CareSource Insurance Coverage for Rehab

CareSource was formed in Dayton, Ohio in 1989. It currently serves members in eight states and is expanding to members of the military and veterans.

As a nonprofit and government-sponsored organization, CareSource offers coverage for drug rehab through Medicare, Medicaid, and the Health Insurance Marketplace.

Learn more about:

• What states have CareSource
• What benefits may be available in your area
• Coverage for substance abuse treatment through CareSource
• How to find out your specific CareSource benefits

Answer: Yes, CareSource covers rehab treatment for drug and alcohol addiction.

Drug rehab treatment plans differ based on your or your loved one’s needs, what treatments are available in your area, and what your insurance policy covers.

Depending on your location and CareSource plan, you may have access to additional benefits with your CareSource insurance.

These benefits may include:

• Life coaches who can help you with life skills like budgeting and meal planning and figuring out goals, housing, employment, and transportation.
• Member services that can explain your specific insurance benefits and provide health and wellness education.
• Nurse helplines available 24 hours a day to answer medical questions and give medical advice.
• Care and disease management assistance, which specifically includes mental health and substance use disorder management.
• Behavioral health assistance program, which includes assessments and screening, detoxification services, addiction services, counseling, psychiatry, opioid treatment, and residential treatment.
• Care Managers for adults and children who work with you and your health provider team to coordinate your treatment plan, encompassing substance abuse and behavioral health among its target chronic conditions.
• Disease management to educate you on your condition and challenges and how to improve your personal wellness.
• Telehealth services for care where you are and when you need it.

Answer: All types of standard addiction treatment are partially to fully covered by CareSource insurance plans.

CareSource plans are only offered as part of Medicare, Medicaid, and the Health Insurance Marketplace. Therefore, they are all mandated by the Affordable Care Act (ACA) to include coverage for mental health and substance use disorder treatment.

Medical Detox

CareSource covers medical detox coverage as part of an inpatient or outpatient program for drug addiction treatment. You’ll need to read through your EOC or contact member services to know what percentage your insurance care plan covers.

That information will help you determine your out-of-pocket costs for copays, coinsurance, and any remaining deductible.

Medication-Assisted Treatment

Under CareSource plans, medication-assisted treatment (MAT) is part of behavioral health services. It may include medications prescribed for withdrawal symptoms, like buprenorphine and methadone.

Prescription drug coverage for formulary and non-formulary medications can be found online through CareSource. They may cover drugs outside of the formulary, but you may need to talk to your provider and member services about it.

If a drug is not available at an in-network pharmacy, you may be able to get it covered through your insurance plan by calling CareSource.

If you’re given a prescription for a drug that is not considered medically necessary but is shown by reputable research to be effective in treating your condition, CareSource may cover it.

Medications for maintenance during recovery are also covered by CareSource as part of continuing care.

Inpatient Rehab

CareSource plans include coverage benefits for inpatient addiction treatment services beginning with admission and stabilization. Inpatient treatment takes place over a period of time in a treatment facility where you stay for an extended length of time, such as 30 or 60 days.

Inpatient rehab may include detoxification and mental health services.

Dual Diagnosis Treatment

When you have a dual diagnosis, or co-occurring substance use and mental health disorders, CareSource covers a portion of treatment for alcohol or drug abuse and mental health services.

Check with your local provider to determine what level of care your exact plan covers. Dual diagnosis treatment involves a combination of treatments for SUD and mental health, like various therapies, counseling, MAT, detox, and others.

Outpatient Treatment Programs

Addiction treatment programs that include outpatient rehab can include doctor visits, evaluations, group therapy, and even detoxification, depending on your health conditions and addiction.

These are all part of the behavioral health services covered by CareSource. Know that some treatment services may require a referral from your primary care physician (PCP), so you need to check your policy information.

Counseling & Behavioral Therapy

Because all CareSource health plans abide by the ACA, every plan covers mental health treatment. This may include individual, family, or group treatment services.

You can work with your care team to decide what care plan will work best for you and be covered by your CareSource health plan.

Some common therapies for addiction include cognitive behavioral therapy, dialectical behavioral therapy, motivational interviewing, and talk therapy.

Continuing Care

Addiction rehab can last a few weeks up to several months. You may need help after you’ve completed rehab at a treatment center, including MAT and care for mental health disorders.

CareSource coverage extends to residential treatment, medications, and counseling later in recovery. However, your plan may place limits on time in a residential treatment facility, prescription types and amounts, and behavioral health appointments.

You must be eligible for a CareSource plan to receive coverage and be a resident of one of the states within its coverage area.

Payment of premiums will affect your coverage, though there may be exceptions for dependents who are minors.

Additionally, what plan you have determines what level of care is covered by CareSource and at what percentage.

Lastly, whether your treatment provider is in-network for CareSource factors into how much your insurance plan will pay versus how much your out-of-pocket responsibility will be.

Answer: Yes, you can receive coverage for out-of-network rehab programs under your CareSource plan.

However, you may need pre-approval for treatment and have higher totals for your co-pays, deductibles, and coinsurance on any treatment services.

You may have some protection against surprise billing from out-of-network drug addiction treatment under the No Surprises Act (NSA), which can help if you receive emergency care or treatment services by an out-of-network provider at an in-network facility.

Know that in-network providers can change, and you should always check with CareSource to find out if a treatment facility or service is covered by your health plan.

Your CareSource health plan may specifically cover out-of-network services if they are:

• Performed at an emergency or urgent care facility
• Not available from an in-network provider but are listed as covered services
• Provided by a non-network provider through an in-network provider (i.e., lab services through a hospital)
• Necessary for continuation of care

The available insurance plans vary in the eight states currently part of CareSource’s coverage area. While plans are offered through Medicare, Medicaid, and the Marketplace, not every state is included in CareSource’s network for each plan type.

You’ll need to visit the CareSource website for your state to find out if the coverage you need is offered and whether you’re eligible for it.

If you already have health insurance through CareSource, you should check your Evidence of Coverage (EOC) for what’s covered with your specific plan.

CareSource offers health plans in these states:

Arkansas

• CareSource Passe

Georgia

• Marketplace
• Medicaid
• Planning for Healthy Babies
• PeachCare for Kids
• MA – Dual Special Needs
• Pathways to Coverage

Indiana

• Healthy Indiana (HIP)
• Hoosier Healthwise (HHW)
• Marketplace
• MA – Dual Special Needs

Kentucky

• Marketplace

Michigan

• Medicaid

North Carolina

• Marketplace

Ohio

• Medicaid
• OhioRise
• Marketplace
• MA – Dual Special Needs
• MyCare Ohio
• Home Care Waiver

West Virginia

• Marketplace

With a CareSource plan, you are eligible for benefits regardless of the substance to which you’re addicted. Coverage for mental health and substance use disorders is required as one of the 10 essential benefits outlined in the ACA.

Additionally, the Mental Health Parity and Addiction Equity Act (MHPAEA) requires insurance companies to cover treatment for mental health and substance use disorders at the same levels as medical and surgical benefits on a policy.

CareSource offers a number of addiction treatment support services. These can be found under your member login.

Though CareSource is only available in eight states at this time, they’re expanding to other states and military personnel. You can use one of the methods below to keep up with their coverage area.

Try one of these top methods for locating rehab centers covered by CareSource:

1. Use the Find a Doctor tool on the CareSource website.
2. Log into your My CareSource member account.
3. Call the number for your state and plan, which you can find on the back of your insurance card or by visiting CareSource’s Contact Us page.
4. Check out RehabNet.com and search our database for high-quality rehab facilities near you.

Figuring out what providers in your area are currently covered by your insurance plan can be a hassle. While some insurance companies have accurate lists of providers, many struggle to maintain those lists.

The lack of reliable information can be frustrating when you’re trying to find help for your drug addiction. Luckily, you can always reach out to RehabNet.com.

We’re available 24 hours a day if you call our helpline. You can also take a look at our website database which includes a curated list of pre-vetted facilities.