Oscar Health Insurance Coverage for Rehab

With a large customer base of about 1 million Americans, Oscar Health insurance is a popular health insurance provider in the U.S. Many Oscar Health policyholders use their insurance plan to cover the cost of substance use disorder (SUD) treatment.

Finding drug and alcohol addiction treatment can be confusing, especially when it comes to finances and finding a way to pay for care.

Keep reading to learn about accessing addiction rehab treatment as an Oscar Health policyholder including the kind of treatment covered, factors that affect coverage, and more.

Answer: Yes, Oscar Health Insurance does cover alcohol and drug addiction treatment, but this coverage is based on several factors.

Addiction treatment coverage is provided by Oscar Health to some extent, as required by the Affordable Care Act (ACA). Under the ACA, substance abuse treatment is an essential health benefit.

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.

Medical Detox

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

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

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

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.

When it comes to Oscar Health SUD treatment coverage, there are several factors to take into account. The following variables may affect how much coverage you receive:

• Your insurance plan
• Where you live
• The kind of treatment you need

You may be able to receive higher coverage based on the state you’re in or the plan you have. On the flipside, these factors may result in lower coverage. Additionally, the kind of treatment you need may not be covered to the same extent as other treatment options.

While most of these factors are out of your control, it’s important to know that they can affect your coverage in order to understand how you may receive the highest level of coverage.

Answer: Oscar Health does not cover out-of-network rehab programs. In other words, you will likely pay full price out of pocket for any out-of-network addiction treatment providers.

That being said, according to Oscar Health, if there is not a provider for the treatment you need within a reasonable distance from where you live, the company will work with an out-of-network provider, but this is not something you should count on.

In order to avoid lack of coverage due to out-of-network providers, make sure to check that the treatment facilities and providers you choose are in-network with your plan. This way, you can pay the lowest amount for your addiction treatment.

Oscar Health offers a wide variety of health insurance plans including individual plans and Medicare Advantage plans. You may have access to several plan options based on your location, job, and other eligibility factors.

Plan options may include:

• Marketplace plans:
  • Bronze 60 EPO
  • Bronze Simple Select EPO
  • Bronze 60 HDHP EPO
  • Silver Classic Select EPO
  • Silver 70 EPO
  • Gold 80 EPO
  • Platinum 90 EPO
• Medicare Advantage plans:
  • HMO plans
• Cigna + Oscar plans

As a disclaimer, plan access will depend on your location, so you may have access to different plans than the ones listed above. You can compare plans and details to determine which plan is best for your needs.

Oscar Health does not provide addiction treatment coverage based on the type of addiction that is being treated. In other words, regardless of your type of addiction, you should be able to get coverage for addiction treatment.

Some common addictions covered include:

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

When looking for a rehab center, you’ll want to ensure that they accept your Oscar Health insurance plan. Here are four ways to find a rehab center that accepts Oscar Health:

1. Call the provider and ask if they accept your insurance.
2. Use the “Find doctors and drugs” function on the Oscar Health website or app. This search engine will help you find providers near you that your plan covers. You can always call Oscar Health as well.
3. Check out our list of treatment centers in each state for an easily digestible, state-centered resource.
4. Ask your primary care physician (PCP) prior to treatment for a list of referrals.

Be sure to look for high-quality rehab facilities with positive reviews and testimonials, accreditations and certifications, and evidence-based care plans.

Many people are able to receive addiction treatment at a lower cost due to coverage through their Oscar Health plan. It’s important to understand the coverage variables associated with your plan to best approach your treatment journey.

If you or your loved one are ready to take the next step or need additional guidance, give our phone number a call today.