Health New England Insurance Coverage for Rehab

Health New England is a non-profit health insurance company that provides healthcare plans to residents of Massachusetts and Connecticut. Many Health New England policyholders use their health insurance plan to access addiction treatment every year.

It can be tricky to understand how substance abuse treatment and health insurance intersect. Keep reading to learn about coverage levels, treatment options, and more.

Answer: Yes, Health New England insurance does cover alcohol and drug addiction treatment. However, this coverage will vary and comes with some caveats.

Due to the passage of the Affordable Care Act in 2010, all health plans on the marketplace must cover drug and alcohol addiction treatment at least partially. This is because substance use disorder (SUD) treatment is listed as one of 10 essential health benefits.

Answer: There is a wide variety of addiction treatment services you can get covered through your Health New England plan.

Whether you’re seeking a particular treatment service, have a recommendation from your primary care provider, or just want to learn more about your options, you’ll find the treatment types covered to be fairly comprehensive.

Read on to learn about some common treatment services, what they entail, and what level of coverage you can expect.

Medical Detox

Medical detoxification is covered by most Health New England plans. Depending on whether you receive this service in an inpatient or outpatient setting, you may be responsible for a copay or receive full coverage once your deductible is met.

Detox is a treatment service designed to help flush addictive substances out of the body.

Trying to detox from an addictive substance on your own can be incredibly dangerous, which is why medical detox services are so important.

During detox, you can expect your care team to monitor your vitals, help you manage withdrawal symptoms and cravings, and administer medications or additional treatments.

Medication-Assisted Treatment

Most Health New England insurance plans also cover medication-assisted treatment (MAT). If you receive MAT in an inpatient setting, you may need to meet your deductible before receiving coverage.

In an outpatient setting, you’ll likely have a copay for each office or virtual visit.

MAT is a very effective addiction treatment service. It’s an evidence-based treatment that uses U.S. Food and Drug Administration (FDA)-approved medications to treat addiction.

These medications are designed to help reduce withdrawal symptoms and cravings and the risk of relapse down the road. Medications include methadone, Suboxone, and buprenorphine.

This treatment option is used as part of a comprehensive care plan. In other words, you’ll receive other addiction rehab treatments while you receive MAT.

Inpatient Rehab

Inpatient rehab is often covered by Health New England healthcare plans. In most cases, you’ll need to meet your deductible before receiving coverage for this treatment type.

Many people start their recovery journey in inpatient treatment. This is because it is considered to offer the higher level of care through round-the-clock, intensive care.

Individuals who participate in an inpatient program will live in the treatment facility through the duration of their program.

Inpatient rehab is very heavily structured and combines the use of multiple treatment options to offer a comprehensive, regimented approach.

Dual Diagnosis Treatment

If dual diagnosis treatment is something you’re looking for in your treatment program, most Health New England plans cover this service.

Much like with other treatment services, you will likely need to meet your deductible before receiving coverage if seeking inpatient care or pay a copay per visit if seeking outpatient care.

Dual diagnosis treatment addresses mental and physical health simultaneously. When it comes to addiction, many people also have mental health disorders, which are referred to as co-occurring disorders.

Common co-occurring disorders include anxiety, post-traumatic stress disorder (PTSD), bipolar disorder, and depression.

These mental health issues can worsen addiction or even be the root of it. With dual diagnosis treatment, you and your clinicians can address your addiction and wellness from multiple angles.

Outpatient Treatment Programs

With most Health New England health insurance plans, outpatient rehab is covered, leaving the policyholder responsible for a copay per visit.

Some outpatient programs require prior authorization to ensure coverage, though you’ll have to check the details of your plan to be sure.

Outpatient treatment is often considered to be a step down from inpatient treatment, but is still very effective.

Rather than living in a rehab facility, participants of an outpatient program travel to a treatment center several days a week. For several hours each day, you’ll receive your specified treatment.

Many people start with inpatient treatment before transitioning to outpatient care, and some people even opt for more “in-between” options like intensive outpatient programs (IOPs) or partial hospitalization programs (PHPs).

Counseling & Behavioral Therapy

Health New England often covers the cost of counseling and behavioral therapy at least in part. Your deductible will apply for these services in inpatient settings whereas outpatient settings will likely require a copay for each visit and may require pre-approval.

Counseling and behavioral therapy are both behavioral health services that are offered throughout your treatment journey. Counseling is a great opportunity to share your thoughts and feelings surrounding addiction and recovery in one-on-one or in group settings.

Behavioral therapy is a little more specific than counseling, as the goal is to adjust behavioral patterns and thought patterns that are contributing to your mental health disorders or addiction.

Some common behavioral therapy types are cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT).

Continuing Care

Coverage through Health New England for continuing care or aftercare is a little bit more complex than that of other treatment services. Some may be covered and subject to copays or coinsurance whereas others are not qualified for coverage.

Aftercare is a very individualized service. You and your case management team will devise a treatment plan for after the completion of your treatment program to encourage long-lasting recovery.

If you choose to continue services like MAT or group counseling, you will likely receive coverage.

However, if you seek sober living, you may not be able to receive any assistance in covering the cost. Other services like support groups often do not have a cost.

When it comes to Health New England coverage for SUD treatment, there are a few factors to keep in mind that can affect your level of coverage.

Factors that affect coverage include:

• Type of treatment: Certain treatment types are eligible for higher coverage than others. You may need a certain kind of treatment or a combination of services, so it’s important to know this can alter how much coverage you receive.
• Your plan: Different insurance plans, even within the same company, offer different levels of coverage. You may have access to higher or lower levels of coverage based on the plan you’ve chosen.
• Your location: Lastly, where you live can affect your coverage. Some states will allow for better coverage due to access to different plans, different state regulations, etc.

Answer: Some Health New England insurance plans cover out-of-network addiction treatment programs. However, this is not without limitations.

Of the plans that do cover out-of-network treatment, you’ll likely be responsible for coinsurance (ex: 20% of the cost) after you’ve met your deductible. In other words, you won’t receive coverage until you meet your deductible, and it won’t be as much as it would be in-network.

Additionally, not all treatment modalities are covered out-of-network. For example, some plans do not cover telehealth services out-of-network.

The bottom line is, you’ll always receive the highest coverage level for addiction treatment by staying in-network.

Health New England offers a variety of individual and employer plans as well as some Medicare and Medicaid plans.

Plan types include:

Health Maintenance Organization (HMO) plans:

• HMO Core
• HMO Essential
• HMO Premium
• HMO Thrive
• HMO Wise

Preferred Provider Organization (PPO) plans:

• PPO Core
• PPO Essential
• PPO Premium
• PPO Thrive
• PPO Wise

Medicare Advantage plans

Medicaid plans

• MassHealth plan

Though subject to other factors, coverage through Health New England insurance is not dependent on addiction type.

Types of addiction covered by Health New England include:

• Cocaine
• Meth
• Heroin
• Alcohol
• Prescription drugs
• Opioids
• Benzodiazepines

Finding recovery centers that are not only accredited but also accept your health insurance plan can seem like a daunting task. However, a number of resources can help ease this process.

Some great resources for finding rehab facilities include:

• Asking your provider for a referral: If you have a regular healthcare provider you see, you can always ask them for facility recommendations within your network.
• Using Health New England’s website: When you log in to your member portal with Health New England, you can utilize the “Find a provider” function to find centers in your area that accept your insurance plan.
• Checking out our list of treatment centers by state: Each list contains information about the best rehab facilities in your state including information about accepted insurance providers.

Health New England offers coverage for a wide variety of treatment services and can make treatment much more accessible for many people seeking addiction rehab.

If you or your loved one is ready to take the first step in their recovery journey, give our helpline a call today.