diagnoses that qualify.

A billable code isn't a promise of payment, though. Legal scholar Stacey Tovino wrote in 2014 that "health insurance policies and plans have long excluded treatment for gambling disorder from health insurance coverage." Some of that has changed, so check your own plan. For background, see whether gambling addiction is a mental illness.

The LawWhat parity does, and what it doesn't

The Mental Health Parity and Addiction Equity Act of 2008 is what people usually mean when they say insurance "has to" cover mental health. It's narrower than that.

If a plan covers mental health or substance use care, it can't apply tougher rules to it than to medical and surgical care. The Department of Labor lists copays, deductibles, visit limits, prior authorization and medical necessity reviews. If a plan pays for out-of-network medical care, it has to offer comparable out-of-network mental health care.

What parity doesn't do is require the coverage in the first place. CMS says the law "does NOT require group health plans or health insurance issuers to cover MH/SUD benefits." It protects gambling disorder coverage once a plan includes it. It doesn't add it.

In May 2025, federal regulators paused enforcement of the newer parts of a 2024 parity rule while they reconsider it. The law itself and the 2013 rules still apply.

The Affordable Care Act sets a floor for some plans. All Marketplace plans cover mental health and substance use services as essential health benefits, per HealthCare.gov, and CMS says that requirement reaches non-grandfathered individual and small-group plans. Specific benefits still depend on your state and plan.

Your PlanThe kind of plan you have changes the answer

• Marketplace plans follow the rules above.
• Employer plans that buy coverage from an insurer are also subject to state insurance regulation, and CMS notes some states have parity rules stricter than federal law.
• Self-funded private employer plans, where the employer pays claims itself, fall under the U.S. Department of Labor rather than state insurance regulators; self-funded state and local government plans are overseen by HHS. HR can tell you which you have.
• Small employer plans (generally 50 or fewer workers) aren't directly covered by federal parity law, but CMS says it applies indirectly through essential health benefits.
• Medicare Part B covers outpatient therapy and intensive outpatient services from psychologists, clinical social workers, marriage and family therapists, mental health counselors and others, including by telehealth. You generally pay 20% of the approved amount after the deductible. Ask whether your clinician accepts Medicare.
• Medicaid varies most of all.

MedicaidIt depends on the state you live in

Medicaid is "the single largest payer for mental health services in the United States," according to Medicaid.gov. Whether it pays for gambling treatment is a state decision:

• New York. Since January 1, 2023, New York Medicaid, both fee-for-service and managed care, has covered gambling-only treatment at state-certified programs with a gambling designation, according to the Office of Addiction Services and Supports.
• Oregon. Oregon added outpatient gambling disorder treatment to the Oregon Health Plan the same day, and the Oregon Health Authority says these services "should be free to the client." Medicaid there doesn't cover residential gambling treatment, but the state-funded residential program is free, by referral after an assessment.
• Illinois. In July 2026, Illinois added gambling disorder to its Substance Use Disorder Act, so the state can offer gambling treatment on its own (the bill itself attached no new funding). Before, state-funded inpatient care for gambling required a co-occurring substance use disorder. The law doesn't address Medicaid reimbursement, and people familiar with the bill told Capitol News Illinois it doesn't make gambling treatment eligible for Medicaid payment. More in our Illinois law explainer.

Free OptionsState-funded treatment, with or without insurance

The eight without public funding in 2023 were Alaska, Alabama, Hawaii, Idaho, Mississippi, Montana, Utah and Texas, according to the National Association of Administrators for Disordered Gambling Services. Examples elsewhere:

• Pennsylvania. The Department of Drug and Alcohol Programs funds outpatient treatment and case management for eligible Pennsylvanians who are uninsured or underinsured. Where a county has no contracted provider, the state's page says to call Pennsylvania's problem gambling helpline to be connected with a provider offering telehealth.
• Ohio. The state-supported Ohio Gambling Telehealth Network bills insurance if you have it, but "clients will not be billed the difference," and uninsured clients aren't turned away. The state calls it no-cost care from gambling-trained clinicians, "regardless of ability to pay."
• Tennessee. The state says gambling help "is free," by telehealth or at clinics in Memphis, Nashville and Johnson City. That matters there: a 2024 study of a national therapist directory found Tennessee had the lowest average insurance-acceptance rate of any state, 51.5% averaged across its counties.
• Oregon. About 46 agencies provide gambling treatment through state contracts, free to the client.

The BillWhat treatment costs without insurance

Outpatient therapy. The best national figure comes from a 2024 Health Affairs Scholar study of 175,083 private-practice therapists in a national online directory in late 2023. Among the roughly two-thirds who posted a rate, the average listed cash rate was $143.26 per session, and about a third of all those therapists didn't accept insurance. The listings are self-reported, and the authors note that therapists who don't post rates may charge more.

Intensive outpatient and residential. We couldn't find a reliable national price for gambling-specific intensive outpatient or residential programs, so we aren't going to guess. Get the full cost in writing before you commit.

Your right to an estimate. If you aren't using insurance, providers must give you a good faith estimate, according to CMS. Book 3 to 9 business days ahead and it's due within 1 business day; book 10 or more ahead and it's due within 3 business days. If the bill comes in $400 or more above the estimate, you can dispute it within 120 days of the bill, for a $25 fee.

Sliding scale. A sliding scale means the price depends on your income. Community health centers work this way and can refer you to mental health care, per HealthCare.gov. Ask any private therapist whether they offer one and what proof of income they need.

Between-session monitoring. If your therapist uses an app between sessions, your statement may show remote monitoring codes such as 98975 (setup), 98978 (monitoring tied to cognitive behavioral therapy) or 98980 (the clinician's monthly treatment-management time, first 20 minutes), per CMS. Ask what you'd owe.

Peer SupportGamblers Anonymous costs nothing

In GA's own words: "There are no dues or fees for Gamblers Anonymous membership; we are self-supporting through our own contributions." The only requirement is a desire to stop gambling. You don't need a referral or an insurance card. Meetings work alongside clinical care, not instead of it. Find one in our meetings directory.

What to AskA script for the number on your card

Call member services or the behavioral health number on your card. Write down the date, the representative's name and a reference number. Then ask:

1. "Is outpatient treatment for gambling disorder, diagnosis code F63.0, a covered benefit on my plan?"
2. "Which in-network behavioral health clinicians near me treat gambling disorder?"
3. "Do I need a referral or prior authorization for outpatient therapy? What about intensive outpatient or residential care?"
4. "Are there limits on the number of sessions or days?"
5. "What will I pay per session, and how much of my deductible have I met?"
6. "Is telehealth covered at the same cost as an in-person visit?"
7. "Do I have out-of-network benefits? What percentage is reimbursed, and how do I submit a claim?"
8. "If a claim is denied, how do I get the reason in writing and start an appeal?"

IntakeWhat your first appointment looks like

Pennsylvania's contract for state-funded gambling treatment, revised in May 2026, shows what a start can look like. At the first appointment, the counselor completes an admission form and a gambling screening. A fuller assessment follows by the second appointment, and a written treatment plan with your goals and target dates is due by the end of the third. Providers also check whether insurance or other resources can cover some of the cost, and ask for proof of residency.

Expect direct questions about how often you gamble, what you've lost or borrowed, whether you've hidden it, and how it's affecting work and relationships. Most of those track the DSM-5 criteria, and nobody's there to judge you. Bring your insurance card and ID. Our guide to finding a gambling addiction therapist covers what to ask before you book.

Next StepDon't let the money question become the reason to wait

Money stress is real, and it can become its own trap. If part of you thinks you'll start treatment once you've made the money back, notice that thought. Going back to get even is one of the nine DSM-5 criteria, and "later" rarely arrives. Treatment doesn't have to wait for your finances. For the money side, start with financial recovery after gambling.

Today:

• Search the free Cope Compass directory by state and insurance, or check your state's funded program.
• Make the call with the script above.
• Find a meeting this week.
• Get the Cope Compass app for between-session tools, and read how to quit gambling.

If you're in crisis right now, go to urgent help.

This article is educational, not legal, financial or medical advice. Coverage depends on your specific plan and state, so confirm the details with your insurer.

Sources

• American Psychiatric Association, What Is Gambling Disorder?. Physician review May 2024. DSM-5 placement of gambling disorder in a behavioral addictions category and its similarity to substance-related disorders.
• DSM-5 Diagnostic Criteria for 312.31 Gambling Disorder, reproduced by the Washington State Health Care Authority. Undated (file modified June 2020). Four or more of nine criteria in a 12-month period; "chasing" criterion.
• New York State OASAS, Medicaid Reimbursement for Gambling Disorder Treatment Provided Certified Programs (fact sheet). January 2023. Medicaid fee-for-service and managed care coverage of gambling-only treatment from January 1, 2023, at programs with the OASAS gambling designation; F63.0 as the diagnosis code.
• Oregon Health Authority, Medicaid Coverage of Outpatient Gambling Disorder Treatment Services. Last updated June 27, 2023. OHP coverage from January 1, 2023; F63.0 as qualifying diagnosis; services "should be free to the client"; about 46 contracted agencies; residential excluded from Medicaid but free through the state program by referral.
• Stacey A. Tovino, "Lost in the Shuffle: How Health and Disability Laws Hurt Disordered Gamblers," 89 Tulane Law Review 191. 2014. Quote that plans "have long excluded" gambling disorder treatment.
• CMS, The Mental Health Parity and Addiction Equity Act (MHPAEA). Last modified March 13, 2026. MHPAEA "does NOT require" coverage; plan types; small employer rule; indirect reach through EHB; insured plans regulated by states, self-funded private plans by DOL; stricter state laws.
• U.S. Department of Labor, Mental Health and Substance Use Disorder Parity. Undated. Comparable cost-sharing, visit limits, prior authorization, medical necessity, and out-of-network benefits.
• Departments of Labor, HHS and the Treasury, Statement Regarding Enforcement of the 2024 MHPAEA Final Rule. May 15, 2025. Non-enforcement of new 2024 provisions; statute and 2013 rule continue to apply.
• HealthCare.gov, Mental health and substance abuse health coverage options. Undated. All Marketplace plans cover these services as essential health benefits, with parity; specifics depend on state and plan.
• Medicaid.gov, Behavioral Health Services. Undated. Medicaid as the single largest payer for mental health services in the U.S.
• Medicare.gov, Mental health care (outpatient). Undated. Part B services, eligible provider types, 20% coinsurance after the deductible, telehealth, intensive outpatient program services.
• Capitol News Illinois, Illinois recognizes gambling addiction, allowing new treatment options. July 27, 2026. SB 2749; standalone state-funded gambling treatment; prior inpatient restriction; no Medicaid eligibility.
• NAADGS, 2023 Budget Update of Publicly Funded Problem Gambling Services in the United States. May 2024. 43 jurisdictions including D.C. funded services in 2023; the eight states that did not.
• Pennsylvania DDAP, Locate Problem Gambling Treatment and Support. Undated. Funded outpatient treatment and case management for eligible uninsured or underinsured Pennsylvanians; telehealth where no county provider exists.
• Pennsylvania DDAP, Statement of Work: Compulsive Problem Gambling Treatment and Intervention Services ITQ. Rev. May 14, 2026. Intake sequence (admission form and gambling screening at first appointment, assessment by second, treatment plan by third), client liability assessment, proof of residency.
• Ohio Gambling Telehealth Network, Insurance and Payment. Undated. Insurance billed when available, clients not billed the difference, uninsured not turned away.
• Ohio Department of Behavioral Health, SFY 2025-26 Ohio Problem Gambling Services Annual Report and Plan. November 19, 2025. No-cost telehealth from gambling-trained clinicians "regardless of ability to pay."
• Tennessee Department of Mental Health and Substance Abuse Services, Problem Gambling Programs. Undated. Gambling help "is free"; telehealth plus clinics in Memphis, Nashville and Johnson City.
• Zhu JM, Huntington A, Haeder S, Wolk C, McConnell KJ, "Insurance acceptance and cash pay rates for psychotherapy in the US," Health Affairs Scholar. September 9, 2024. 175,083 providers; $143.26 average cash rate; about one-third not accepting insurance; Tennessee 51.5% acceptance, lowest of any state (D.C. lower at 41.0%).
• CMS, Good Faith Estimate. Undated. Estimate rights when not using insurance, and timing rules.
• CMS, Dispute a bill. Undated. $400 threshold, 120-day window, $25 fee.
• HealthCare.gov, Community health centers. Undated. Payment depends on income; referrals to mental health care.
• CMS Medicare Learning Network, Transitional Care Management Services (MLN908628). August 2025. Descriptors for remote therapeutic monitoring codes 98975, 98978 and 98980.
• Gamblers Anonymous, About Gamblers Anonymous. Undated. "No dues or fees"; the only requirement is a desire to stop gambling.
• HealthCare.gov, Appealing a health plan decision. Undated. Insurers must explain denials; internal appeal and external review rights.
• Center for Connected Health Policy, Cross-State Licensing. Undated. Telehealth is considered rendered where the patient is; providers typically need a license in the patient's state.