Using Tufts Health Insurance for Addiction Rehab

What Is Tufts Health Insurance?

Tufts Health is a not-for-profit organization that provides high-quality, innovative healthcare coverage in the United States.¹ Headquartered in Massachusetts, Tufts Health serves over 1.1 million members in Massachusetts, Connecticut, and Rhode Island.¹ With over 110 hospitals and more than 51,000 healthcare providers, Tufts Health Plan offers its members a variety of evidence-based healthcare options.¹

Tufts Health Plans

Tufts Health Plan has a variety of options to provide coverage to suit an individual’s needs and budget—from Tufts Health Medicaid to traditional HMO and PPO plans, including tiered and limited-network plans.¹

HMO plans offer healthcare that’s coordinated through your primary care physician and have some cost sharing, typically in the form of a copay.

PPO plans allow you to receive care from any doctor without the need for a referral, which provides more flexibility.

Advantage saver HMO and PPO plans offer the lowest monthly payments, but they are high-deductible plans that also may be paired with Health Savings Accounts (HSAs).

Tiered plans put all providers in the network into different “tiers” based on the value of care they provide, encompassing both cost and quality.

Tufts Health Plan offers a wide range of coverage options for various healthcare needs, including treatment for substance use disorder, the clinical term for a drug or alcohol addiction.

If Tufts Health Plan is your healthcare insurance provider, your policy likely covers some of the costs of drug and alcohol rehabilitation. Call the number on the back of your insurance card for more information about what your specific plan covers in regards to drug and alcohol rehab and treatment. Alternatively, you can call American Addiction Centers (AAC) at and speak to an admissions navigator, who can check your coverage for you.

What Different Types Of Addiction Treatment Does Tufts Health Plan Cover?

As with other health insurance providers, Tufts Health Plan offers addiction treatment coverage for members who need help recovering from a substance use disorder.² Tufts Health Plan offers members access to substance use specialists who can help individuals struggling with addiction find a recovery program. Most plans cover office visits, medications, and treatment programs.³

Covered addiction treatment services may include:²

• Medically managed detox.
• Inpatient treatment.
• Outpatient therapy and medication management.
• Medication for addiction treatment.
• Co-occurring disorder treatment programs.
• Outpatient detox.
• Partial hospitalization programs (PHPs).
• Intensive outpatient programs (IOPs).

Tufts Health Plan recognizes that treatment can save lives, so it provides coverage for addiction treatments needed in the same way they cover care for physical ailments. For example, admission for detox is the same cost as admission for an appendectomy.²

Some of the addiction treatment services covered by Tufts Health Plan include:

• Medical detox. With medical detox, medications are used during the withdrawal process to help individuals safely withdraw. Healthcare professionals oversee the process to help keep individuals as comfortable as possible.
• Inpatient treatment. Inpatient rehab requires individuals to live in a rehab facility 24 hours a day, 7 days a week for the duration of treatment, often somewhere between 14 and 90 days, depending on their situation and needs. While in inpatient treatment, individuals attend 1-on-1 counseling as well as group therapy sessions to help them learn healthy coping mechanisms for long-term recovery.
• Outpatient treatment. Outpatient programs are recommended for individuals who need significant support but cannot or do not want to enter inpatient rehab. Depending on the program, a person may be required to attend treatment for a certain number of hours a day, anywhere from 2-7 days a week.
• Partial hospitalization programs (PHPs). Sometimes referred to as day treatment, partial hospitalization programs allow individuals to live at home or in a sober living environment while attending treatment during the day. Treatment sessions generally take place most days of the week for several hours at a time.
• Intensive outpatient programs (IOPs). Intensive outpatient programs require individuals to attend treatment programs/meetings, usually delivered in 3, 3-hour sessions each week, during the day or in the evening. Individuals live at home or in a sober living residence and are able to work, go to school, and/or fulfill their responsibilities at home while in treatment.
• Drug and alcohol counseling. Drug and alcohol counseling is an important part of recovery. Individuals who go through treatment—whether inpatient or outpatient—must attend counseling sessions, both 1-on-1 with a counselor and in group settings. Counseling can help identify reasons and triggers for addiction and can help provide important life skills and coping mechanisms to prevent future relapse.

Knowing that your treatment is covered by your Tufts Health Plan can provide much-needed peace of mind without worrying about the financial impact of seeking help.

For more information on Tufts Health Plan options and to learn the details of what your plan covers, call the number on the back of your insurance card or call us at to speak with a knowledgeable admissions navigator who can walk you through what is covered.

Does Tufts Health Plan Cover Inpatient Mental Health Treatment Facilities?

Tufts Health Plan provides a wide range of behavioral health and substance use support and services for its members.⁴ In many cases, substance use disorder and other mental health conditions such as anxiety, depression, mood disorders, and post-traumatic stress disorder (PTSD) occur together. More than 8 million adults aged 18 and older have mental illness and a substance use disorder at the same time.⁵ This is known as co-occurring disorders. It is important to treat both mental health disorders and substance use disorders simultaneously. If only one is treated, it can lead to challenges down the road. To get the most out of treatment, both disorders should be treated at the same time.⁶

For plans with behavioral health benefits administered by Tufts Health Plan, the company offers coverage for outpatient care services (including behavioral health and substance use treatment, medication, evaluation, and monitoring). Tufts Health Plan is contracted with several hospitals to provide emergency, inpatient, and partial hospitalization for behavioral health and substance use/addiction care and treatment.⁵ Most Tufts Health Plan policies provide coverage for outpatient counseling and inpatient behavioral health services, including addiction treatment. However, there are some exceptions. For example, if you have a point of service (POS) or exclusive provider organization (EPO) plan, Tufts Health Plan may not administer these services.⁷

Types of Mental Health Treatment Covered by Tufts Health Plan

All insurance plans in the Health Insurance Marketplace are required to cover mental health treatments to some degree, regardless of pre-existing conditions, according to the Affordable Care Act. So coverage for the therapies and other interventions used in the treatment of substance use and other mental health disorders will vary, depending on the specifics in an individual plan, the intensity and length of treatment, and where treatment takes place.

Some of the common therapies used in the treatment for substance use and other mental health disorders include (but are not limited to):

• Cognitive-behavioral therapy (CBT).
• Dialectical behavior therapy (DBT).
• Motivational interviewing.
• Contingency management.

As previously mentioned, therapy sessions often take place in both individual and group settings and are part of inpatient and outpatient care.

How Long Does Tufts Health Plan Cover Rehab? 

There are many different types of policies and plans offered by Tufts Health Plan, and each policy’s coverage varies. So, the length of time for treatment coverage depends on the specific plan.

Typical treatment times include 30-day, 60-day, and 90-day programs. Research shows that most people with addiction to alcohol or drugs need at least 3 months in treatment to significantly reduce or stop their substance misuse, and longer treatment times are associated with better outcomes.⁸

You can look up your Tufts Health Plan information on the member portal to learn how many days of treatment are covered each year by your plan. You can also call the number on the back of your insurance card to learn more about what your specific plan covers for drug and alcohol rehab.

What if My Tufts Health Plan Does Not Cover Rehab?

As a Tufts Health Plan member, at least some of your treatment should be covered by your Tufts insurance plan. If your specific insurance policy does not cover all of your rehab expenses, don’t let that keep you from getting the treatment you need. Cost should never keep anyone from seeking help. Getting treatment now is more important than waiting until you have insurance coverage or have the money to pay for it.

If you have out-of-pocket expenses beyond what Tufts Health Plan covers, you have several options to help you pay for treatment, including:

• Payment plans offered by the rehab center that allow you to pay over time.
• Scholarships and grants provided by rehab centers or by the state and federal government.
• Crowdfunding (asking family and friends for support).

Talk with an admissions navigator at the rehab center(s) you are considering to discuss your payment options. At AAC, and admissions navigator can verify your insurance to determine what is covered by your plan and help you formulate a plan to cover any of your out-of-pocket expenses.

Tufts Health Plan In-Network vs. Out-of-Network Rehab Centers 

An in-network facility is a rehab center that has an agreement with a health insurance provider. Out-of-network means the rehab center does not have an agreement with a particular insurance company. The difference in cost of an in-network facility versus out-of-network can be significant. When possible, try to choose an in-network facility to keep your costs lower. Selecting a center within Tufts Health Plan’s network can decrease your out-of-pocket expenses.

Tufts Health Plan prefers their members to stay in-network and believes that members should seek treatment closer to home when possible to keep costs down. In some cases, Tufts Health Plan may cover an out-of-network treatment facility, but you will need pre-authorization from Tufts Health Plan and a healthcare provider.⁹

What Rehab Centers Take Tufts Health Plan Insurance? 

American Addiction Centers (AAC) has various rehab facilities around the country that provide drug and alcohol addiction treatment. If you have a Tufts Health Plan, the following AAC facility accepts Tufts Health Plan for drug and alcohol addiction rehab.

• AdCare Rhode Island. With various facilities located in Rhode Island, AdCare provides innovative, quality, and cost-efficient addiction treatment. Its integrated system of care offers an inpatient treatment center in North Kingstown and an outpatient treatment center in Warwick. AdCare’s continuum of care includes detox services, residential treatment, co-occurring disorder treatment, intensive outpatient services, and case management and discharge planning.

There are various treatment programs for individuals struggling with drug or alcohol addiction, so don’t give up if the first program you check out doesn’t meet your individual needs. There are rehabs near me that can provide the treatment you need. Check out the directory to find a list of facilities and programs. You can search by location and filter by Tufts Health Plan.

How To Check Tufts Health Plan Coverage & Benefits for Addiction Treatment

Before you select a rehab facility, check your Tufts Health Plan’s benefits to determine which costs will be covered by your provider and which will be out-of-pocket expenses for you. Knowing what to expect financially can help provide much-needed peace of mind while in treatment.

To check your insurance benefits under Tufts Health Plan, call Tufts at (888) 257-1985 (TTY: 711).¹⁰ A customer service representative will access and review your insurance benefits with you. You may also use Tufts Health Plan’s self-service tool at Tufts Health Member Connect.

American Addiction Centers can also verify your insurance coverage for you. Complete the form below to see immediately if the center you are considering is in-network with Tufts Health Plan. Alternatively, you can call our helpline at to speak to an admissions navigator who can check your benefits for you.