Centene Insurance Coverage for Rehab

Centene Insurance was founded by an orphan who spent her career as a hospital’s bookkeeper. The company is now one of the country’s biggest carriers of Medicaid plans.

It offers coverage through the Healthcare Insurance Marketplace, contracts with the American Department of Defense, and coverage available through its subsidiaries. Centene policyholders can use their health care coverage to access substance use disorder treatment.

Learn more about what substance abuse treatment options Centene Insurance offers, where you can get coverage, and what factors affect your health insurance coverage.

Answer: Possibly. If you’ve purchased Centene Insurance through the Healthcare Insurance Marketplace, rehab coverage is required under the Affordable Care Act (ACA).

If it’s offered through a different subsidy of Centene Corporation, it will depend on the state and county you live in, your insurance plan, and the treatment program.

You’ll need to check that the treatment center or rehab facility for your drug abuse or alcohol addiction is considered a network provider.

Answer: Centene covers all types of substance use disorder treatment. However, your specific insurance plan may not cover all of your addiction treatment.

It may cover a lower percentage of the total cost of inpatient treatment plans but a higher percentage of outpatient programs, as those can cost significantly less. It may not cover detox unless your healthcare providers submit a referral.

If your plan was purchased by March 23, 2010, and has not changed significantly, offering the same coverage as later insurance plans isn’t required.

Medical Detox

Centene may cover medical detox, but you must check your specific plan. Even if it’s generally covered, you may negate that coverage if you’re treated at an out-of-network facility or fail to gain pre-approval.

Medication-Assisted Treatment

Your insurance plan may cover medication-assisted treatment (MAT), but there may be restrictions on that coverage. Sometimes, health insurance will only cover a portion of a prescription, so you may have out-of-pocket costs even if your medication is covered.

MAT can refer to medication used to help you through initial withdrawal symptoms in drug addiction treatment. It can also apply to medication that you take to maintain your sobriety.

Inpatient Rehab

Centene’s Medicare Part A covers inpatient rehab. Before the ACA, Medicaid did not cover substance abuse treatment for minors or childless adults. However, some states now offer coverage for those individuals.

This type of treatment falls under the Mental Health Parity and Addiction Equity Act (MHPAEA), which requires insurance coverage for substance use disorder (SUD) treatment to be equivalent to any other medical and surgical benefits.

Additionally, any plan purchased from Centene health insurance companies through the Health Insurance Marketplace will include some coverage for inpatient rehab.

Dual Diagnosis Treatment

A dual diagnosis is given when a patient has co-occurring disorders of substance abuse and mental health. You’ll need to check your specific Centene health plan or contact your insurance provider to determine what benefits might apply to your dual diagnosis.

Outpatient Treatment Programs

Medicare, Medicaid Part B, and any ACA plans through Centene will cover some outpatient treatment programs.

Your explanation of benefits (EOB) will tell you what percentage of treatment will be paid through insurance and what portion will be your responsibility.

You may have copays and a remaining balance if you haven’t met your deductibles.

Counseling & Behavioral Therapy

Behavioral health services are considered Essential Benefits under the Affordable Care Act and, therefore, are covered by Centene plans. Medicare and Medicaid also cover mental health services.

Even if your insurance plan was grandfathered in before the ACA took effect, you may have some sort of Employee Assistance Program (EAP) benefits that offer a few behavioral health counseling sessions for free.

Behavioral health treatment is evidence-based and shown to heavily contribute to your overall wellness and relapse prevention.

Continuing Care

Check with the Centene provider in your area to find out what types of continuing care are covered under your plan.

Coverage may apply to additional inpatient or outpatient treatment, residential treatment, or sober living communities.

Verify that these treatment services are in-network and whether you need a referral. It’s important that you (or your loved one) receive the right type of treatment for substance use disorder.

Centene Corporation has an extensive network of health plans through its subsidiaries. However, each plan is shaped by factors that affect which network providers are covered and the total cost of your monthly premiums.

Factors that affect coverage levels and pricing include:

• State of residence
• County of residence
• Family size
• Income level
• Age
• Gender
• Tobacco use
• Pre-existing conditions*

*While insurance companies must offer coverage regardless of pre-existing conditions, your insurance plan may pre-date this law.

Answer: Whether Centene will cover out-of-network rehab centers depends on your plan and location. To find out if your insurance covers healthcare providers, you’ll need to contact your local insurance office.

If your policy has you listed as a Georgia resident, for example, it may be hard to get treatment covered if you decide to seek help in Florida.

There are a variety of options through Centene Corporation, depending on your location, income, and military service.

Centene provides healthcare plans through:

• Medicare
• Medicaid
• Health Insurance Marketplace
• Military & Veterans

However, the coverage for each of these will vary by state, county, and plan type.

For example, a search for plans in Texas resulted in the following options:

• Superior HealthPlan
• Wellcare
• Ambetter from Superior HealthPlan

Centene also takes a whole health approach by including:

• Specialty Pharmacy
• Dental
• Vision
• Nurse Advice Line & After-Hours Support
• International Solutions (UK)

Addiction is a chronic disease, and treatment is ongoing for the rest of your life.

Depending on your plan, you may be eligible for coverage for addiction to:

• Alcohol
• Cocaine
• Heroin
• Marijuana
• LSD
• Prescription drugs, like opioids or benzodiazepines

Centene Insurance offers Medicaid plans in 30 states, with coverage to be extended to Oklahoma residents starting in 2024.

Medicare Prescription Drug Plans (PDPs) are offered in all 50 states and Washington, D.C., and Wellcare has Medicare Advantage Plans in 36 states. Illinois, Michigan, Texas, South Carolina, and Ohio are all part of the Medicare-Medicaid Demonstration Plan through Centene.

Here are the top ways to find Centene-approved rehab facilities near you:

1. Look at your insurance card to find out what covered treatment facility is available near you.
2. Visit the website listed on it or call the customer service number provided there for more information.
3. Use the SAMHSA website treatment locator to find authorized rehab facilities in your state.
4. Navigate our directory of state-based rehab facilities to find carefully vetted, high-quality rehab centers near you.

If you’re struggling to make sense of your insurance company’s coverage even with the information they provide, don’t worry.

RehabNet.com can help with locating drug and alcohol rehab programs that are covered by your Centene insurance plan. Simply call our helpline today, and we’ll walk you through it.