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.