Molina Healthcare: Insurance Benefits & Opioid Detox and Rehab Coverage

Does Molina Healthcare Insurance Cover Opioid Rehab?

The opioid epidemic continues to be a public health emergency. In 2020, 74.8% of the 91,799 drug overdose deaths involved opioids.¹ What’s more, an estimated 10.1 million Americans aged 12 or older misused opioids in the past year in 2019.² What these statistics go to show is that the opioid crisis is nationwide and that, if you’re struggling with opioid addiction, you’re not alone.

Getting treatment for opioid addiction, including going to opioid rehab, is a way to recover from and overcome addiction. But it often comes with a cost. Fortunately, if you have a health insurance plan, such as Molina Healthcare, you may be able to use your health plan to cover some or all the costs associated with rehab.

Depending on the plan you have, your Molina Healthcare insurance coverage may extend to rehab centers across the nation that may be in-network with your plan. Because Molina Healthcare coverage nationwide involves many different types of plans, and each plan has its own network, the only sure way to check whether your plan is accepted at 1 of the more than 14,000 substance use facilities in the United States is to verify your benefits and coverage.²

What Does Molina Healthcare Insurance Cover for Opioid Treatment?

Molina Healthcare rehab coverage for opioid treatment will depend on your specific Molina Healthcare plan. Molina Healthcare provides Medicaid, Medicare, and Marketplace plans to millions of Americans across the country.³ Each of these plan types is different, and there may be variances in plan tiers and designs, which can affect coverage details.

The best way to check whether your specific Molina Healthcare plan is accepted at 1 of the more than 14,000 substance use facilities in the U.S. is to call the number on the back of your insurance card or work with the rehab center directly to verify your benefits.²

Despite differences in coverage levels, there are a handful of common opioid rehab treatments that may be fully or partially covered by your plan. These common opioid treatments may include:

• Screenings, interventions. Rehab centers and mental health providers often use opioid screenings to identify whether a patient has an opioid use disorder or opioid addiction.⁴ Screenings can help assess a patient’s opioid use, opioid-related problems, and any other mental health or behavioral conditions.⁴
• Detox. Upon admission to a program, the first treatment step is to undergo medically supervised detox.^{5, para 2} In detox, a patient is ridding their body of substances, such as opioids, other drugs, or alcohol.^{5, para 2} This treatment is often done in a medically supervised setting, as the side effects of withdrawal can be acute and life-threatening, so medical professionals can administer medications to help manage these side effects. ^{5, para 2}
• Inpatient. An inpatient opioid rehab program is one in which the patient remains at the facility for the duration of their care, which could range from days to months.^{6, (How are behavioral therapies used to treat drug addiction?)}
• Outpatient. An outpatient opioid rehab program is one in which a patient attends a facility for their treatment sessions each week, usually 1 or 2 meetings or therapy sessions, but return home after.^{6, (How are behavioral therapies used to treat drug addiction?)}
• Behavioral therapies. Various behavioral therapies may be offered at any stage of opioid rehab. A behavioral therapy program is designed to engage those who are in treatment and may offer incentives to patients for modifying attitudes, getting and remaining sober, and learning skills to cope with the stresses of life without using opioids.⁷
• Treatment for co-occurring disorders. If a patient has both a substance use disorder (e.g., opioid addiction) and a mental illness, they are experiencing a co-occurring disorder. ⁸ Because a mental illness can influence a substance use disorder, and vice versa, an integrated treatment approach, where both conditions are treated separately but at the same time, is recommended.^{8 “What should I do?”}

What Molina Healthcare Insurance Does Not Cover for Opioid Treatment?

There may be a handful of other types of opioid treatment that are not covered by your Molina Healthcare drug abuse coverage. Some of the following elements are examples of what may not be covered under your plan:

• Non-medical amenities
• Holistic care services
• Recreation programs
• Food delivery
• Private treatment services
• Alternative therapies

Please note that every plan is different. Check with your Molina Healthcare insurance representative to understand what is and is not covered under your plan type.

What Is Molina Healthcare Insurance?

Molina Healthcare is a Fortune 500 company that provides managed health care services through locally operated health plans.³ Specifically, it provides its managed health care services through Medicaid and Medicare programs, as well as various state-run Exchange programs.³ In total, about 4.6 million members have been served by a Molina Healthcare plan.³

Here is more information about each of the plan types that Molina Healthcare provides:

• Medicaid plans: Molina Healthcare works in conjunction with Arizona, California, Florida, Idaho, Illinois, Kentucky, Massachusetts, Michigan, Mississippi, Ohio, New Mexico, New York, South Carolina, Texas, Utah, Virginia, Washington, and Wisconsin state governments to provide Medicaid health plans to eligible individuals and families. Molina Healthcare also provides State Children’s Health Insurance Program (SCHIP) plans to eligible individuals in the states.⁹
• Medicare plans: Molina Healthcare provides Medicare Advantage (Part C) plans to eligible individuals who may need Medicare or a combination of Medicare and Medicaid coverage.⁹ These plans offer benefits and programs that can include access to a large network of providers with little to no out-of-pocket costs for patients.⁹
• Integrated Medicaid/Medicare (Duals): Molina Healthcare provides eligible individuals with access to Medicare and Medicaid plans, helping them navigate the complexities of such plans while providing them with access to quality care.⁹
• Molina Marketplace: Finally, Molina Healthcare is authorized to sell Exchange (federal Marketplace plans) in some of the same states where Medicaid is offered by Molina. Molina also works with individuals transitioning from a Medicaid to a Marketplace plan to remain with the same doctors if they so choose.⁹

To find out more about your specific Molina health plan, call the number on the back of your insurance card. A representative will talk you through your specific levels of coverage and plan type.

How Much Does Opioid Rehab Cost?

The cost of opioid rehab can vary widely. The facility you attend for rehab, including the amenities offered by that center, and whether it’s in-network with your Molina Healthcare plan may affect the overall cost of treatment. Other factors that contribute to the cost of opioid rehab include the services you receive, the intensity of those services, and the duration of your opioid rehab treatment. Be sure to work with your rehab center to understand what your costs may entail.

Cost of Inpatient Opioid Rehab

The average cost of inpatient opioid rehab will vary based on the plan you have, where you receive care, and the extent of health care services that you receive. Every Molina Healthcare plan will provide different levels of coverage for services rendered at a rehab facility. Though, inpatient opioid rehab tends to cost more than outpatient rehab, as you’re staying at the facility 24/7 until your care is complete.⁶

Cost of Outpatient Opioid Rehab

Outpatient opioid rehab care costs will range drastically based on the number of sessions you attend, what Molina plan you have, and where you receive care from. For example, the cost of a 1-on-1 therapy session may cost more than attending a group therapy session or sobriety meeting. Consult your Molina health benefits to find out what outpatient opioid rehab coverage your plan provides.

Cost of Opioid Partial Hospitalization Programs (PHP)

How much attending an opioid partial hospitalization program, which is also known as a day program, costs will depend on a variety of factors. The length of the treatment stays and where you attend treatment will influence the overall cost of your care. If your Molina Healthcare plan doesn’t fully or partially cover the cost of PHP treatment for opioid addiction, ask whether the facility offers scholarship or financing payment options, which you can use to offset some of the costs of care.

Cost of Medication-Assisted Treatment (MAT)

MAT is a common treatment method for those in rehab for opioid addiction.¹⁰ MAT is a type of treatment where medical professionals administer medications to patients to help overcome their opioid addiction while still providing behavioral or counseling therapies.¹⁰ Whether MAT is covered under your Molina plan and to what extent it may be covered will vary. Call the number on the back of your card to learn more.

Opioid Rehab vs. the Cost of Opioid Addiction

The estimated overall economic burden on untreated opioid addiction is $78 billion annually.¹¹ Plus, untreated opioid addiction leads to a higher risk of incarceration, health problems, and lost income due to the loss of jobs.¹¹ Opioid and drug addiction treatment is proven to help reduce the health and social costs associated with addiction far more than the cost of the treatment itself.¹² That’s why choosing rehab is the wiser option rather than continuing to use opioids.

What Length of Opioid Rehab Does Molina Healthcare Insurance Cover?

How long your Molina Health Insurance plan will cover opioid rehab will vary. Where you seek care for opioid rehab and the type of rehab treatment you receive, as well as the specific plan you have, will determine how long rehab may be covered. Taking the time to look up your insurance information on the back of your card or calling the number on your card to have a representative explain your coverage details can help you learn more about the length of opioid rehab that’s covered by your plan.

Regardless of coverage, it’s important to remember that remaining in rehab for an appropriate amount of time is imperative. Having a good outcome from attending rehab is contingent upon staying in treatment. Most treatments should last at least 90 days for patients to maintain positive outcomes and reduce or stop drug use.¹³ Every person’s path to recovery is different, though, so be sure to work with your provider to determine what’s best for you.

Choosing Between Molina Healthcare Insurance Inpatient vs. Outpatient Opioid Rehab Centers

Deciding whether to attend an inpatient vs. outpatient opioid rehab center is something that should be done with the advice of your health care provider. Discuss the quality of care, treatment ecosystem, support groups, environment, and accountability expected at each type of rehab center. Depending on where you’re at in your recovery, your provider may recommend one over the other to you.

How to Use Molina Healthcare Insurance for Opioid Rehab?

The typical process for using your Molina Healthcare insurance for opioid rehab starts with consulting a doctor, who can help evaluate your opioid addiction and refer you to an opioid rehab center. You can work together to find a suitable rehab program near you. Then, you’ll want to determine your ability to use insurance at the rehab facility. Most rehab centers will work with you directly to check whether your insurance is accepted at the facility. Then, the rehab center will coordinate with the insurance company for services rendered.

How to Find Opioid Rehabs That Accept Molina Healthcare Insurance

If you’re ready to get the care you need, you may be wondering how to find a nearby facility that accepts Molina Healthcare insurance. After you’ve spoken to a doctor about treatment for opioid addiction and decided attending opioid rehab is the right choice, give American Addiction Centers (AAC) a call. Our team is trained to help you every step of the way on your journey to recovery.

When you call our opioid helpline, you’ll speak to a real person on the phone who can help you check your benefits right away. They can also help you find a treatment center near you or help you check whether your insurance is accepted at any 1 of the AAC’s industry-leading treatment centers across the nation. Don’t wait any longer to get care. Call the hotline today to get started.