Medica Insurance Coverage for Rehab

Medica Insurance covers policyholders in select midwestern American states. All of its plans cover the 10 essential benefits outlined in the Affordable Care Act (ACA), which includes substance abuse treatment and mental health services.

Read on to discover more about what Medica coverage has to offer for inpatient and outpatient rehab and mental health care services.

Answer: Yes, Medica insurance covers drug rehab. However, you must have insurance through Medicare, Medicaid, the Health Insurance Marketplace, or your employer to qualify for drug rehab coverage.

Because all their plans offer some coverage for substance abuse treatment, you won’t have to pay all treatment costs. Your plan type, deductible, and treatment center and services will determine your coverage level.

Answer: Medica plans follow the ACA guidelines regarding the 10 essential benefits. Each plan will offer some coverage for most types of addiction treatment.

However, some plans may require you to meet your deductible before insurance coverage kicks in.

Additionally, Medica has a partnership with LiveAndWorkWell.com, giving its members access to extra support for behavioral health and substance use disorders.

Medical Detox

Medical detox can be done as inpatient or outpatient services, so coverage under your specific plan would partly depend on the level of care required by your treatment provider. All Medica plans cover some portion of this treatment.

Detoxification is the process of eliminating drugs or alcohol from the body safely so you can move on to a formal treatment program for rehab.

Medication-Assisted Treatment

Medication-assisted treatment (MAT) is covered by Medica, but you’ll need to review your Explanation of Benefits (EOB) to know the limits of coverage and any copays, coinsurance, and deductibles that will be your responsibility.

MAT involves treating the withdrawal symptoms of physical dependence with prescription medications and the mental health aspect of addiction with counseling and therapy. Many prescription drugs are covered completely with a Medica plan.

Inpatient Rehab

Because inpatient rehab involves many treatment services, you should log in to your member site or call Medica to verify each provider’s in-network status. Some Medica plans also include a care management team that may be able to help you sort out coverage.

Inpatient treatment is a form of addiction treatment that requires you to stay at a facility for the duration of care to receive comprehensive treatment. Plans may cover 30, 60, or 90 days of care depending on your coverage and healthcare needs.

Dual Diagnosis Treatment

Receiving a dual diagnosis means that you have co-occurring substance use and mental health disorders. Your treatment plan will reflect the need for this type of care, and you may have a few extra steps with your Medica coverage.

To help you navigate treatment options, you can check which Medica Care + Wellness tools are available with your plan.

Dual diagnosis care will involve a combination of treatments to address mental health and alcohol or drug addiction. These could include detox, MAT, inpatient or outpatient care, several forms of therapy, and more.

Outpatient Treatment Programs

Depending on your level of addiction and where you are in recovery, your outpatient treatment plan may be more standard, or it could be an intensive outpatient program.

Whatever outpatient services you need, any Medica plan should cover at least a portion of the expense. However, you may need to meet a deductible first, so be sure you know what your plan covers.

Counseling & Behavioral Therapy

Coverage includes a multitude of behavioral health benefits. Medica offers several behavioral health services, from apps to a crisis line, to help you through stressful moments.

Many of these resources are virtual, so support is available when and where you need it.

Continuing Care

Your insurance provider may partially cover residential treatment, group therapy, support groups, and sober living communities. Many Medica plans include whole-person support, so you may get perks like free gym membership, which can be significant in recovery.

Medica is available in some states, so where you live or work will affect your coverage. Your plan type and where you’re seeking rehab treatment will also factor in.

Other factors affecting Medica coverage for drug rehab include:

• Level of addiction
• Treatment plan
• Deductible met

Note that Medica is available in these 12 states:

• Minnesota
• Wisconsin
• North Dakota
• South Dakota
• Iowa
• Nebraska
• Kansas
• Missouri
• Oklahoma
• Arizona
• Wyoming
• Illinois

Answer: Medica plans do cover out-of-network rehab programs, but your out-of-pocket costs will be higher if you’re treated by those providers.

You also want to pay attention to treatment services like labs and other tests, as these may be done at an in-network treatment facility but performed by an out-of-network provider.

Also, employers who are based in Medica’s service area can offer plans to employees who live outside of the states listed above through a national plan option.

The standard metal types — Bronze, Silver, Gold, and Platinum — apply to some of Medica’s plans but not all. Each category of healthcare plans is broken down below.

These are some of the healthcare plans offered by Medica:

Individual + family

• HSA-compatible
• Copay only
• Catastrophic*

Medicare

• Part A – inpatient hospital and skilled nursing facility (SNF) care
• Part B – office visits, tests, supplies, and outpatient care
• Part C – Advantage plans, which can include a combination of Parts A, B, and D
• Part D – prescription medication

Medicaid

• ChoiceCare℠ Prepaid Medical Assistance Program (PMAP)
• MinnesotaCare
• AccessAbility Solution® Enhanced (HMO D-SNP)
• AccessAbility Solution®
• DUAL Solution®
• ChoiceCare℠ MSC+

Employer-provided plans

• Altru & You
• Clear Value
• Essential Choice Care
• Choice National
• Choice Passport
• CompleteHealth
• Elect
• Essential
• Focus
• CHI Health
• Park Nicollet and HealthPartners Medical Group First
• Ridgeview Community Network
• Vantage Plus

*The Catastrophic plan is generally recommended for people under the age of 30 with few health issues and dependents. It has the lowest premium and the highest deductible.

Medica may not offer some coverage types in all areas, so be sure to check your insurance card to verify your insurance company, even if you think you’re in Medica’s service area.

Medica covers treatment for mental health and substance use disorder as well as chronic conditions. Addiction treatment fits all three categories.

What you’re addicted to is less of a factor in coverage than what treatment plan your healthcare provider has recommended and how that fits with the coverage limits in your specific plan.

You have many options to locate information on nearby rehab centers that are in-network for Medica.

You can choose your preferred method from this list:

1. Fill out the Contact Form on Medica’s website, and they will respond via email or phone within one business day. Keep in mind that you’ll need to wait a little longer for a response on a weekend or holiday.
2. Log in to your member account and search for local providers. You can also double-check your coverage by reading your plan’s Explanation of Benefits (EOB) and find out if your prescriptions and treatment services are covered.
3. Read through Medica’s FAQ page for your coverage type.
4. Call one of the numbers listed at the bottom of their Contact Us webpage. Separate contact information is included for each plan type, including their Medicare and Medicaid plans.*
5. Check your insurance card and call the number listed there.*
6. Go to RehabNet.com and browse our curated list of rehab centers to find quality care near you.

*Hours of availability will vary for different plan types, so make sure you know what the hours are for the phone number you’re calling. You can find that information on Medica’s website.

Stressed and wondering which rehab program is covered by Medica? Let us help you or your loved one find the care facility you need.

RehabNet.com is available 24 hours a day through our helpline and website.