Health Plans SUD Impact Calculator.

Health plans are absorbing the cost of substance use disorder whether they manage it or not. Members with a formal SUD diagnosis cost plans approximately 2.5 times more annually than those without — yet only 1.4% carry that diagnosis despite an estimated 11% prevalence. That leaves a high-cost, high-risk population generating disproportionate spend across ED visits, inpatient stays, and chronic disease management — unidentified and unmanaged. Calculate the impact of SUD on your plan’s business and how CHESS Health’s digital tools can improve cost savings and clinical outcomes.

SUD Impact on Membership

Total Covered Lives
Enter total covered lives.
Estimated SUD Prevalence
3%11%25%
Defaulted to 11% as a best estimate based on national data. Adjust if your plan has claims-based or population-specific data.
11%
Estimated Members with SUD
Total Covered Lives × SUD Prevalence Rate
—
Average Annual Medical Cost Per Member with SUD
Members with SUD cost health plans approximately 2.5× more annually than those without ($26,000 vs. $10,400/yr). The $15,640 figure represents the average annual medical cost per enrollee with a formal SUD diagnosis — the true cost per affected member, including the undiagnosed majority, is likely higher.
$15,640
Total Estimated Annual SUD Cost Burden to Your Plan
Estimated Members with SUD × $15,640
—
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Estimated Cost Avoidance

These figures represent potential cost savings based on plan-specific data provided on tab one and published outcomes from programs using CHESS Health’s recovery engagement tools. Actual impact depends on program implementation following best practices. Outcomes are not guaranteed.

Potential Cost Savings

Estimated Members with SUD
—
Estimated Members Currently Receiving SUD Treatment
Default to 12% of your estimated SUD membership based on national data averages. Adjust to plan-specific data if different.
Estimated SUD Members × 12% = —
Estimated Rate of Return to a Higher Level of Care
10%40%60%
The National Institute on Drug Abuse (NIDA, 2020) estimates that 40–60% of individuals with SUD experience relapse and require return to a higher level of care. Adjust the slider based on your plan data.
40%
Estimated Members at Risk of Return to a Higher Level of Care
Members in Treatment × Return-to-Care Rate
—
Estimated Reduction in Members Returning to a Higher Level of Care
Members at Risk × 24% (CHESS Health reduction rate — Oklahoma DMHSAS study)
—
Estimated Annual Cost Savings
Reduction in Members Returning × $9,766 (avg. residential episode cost)
—
Note: These estimates do not account for additional savings potential in specific member populations, including pregnant members and reductions in neonatal abstinence syndrome (NAS) costs. For a full analysis, see the CHESS Health White Paper: The True Cost of Substance Use Disorders in the United States.

How Cost Exposure Is Calculated

SUD membership = total members × prevalence rate (default 11% — national self-report rate, Peterson et al., JAMA Network Open, 2023)
Direct SUD medical cost = SUD members × $15,640 — average annual medical cost per enrollee with a formal SUD diagnosis (D’Arrigo, Psychiatry News, 2023)
Total cost burden = SUD members × $15,640

How CHESS Health Impact Is Calculated

Treatment population = user input (default: SUD members × 12% — share actually receiving treatment, Peterson et al., 2023)
At-risk population = treatment population × relapse rate (default 40% — NIDA, 2020)
Calculated reduction = at-risk population × 24% — CHESS reduction in rate of return to a higher level of care (Oklahoma DMHSAS study)
Savings = reduction × $9,766 — average cost of an adult residential episode (NDAS, 2022)
Actual savings will vary based on implementation fidelity, member characteristics, and plan structure.
Savings do not reflect impact on prevention initiatives tied to CHESS Health’s automated SBIRT capabilities.

National Benchmarks

FigureValueSource
SUD prevalence — self-report11%Peterson et al., JAMA Network Open, 2023
Formally diagnosed in employer plans1.4%Peterson et al., JAMA Network Open, 2023
Avg. annual SUD medical cost per enrollee$15,640D’Arrigo, Psychiatry News, 2023
Share of SUD members receiving treatment12%Peterson et al., JAMA Network Open, 2023
SUD relapse / return-to-care rate40–60%NIDA, Treatment and Recovery, July 2020
CHESS return to care reduction24%Oklahoma DMHSAS study (White Paper)
Avg. residential episode cost$9,766NDAS, 2022 — White Paper

Data Sources

All national benchmarks are drawn from peer-reviewed research and federal data sources cited in the CHESS Health White Paper: The True Cost of Substance Use Disorders in the United States. Estimated CHESS Health impact reflects published outcomes and represents a potential range, not a guaranteed result.