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Humana Insurance Coverage for Rehab

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A common concern for people considering seeking treatment for drug and alcohol addiction is how they will afford a treatment program. Luckily, many insurance companies such as Humana offer coverage for a variety of addiction services including inpatient and outpatient rehab. Let’s explore the different types of coverage that a Humana insurance plan may provide for drug and alcohol addiction recovery. We can fit your Humana insurance policy with the best suitable drug and alcohol rehab center.

Humana Insurance Coverage for Drug and Alcohol Rehabilitation

Looking into their insurance coverage is often one of the first things many people do when deciding when and where to seek treatment for drug and alcohol addiction. Humana, one of the nation’s leading private insurance carriers, commonly provides some level of coverage for several forms of addiction treatment. Humana currently provides insurance coverage to more than 13 million individuals throughout the United States and works closely with thousands of medical providers to give its clients the best prices available for medical services.

Healthcare Plans Offered Through Humana Insurance

As one of the largest insurance providers in the nation, Humana offers several different types of plans for its customers. These plans range from Medicare and Medicaid to individual and group plans that can be acquired through employers. Additionally, Humana offers coverage for active service members and their families in partnership with TRICARE and the Department of Defense.

The following are a few commonly offered Humana healthcare insurance plans:

  • High deductible: This plan requires a higher deductible to be met before insurance coverage will be provided. However, this plan also typically has a lower monthly premium payment.
  • Copay only: This type of Humana plan requires customers to pay a fixed amount for each doctor’s visit or other medical service received. There are no deductibles that must be met unless seeking out-of-network treatment.
  • Traditional: This Humana plan combines the most popular insurance offerings into one by requiring a mix of co-insurance, deductibles and copays.

In addition to the above plans, Humana also uses a metal rating system for some plans to help customers better understand their payment expectations. For example, a Bronze-level insurance plan typically has a lower monthly premium but requires higher copays and/or deductibles. A Platinum-level Humana plan often requires a higher monthly premium but is the least expensive in terms of copays, deductibles and co-insurance.

Additional plans that Humana may offer include:

  • HMO (Health Maintenance Organization) healthcare plans
  • PPO (Preferred Provider Organization) healthcare plans
  • Self-funded plans
  • Total Health
  • Humana Simplicity

The specific names of plans and their features and benefits may vary depending on whether the plan is individual or group as well as the geographical location where the plan is being purchased.

Humana In-network Versus Out-of-network Coverage

Knowing the difference between in-network and out-of-network coverage and whether your plan provides coverage for out-of-network medical services is an important factor in determining where you will seek treatment. Like other insurance providers, Humana has several healthcare plans with some offering coverage for only in-network services as well as plans that offer coverage for both in- and out-of-network medical care.

If your Humana plan does not provide coverage for out-of-network medical services, this means that you will be required to pay the full price of treatment out-of-pocket. On the other hand, if your Humana healthcare plan does offer some level of coverage for out-of-network treatment, you can seek medical services at facilities that do not work directly with Humana and still receive assistance from Humana through your plan. However, out-of-network services are often more expensive than in-network services even if your healthcare plan offers coverage.

When a treatment center is in Humana’s network, this means that the center has worked directly with Humana to offer a lower price for Humana clients. For example, when visiting a medical clinic that is in-network, a $35 copay may be all that’s required. However, for an out-of-network clinic, you may be required to pay the full price of the service.

Does Humana Cover Drug and Alcohol Detox Programs

Many people are required to complete a medically-supervised medical detox program before they will be admitted to an inpatient or outpatient addiction program. Detox programs are one-to-several-day programs in which a person is medically monitored round-the-clock while they withdraw from drugs and/or alcohol. The withdrawal effects of some substances like heroin and Xanax can be incredibly uncomfortable and even dangerous and attempting to detox on one’s own is often not advised.

Most Humana healthcare plans will cover at least a portion of the costs associated with attending a medically-supervised detox program. Some plans may require a one-time copay while others may require more. Additionally, whether the detox program is in-network or out-of-network will also play a role in how much coverage will be offered through a Humana insurance plan.

Will Humana Cover Inpatient Addiction Programs?

Inpatient drug and alcohol addiction programs are often considered the most effective form of substance addiction treatment. These programs require individuals to reside at a residential rehab facility for several weeks or even months and receive intensive and daily treatment. The primary goal of inpatient treatment is to help patients uncover the reasons why they abuse drugs and alcohol as well as determine ways in which they can get and stay substance-free. Common treatment services offered in an inpatient addiction program include individual counseling, group therapy, behavioral therapies and other proven approaches to addiction treatment.

Many Humana healthcare insurance plans provide some form of coverage for inpatient drug and alcohol addiction treatment. The exact coverage will vary and will depend on if the rehab facility is in Humana’s network of healthcare providers. Examples of copay for inpatient treatment when using Humana insurance include:

  • A $1,500 copay/per day for the first three days of treatment and then no copay after that
  • A $400 copay/per day for the first three days of treatment and then a $200 copay for the remaining days in inpatient treatment
  • A $300 copay/per day for the first five days of treatment and then no copay after that
  • A $2,000 copay at the onset of treatment and no copay after that

If a person leaves the treatment facility and returns again, they will be required to pay the same copays again.

Inpatient drug and alcohol addiction treatment is most commonly recommended for the following people:

  • Those who do not have a supportive home environment
  • Those who cannot attend an outpatient program several times a week
  • Those who have a severe substance use disorder
  • Those who have co-occurring disorders such as a mental health condition and a substance use disorder

Will Humana Cover Outpatient Addiction Programs?

Outpatient addiction programs are another common and highly recommended form of treatment for substance use disorders. There are several different types of outpatient programs, including partial hospitalization programs (PHP), intensive outpatient programs (IOP) and standard outpatient treatment. Each program varies in the level of intensity and what is required of patients. For example, a partial hospitalization program often requires that patients attend the program for several hours a day every day and submit to regular drug tests. On the other hand, a standard outpatient program may only have patients attend the treatment program once or twice a week.

Most Humana plans will provide at least minimal coverage for outpatient addiction programs. Each plan will vary as to how much coverage will be offered. Some Humana plans may require a copay for each visit to an outpatient program. For example, you may pay a $35 copay each day of outpatient treatment you attend.

It’s important to note that you may be required to get prior authorization before Humana will provide coverage for outpatient addiction treatment. Prior authorization is when you submit paperwork to Humana as well as have a recommendation from a physician that outpatient treatment is needed for your condition.

What Other Addiction Recovery Services May Be Covered under a Human Insurance Plan?

There are several other types of addiction treatment that individuals may seek when trying to recover from drug and alcohol addiction. The type of plan you have and where you seek additional substance abuse and alcohol rehabilitation will impact whether your Humana insurance will cover these services.

Addiction treatment services that may be covered under a Humana healthcare plan include:

  • Medication-assisted treatment (MAT): This type of treatment is when an individual is prescribed medication to assist in the withdrawal and recovery process. For example, someone who is addicted to heroin may be prescribed suboxone to reduce withdrawal symptoms and ease cravings. Not all individuals are eligible for MAT and the type of drug and level of addiction will play a factor in whether MAT is recommended. Many Humana plans offer coverage for medication-assisted treatment. Some plans may require prior authorization for this form of treatment.
  • Sober living: Aftercare is a common part of a person’s overall plan of recovery. Sober living is when a person moves from an inpatient facility to housing where everyone is committed to staying sober. This type of aftercare can help people stay sober after treatment and provide a safe environment for further recovery. Some Humana plans may offer coverage for sober living programs.
  • Counseling: There are various types of counseling used in the treatment of substance use disorders. This can include individual, group and family counseling as well as behavioral therapies like cognitive behavioral therapy (CBT). Many Humana plans will provide coverage for addiction-related counseling.

When attending an inpatient treatment program, many of these additional treatment services will be incorporated into a person’s plan of recovery. Outside of an inpatient program, people can seek these services on their own through a primary care physician or addiction specialist.

What to Ask Your Humana Insurance Representative

Before you make a decision regarding where you will seek substance use disorder treatment, it is highly recommended that you speak with a Humana representative. This gives you the chance to ask any questions as well as ensure that you fully understand your plan and the coverage you are eligible for. Here are a few questions that you should consider asking:

  • Is prior authorization required for any addiction treatment services? If so, what services?
  • What is required when getting prior authorization from Humana for a treatment service?
  • Does my Humana plan cover inpatient drug rehab?
  • Will my Humana healthcare plan cover outpatient drug and alcohol addiction treatment?
  • What treatment services are not covered under my Humana plan?
  • What is the payment required for the different types of treatment that my plan covers?
  • Do I need to meet any deductibles before my plan will cover alcohol and drug rehab?
  • Do I have to get a referral from a primary care physician before attending a rehab program?

How to Find a Drug Rehab Program that Accepts Your Humana Insurance Plan

Whether you have been recommended by your primary care physician or you are choosing to seek treatment on your own, you’re making the right choice. The decision to seek treatment for a substance use disorder can be life-changing and help you reclaim a sober and healthy life in recovery. To find out what coverage options you have for addiction treatment through your Humana insurance plan, contact a Humana representative by calling the number on the back of your insurance card. You can additionally reach out to one of our dedicated treatment specialists to help decide what type of treatment would be best for your condition and which treatment centers accept your insurance plan.