Answer: There is a wide range of addiction treatment services you may receive coverage for through Oscar Health. Oscar Health partners with Optum for mental health services, including addiction treatment.
The type of treatment you seek will likely be fairly personalized. Keeping your needs, goals, type of addiction, and care provider’s recommendations in mind, you may need a particular kind of treatment or a combination of services.
Learn a little bit about some common treatment services below as well as the coverage you may receive for them through Oscar Health.
Many Oscar Health insurance plans cover medical detoxification at least partially, though you may need to pay a copay or coinsurance. Detox coverage is offered in both inpatient and outpatient settings.
Medical detox is a common health service offered at the beginning of rehab programs. Essentially, detoxification is a process that involves getting rid of any addictive substance still in the body (alcohol, drugs).
Detoxing from addictive substances at home can be very dangerous, which is why medical detoxification is such an important step. During this service, your care providers will monitor your vitals, manage withdrawal symptoms, and administer any necessary medications.
Medication-assisted treatment (MAT) is another service many Oscar Health plans offer at least partial coverage for, often alongside a copay or coinsurance.
MAT is an evidence-based treatment option that uses specific medications to treat addiction. These medications, which are FDA-approved, are designed to help manage withdrawal symptoms and cravings as well as reduce the risk of relapse.
MAT is often offered as part of a comprehensive treatment plan in either inpatient or outpatient programs.
Inpatient rehab is a covered service under most Oscar Health plans but you may have to pay 50% coinsurance subject to your deductible.
Considered the highest level of care, inpatient treatment is a great service for people with more severe addictions. Many people start their recovery journey in inpatient care. Here, you will live in the care facility for the length of your treatment.
Inpatient treatment is very structured and often involves a regimented schedule. Inpatient programs use a combination of treatment approaches to treat addiction.
Dual Diagnosis Treatment
Dual diagnosis treatment is similar to inpatient treatment as far as coverage through Oscar Health goes. This service is covered under most plans, but you may need to pay coinsurance subject to your deductible or a copay per visit.
Many times, people who have a substance addiction also have mental health disorders, called co-occurring disorders. These disorders can often be the root of someone’s addiction and, therefore, need to be treated as well.
Dual diagnosis treatment is a service that offers mental health treatment in conjunction with addiction treatment. It often involves the use of therapy in addition to a comprehensive treatment plan.
Mental health disorder treatment may be for conditions like anxiety, depression, or bipolar disorder.
Outpatient Treatment Programs
Most Oscar Health plans cover outpatient treatment, but you may need to pay 50% coinsurance subject to your deductible or a copay for each office visit.
Outpatient treatment is a less-intensive treatment service than inpatient treatment, but still provides effective care. Outpatient programs don’t require participants to live in a care facility, but rather travel to a facility several days a week for several hours at a time.
Many people transition from inpatient care to outpatient care as a step down in their treatment journey. Outpatient care can be more suitable for people with less-severe addictions or those who are absolutely unable to leave their home for an extended period of time.
There are also variations of outpatient treatment that are sort of in-betweens of inpatient and outpatient rehab. Some you may come across include partial hospitalization programs (PHP) and intensive outpatient programs (IOP).
Counseling & Behavioral Therapy
Counseling and behavioral therapy are covered by Oscar Health plans, though you will likely have to pay 50% coinsurance subject to your deductible or a copay per office visit.
Both services are vital parts of a well-rounded care plan, as they help address the mental health and behavioral health of individuals. Counseling focuses primarily on sharing one’s thoughts, emotions, worries, and goals regarding addiction treatment. It can occur in individual or group settings.
Behavioral therapy, on the other hand, is a type of talk therapy that focuses on the behavioral patterns of individuals, often those with mental health conditions.
The idea is to change behavioral and thought patterns that may be exacerbating your addiction. Some common kinds of behavioral therapy are dialectical behavioral therapy (DBT) and cognitive behavioral therapy (CBT).
Continuing care may be covered in part by your Oscar Health plan, though coverage will differ.
Aftercare, or continuing care, is treatment that occurs post-addiction treatment program. It is a very individualized service as it is based on the needs of the person after treatment. This may look like group therapy, counseling, sober living, or 12-step programs.
Because aftercare can differ so much between individuals, coverage can also differ. You may be able to get some of these services covered while others may not be covered under your plan.