Does Magellan Insurance Cover Alcohol and Drug Rehab? - Treatment Solutions

Does Magellan Insurance Cover Alcohol and Drug Rehab?

Magellan Insurance Coverage for Drug and Alcohol Treatment

If you or a loved one is struggling with drug addiction, you may be at the point where you’re looking for affordable drug or alcohol rehab programs. In many cases, rehabilitation is a costly but necessary step to take on the path to recovery. Fortunately, if you or your loved one has an insurance plan, including one through Magellan Health, you may be able to receive rehab treatment at little to no cost.

Magellan Health is a managed care company and health care provider that specializes in mental and behavioral health care. Currently, it provides services and coverage to more than 30 million customers with its network of 77,000 mental health providers, many specializing in treating addiction.1

Because Magellan Health specializes in mental health and behavioral health treatment, they may be the right fit to help you get the care you need as well as gain a better understanding of your health insurance benefits. Your exact coverage details may vary based on your health plan and location, so it’s important to call the number on the back of your insurance card and speak with a Magellan representative to learn more about your health benefits.

What Will Magellan Insurance Cover?

Every health plan is different, which means that what your Magellan plan may cover will be different than what someone else’s plan will cover. Regardless, it’s important to note that the Affordable Care Act (ACA) mandates all health plans in the United States to provide some sort of coverage for 10 essential health benefits.2 One of those 10 health benefits is mental and behavioral health. What this means is that your Magellan plan will need to provide coverage in some capacity for your mental health care services.

While recommended treatments may vary, as will plan coverage details, the following is a list of common drug rehab treatment types:3

  • Outpatient rehab or therapy: Designed for those who need to receive regular treatment but don’t need intensive monitoring or rehabilitation, outpatient rehab programs involve a patient traveling to a facility to seek treatment during the day (e.g., therapy or medicine), but then returning home following that appointment.3, “How are behavioral therapies used to treat drug addiction?” If you need outpatient rehab or therapy, your Magellan plan will most likely cover it in some capacity.
  • Inpatient or residential rehab: Designed for those who need round-the-clock and intensive care (e.g., detoxing patients), inpatient or residential rehab involves a patient entering a facility and living there until they’re stable enough to be discharged.3, “How are behavioral therapies used to treat drug addiction?” If you or your loved one needs inpatient or residential rehab treatment, it may be covered in some capacity under your Magellan plan.
  • Intensive outpatient programs (IOPs): IOPs are typically the recommended course of treatment for those who need more care than the traditional outpatient program would provide, but don’t necessarily need to remain in a facility for constant supervision or care. 4 (under section after conclusion) IOPs generally are covered in some capacity under Magellan Insurance plans.
  • Partial hospitalization programs (PHPs): Like IOPs, PHPs combine elements of different treatment methods. With a PHP, a patient would be in a structured day or hospital program and often allowed to return home at night.5 Generally speaking, PHPs are covered under most health plans in some capacity, including your Magellan plan.

It’s important to note that this list of common treatment types is not exhaustive and does not guarantee that your Magellan plan would cover these offerings. The only way to be certain is to call your Magellan representative at the number on the back of your card and ask about your benefits and coverage.

Does Magellan Insurance Cover Mental Health Care?

Due to the Affordable Care Act (ACA), all health plans must provide some level of coverage for mental and behavioral health services. This mandate includes but is not limited to coverage for substance use disorder treatment, behavioral health treatment, and mental and behavioral health inpatient care.2 While coverage in some capacity is mandated, coverage amounts will vary, so be sure to talk to your Magellan representative.

Coverage for such services is incredibly important, as the percentage of those with mental health disorders continues to rise in the United States. Moreover, it’s incredibly common for a mental health and substance abuse or use disorder to occur simultaneously. This phenomenon is known as a co-occurring disorder, and according to the National Institute of Drug Abuse (NIDA), 7.7 million Americans suffer from it. 6 If you have a co-occurring disorder, treating both disorders is essential for making a full recovery, and the ACA mandate ensures that you can get both stand-alone and co-occurring rehab treatment.

How Long Does Magellan Insurance Cover Alcohol & Drug Rehab?

When it comes to mental health, behavioral health, and substance use disorders, there is no one-size-fits-all treatment approach. With that being said, you should note that longer treatment is generally more successful. Many experts point to research that indicates treatment should last for a period of at least 3 months to increase the odds of success and decrease the risk of negative outcomes.7 (Numbered list number 5) Despite this, it will be up to your care provider to determine how long your treatment course will be. Then, it will go to your insurance company to sort out how long they will cover rehab.

How long your Magellan plan will cover rehab will depend on your plan, your location, and whether you’re seeing an in-network or out-of-network provider. Call Magellan Healthcare at the number on the back of your card to find out more information. In many cases, you could also call an American Addiction Center (AAC) facility that you’d like to receive care from and ask a representative to verify your benefits and coverage.

What if My Magellan Insurance Policy Does Not Cover Drug Rehab?

Depending on your plan or treatment program, it’s possible that you may not receive full or partial insurance coverage for your rehab. This means that you may be responsible for all or part of your treatment costs. If this happens, it’s important to not panic or forego getting treatment. Delaying treatment could be a huge detriment to your overall health, and could cause treatment down the road to be even more expensive because your condition has worsened over time.

Be sure to ask whether the facility at which you’re receiving care has special financing options to pay for any amount of rehab costs that your Magellan coverage doesn’t cover. You could also ask whether the AAC facility you’re attending offers scholarship opportunities to offset the cost of treatment. It never hurts to ask an AAC representative what your financing options are, especially if Magellan Healthcare doesn’t cover all or part of your treatment costs.

Magellan Insurance In-Network vs. Out-of-Network Drug Rehab Centers

In-network and out-of-network providers are terms that get thrown around a lot in health care. While they can be confusing, it’s absolutely crucial to protecting your pocketbook that you understand the difference between these terms. Typically, an in-network provider is one that has negotiated rates and discounts to you as the patient through your health insurance provider in exchange for prompt insurance reimbursement and referrals. When you see an in-network provider, your care is typically covered at a higher percentage, and sometimes fully covered, depending on the plan. When you see an out-of-network provider, there are no negotiated rates or discounts, so you’ll typically have to pay more for services rendered by an out-of-network provider.

To find an in-network provider and keep your health care costs as low as possible, consider asking your Magellan Healthcare representative for a list of in-network rehab facilities located near you. AAC facilities are often considered in-network providers under many different health care plans. An AAC representative can also help you determine whether your plan considers the facility of your choice to be an in-network or out-of-network provider. All you need to do is call our helpline and provide some information about your insurance plan and yourself.

Check Magellan Insurance Coverage for Addiction Treatment

Checking your insurance coverage for addiction treatment may seem complicated, but we’re here to help. Contact our team of representatives by calling our helpline today.

The team at AAC is here for you on your path to recovery, and we’re ready to help you every step of the way. Reach out today for more information.