EmblemHealth Insurance Coverage for Rehab

If you or a loved one is a current EmblemHealth policyholder seeking substance abuse treatment, it’s important to understand the type of rehab coverage your plan provides.

Understanding your coverage can help you determine where you’ll seek treatment for your substance use disorder and the costs you can expect to see out of pocket.

Read on to learn more about what EmblemHealth offers in terms of substance use treatment coverage and the types of addiction treatment that are covered under their plans.

Answer: Yes, EmblemHealth Insurance does cover drug and alcohol rehab, though the amount of coverage will vary with each individual and their specific plan.

In many instances, a policyholder will still be responsible for part of the costs of their treatment, and depending on their plan, may still have to pay copays, coinsurance, or a deductible.

It will also depend on the state that a person lives in. EmblemHealth is only available in the tri-state area of New York, New Jersey, and Connecticut, and limited areas of Florida and Georgia.

Answer: Addiction treatment encompasses many different types and levels of treatment, depending on the severity of an individual’s addiction.

EmblemHealth covers most available substance abuse treatment options, though the amount that is covered will vary and people may still be responsible for partial costs.

Medical Detox

Medical detox is typically the first step in any addiction treatment program, and involves using medications and supervision to get a person safely and comfortably through withdrawal.

EmblemHealth plans do usually cover medical detox services, for both inpatient or outpatient detox, though the extent of coverage may vary per plan.

Medication-Assisted Treatment

Medication-assisted treatment (MAT) is a standard treatment for people who are seeking help for an opioid use disorder or alcohol use disorder.

MAT is typically covered by EmblemHealth, though people will want to check with their individual plan and their drug list to find out if the drugs used for MAT, such as methadone or Suboxone, are covered under their plan.

Inpatient Rehab

During an inpatient rehab stay, a person goes through addiction treatment while living onsite and attending counseling and group therapy with other residents of the program.

This type of treatment is covered under EmblemHealth, though it may depend on the plan and the length of stay that the person requires.

Dual Diagnosis Treatment

For people who have co-occurring disorders with their substance use disorder, such as depression, bipolar disorder, or other mental health conditions, dual diagnosis treatment can be very effective.

This type of treatment utilizes both mental health services and substance abuse services, both of which are covered by EmblemHealth at varying levels per plan.

Mental illness and other forms of co-occurring disorder treatment often utilize prescription medications, such as anti-anxiety medications or antidepressants. Members should always check to make sure their needed drugs are covered.

Outpatient Treatment Programs

Outpatient treatment for substance abuse often includes a combination of medication-assisted treatment and therapy, depending on the substance that a person has been abusing.

EmblemHealth covers a variety of necessary outpatient treatments for substance abuse, including counseling, MAT, and detox.

This also includes intensive outpatient programs, in which people attend treatment services several days each week, and partial hospitalization programs (PHP).

Counseling & Behavioral Therapy

Counseling and behavioral therapy can be some of the most effective forms of substance use and mental health treatment.

People in addiction treatment can access individual therapy or group therapy, and sometimes couples therapy or family therapy as well.

EmblemHealth covers a wide range of mental health and behavioral health therapies for members, and always covers some level of counseling and therapy.

Continuing Care

Continuing care for substance use treatment usually involves some form of transitional housing, such as a sober home, where people in recovery can transition back into their lives while focusing on their goal of sobriety.

EmblemHealth does cover continuing therapy and counseling, but does not cover any type of transitional or sober housing, as these are not considered medically necessary and not a formal treatment program under the Affordable Care Act.

There can be a lot of variation among plans for EmblemHealth and what they cover. Understanding your plan and the other factors that influence your coverage can help you prepare in advance for the costs.

Factors that can affect your EmblemHealth coverage for alcohol and drug rehab include:

• The length of your treatment
• The level of care you need
• Whether your addiction treatment provider is in-network
• That state that you live in
• Out-of-pocket costs and maximums for your plan
• Whether your insurance policy is an HMO or PPO
• What kind of insurance benefits are offered with your plan

If you need further assistance in understanding the factors that affect your substance abuse coverage, you can contact us with questions at any time.

Answer: Yes, EmblemHealth does cover out-of-network rehab programs to a certain extent, but this coverage depends on the individual plan and is limited in what it may cover.

Further, of the plans which do provide coverage for out-of-network care, most of them only provide this coverage for emergency care.

So, while EmblemHealth does provide some coverage for out-of-network coverage, members who use out-of-network care should be prepared to pay a significant portion of their costs, and in some cases, all of their costs.

For this reason, members are much better off seeking treatment for substance abuse or mental health disorders from in-network providers and in-network facilities.

EmblemHealth is a private insurance company that offers multiple types of healthcare plans to its customers, depending on their needs for care.

EmblemHealth for Individuals, Families, and Small Groups

For individuals and families, EmblemHealth offers Millenium plans, Select Care plans, and an Essential plan which allows adults aged 19-64 to pay $0 monthly premiums. It also provides the ability to see specialists without a referral.

EmblemHealth also offers group plans for employers that include both POS (point of service) plans and HSA (health savings account) plans.

EmblemHealth Medicare Advantage and Medicare Supplement

For older adults, EmblemHealth offers plans through Medicare Advantage, which also gives members access to a Medicare Advantage Prescription Drug plan.

EmblemHealth also offers Medicare Supplement plans, which serve as a supplement to Original Medicare, including Medicare Parts A and B.

This type of plan is meant to cover, or supplement, some of the additional costs not covered by Original Medicare, which can include deductibles and copays.

EmblemHealth Medicaid, HARP, and CHPlus

EmblemHealth also offers Medicaid Managed Care plans that are state-sponsored and which are offered to people who qualify at little to no cost.

Members who qualify can also access Enhanced Care Plus (HARP), which is a state-sponsored Health and Recovery plan, or Child Health Plus (CHPlus), which is dependent on a family’s income and size.

There are several different substances which a person might find themselves addicted to and seeking professional treatment for in stopping use. Note that your coverage does not depend on the type of substance you’re addicted to.

Some treatment facilities specialize in the treatment of one or a few types of substance use disorders, such as those which offer MAT, while others treat all types of addiction.

Some of the addictions that may be covered by EmblemHealth Insurance include:

• Marijuana
• Cocaine
• Heroin
• Opioids and other prescription drugs
• Methamphetamines
• Alcohol

It is always a good idea to check with a rehab facility in advance to learn if they accept your EmblemHealth Insurance and if they treat the specific disorder you are struggling with.

In addition to calling the phone number on the back of your EmblemHealth ID card and speaking to a customer service representative, you can also talk to your primary care physician and ask for rehab center recommendations that are in your network.

There is also a search tool through the EmblemHealth website that allows policyholders to search for healthcare providers by network or plan.

And you can search for rehab centers by state using our comprehensive list of addiction treatment centers in all 50 states.

If you are an EmblemHealth policyholder and would like further assistance understanding your health insurance coverage for drug and alcohol addiction treatment, contact RehabNet any time.

You can fill out our contact form or call our helpline and speak to one of our trained addiction experts, and begin your recovery journey today.

Your insurance provider or coverage should never come between you and getting the substance abuse treatment that you need. No matter your situation, we will help you find a rehab program or treatment center to suit your needs and finances.