Molina Insurance Coverage for Rehab

Molina is a health insurance provider that offers healthcare coverage through Medicare and Medicaid programs, as well as Marketplace plans.

Insuring approximately 5.1 million Americans, many Molina policyholders use their insurance to receive substance use disorder treatment (SUD).

Understanding insurance coverage for drug and alcohol addiction rehab can be confusing and overwhelming. Consult this guide for everything you and your loved ones need to know about Molina and rehab treatment coverage.

Answer: Yes, Molina does cover alcohol and drug addiction rehab, but there are some limits to this coverage. In other words, your plan, location, and other factors may alter the amount of coverage you are eligible for.

Coverage for addiction treatment must be covered, at least to some extent, by any plan in the Health Insurance Marketplace. This is due to the Affordable Care Act (ACA), which lists substance abuse treatment as an essential health benefit.

Answer: There is a wide array of addiction treatment services you may be able to get coverage for through Molina.

When it comes to substance abuse rehab, there are a number of treatment approaches, as addictions have varying needs and individuals may have unique goals/needs.

Keep reading to learn a bit about some common treatment approaches.

Medical Detox

Many Molina plans will cover detox services, but you may be required to get prior authorization to receive coverage.

One treatment service you may get covered is medical detoxification or detox. This service helps to get rid of any addictive substances still in your body.

It’s important to make sure your body is substance-free so you can begin your treatment plan. In addition to monitoring your vitals and administering medications, detox services manage withdrawal symptoms and ensure you are detoxing safely.

Medication-Assisted Treatment

Depending on your plan, Molina will often cover medication-assisted treatment (MAT), but Molina encourages providers to verify coverage prior to treatment.

MAT is the practice of using U.S. Food and Drug Administration (FDA)-approved medications to treat addiction, alongside therapy and counseling.

There are three main MAT medications: buprenorphine, methadone, and suboxone. MAT helps manage withdrawal symptoms, reduce cravings, and reduce the risk of relapse. It is used in combination with other treatment services.

Inpatient Rehab

Many Molina policyholders may be able to get inpatient treatment partially or fully covered. Individuals must meet medical necessity, receive prior authorization, and choose an in-network provider.

Inpatient treatment is a very intensive treatment option, offering the highest level of care. People with more severe addictions may benefit from inpatient treatment as it is very regimented and provides 24/7 care.

People who enroll in an inpatient program can expect to temporarily live in the facility where they receive care. This will endure the length of the program.

Dual Diagnosis Treatment

Molina healthcare insurance plans may cover dual diagnosis treatment contingent upon verified benefit coverage and the selection of an in-network provider.

Dual diagnosis treatment is a service that addresses addiction alongside co-occurring disorders, or mental health disorders that frequently occur in conjunction with addiction. In many cases these disorders are even the root of SUD.

This service combines mental health treatment approaches like therapy, counseling, and more to comprehensively treat the individual.

Outpatient Treatment Programs

Much like inpatient treatment, outpatient rehab may be covered at least partially by your Molina insurance plan. As a disclaimer, prior authorization and in-network care is required.

Often a step-down from inpatient care, outpatient treatment provides addiction care for set days and times, often several days a week for multiple hours.

Outpatient care allows individuals to continue living at home and is offered in variations such as partial hospitalization programs (PHP) and intensive outpatient programs (IOP).

Counseling & Behavioral Therapy

Molina policyholders will need to have their provider verify benefit coverage and find an in-network provider to receive coverage for counseling and behavioral therapy.

Counseling is a service that allows individuals to discuss their emotions, thoughts, and worries throughout their addiction treatment journey with their provider.

On the other hand, behavioral therapy is a kind of talk therapy that focuses on changing behavioral/thought patterns that exacerbate addiction.

It is often used as a mental health service and may come in many forms such as dialectical behavioral therapy (DBT) or cognitive behavioral therapy (CBT). Behavioral health services are part of a comprehensive treatment plan.

Continuing Care

Continuing care services differ between individuals, so Molina coverage will depend on the type of service you receive.

Often also referred to as aftercare, continuing care is treatment services provided after you complete an addiction treatment program.

You and your case manager will determine what aftercare services are best for you, but some include counseling, therapy, support groups, and sober living.

First and foremost, the plan you choose with Molina may affect the level of coverage you receive.

Certain plans may provide more coverage, some may require copays, and others may limit the providers you can receive care from. Additionally, you may need a diagnosis or referral for your plan to cover your treatment.

Another factor in coverage determination is your location. Where you live can determine the amount of coverage you receive. This is due to different plans being offered in different areas, state laws, and more.

Lastly, the type of care you need can affect your coverage level. Some plans may cover certain services at a higher level than other services. In other words, if you need a specific type of treatment, it may not be covered to the same extent as others.

Answer: Sometimes, Molina will cover out-of-network programs. However, this is only the case if Molina cannot provide necessary and covered services through an in-network provider.

It’s best to seek out an in-network provider to ensure the highest level of coverage and, in turn, lowest out-of-pocket expenses. Your provider may be able to refer you to in-network programs.

Molina offers various types of health insurance plans, which differ based on the state in which you live.

These may include:

• Molina Medicare plans:
  • Molina Medicare Complete Care (HMO D-SNP)
  • Molina Medicare Choice Care (HMO)
  • Molina Medicare Choice Care Select (HMO)
  • Molina Medicare Complete Care Plus (HMO D-SNP)
• Molina Medicaid plans
• Marketplace plans:
  • If you don’t qualify for the above plans, Molina may help you pay for a Marketplace plan.

Different plans may be available to you based on your location and eligibility. When choosing between plan options, you’ll want to consider the terms and out-of-pocket costs such as copays, deductibles, and coinsurance to determine what plan will be best for you.

There are many kinds of substance addictions that may be covered by Molina health insurance plans. Your rehab coverage will not be determined based on the type of addiction you have.

Common addictions Molina may cover treatment for include:

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

As long as your plan provides coverage for the care you’re seeking, and you find an in-network provider, your addiction will likely be covered.

Finding treatment facilities can be half the battle for some people when seeking addiction treatment. There are several great resources to find reputable and reliable treatment centers.

First, you can always ask your primary care provider for referrals that accept your health insurance plan.

Another reliable way to find rehab centers that accept Molina is to take advantage of your patient portal. Here, you can click “Find a doctor or pharmacy” and instantly receive a list of in-network providers.

If you find a rehab facility via another search method, you can always call Molina and speak with a representative to ensure the provider is in-network.

We also recommend pursuing our list of addiction treatment centers by state. Each list will have accepted insurance providers listed and is a well-accredited facility.

Make sure to look for treatment centers that have positive reviews and testimonials, provide evidence-based care, and have accreditations and certifications like Joint Commission and LegitScript.

Molina health insurance can benefit policyholders in receiving substance abuse treatment more affordably. Many different kinds of addictions and treatments may be covered under your plan.

For more information about addiction treatment coverage and Molina, give our helpline a call now.