Does Tufts Health Cover Drug Rehab? - Treatment Solutions

Does Tufts Health Cover Drug Rehab?

Tufts Health Plan for Addiction Treatment

Tufts Health is a not-for-profit organization that provides high-quality, innovative health care 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 51,000+ health care providers, Tufts offers its members a variety of evidence-based health care options.1

Tufts Health has a variety of plans to provide coverage that suits an individual’s needs and budget, from Tufts Health Medicaid to traditional HMO to PPO plans, including tiered and limited network plans.1 Tufts Health offers a wide range of coverage options for various healthcare needs, including treatment for substance use disorder (drug and alcohol addiction).

If Tufts Health 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 specialist who can check your coverage while you’re on the phone.

What Will Tufts Health Cover?

As with other health insurance providers, Tufts Health offers addiction treatment coverage with no additional costs for members who need help recovering from a substance use disorder.2 Tufts Health offers members access to substance abuse specialists who can help you or someone you love find a recovery program. Their plans cover office visits, medications, and treatment programs.3

Covered addiction treatment services cover include:2

  • Medically assisted detox.
  • Inpatient treatment.
  • Outpatient therapy and medication management.
  • Medication-assisted treatment.
  • Dual-diagnosis treatment programs.
  • Outpatient detox.
  • Partial hospitalization programs (PHP).
  • Outpatient treatment.

Tufts Health coverage for all substance use disorder treatments is included in the cost of your policy, at no additional cost.2 Tufts Health 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 include:

  • Medical detox: With medical detox, medications are used during the withdrawal process to help you or your loved one safely withdraw. Medically trained staff supervise all patients around the clock while you undergo medical detox. This is known as medication-assisted detox treatment.
  • Partial hospitalization (PHP): Sometimes referred to as day treatment, partial hospitalization programs allow you to live at home while attending treatment during the day, and usually last between 15-90 days.
  • Intensive outpatient: Intensive outpatient programs require you to attend treatment programs/meetings a few times a week. You may live at home and work during the day and must attend treatment in the evenings. This format is often preferred for people who are unable to take time off of work or have family obligations they must attend to during the day.
  • Inpatient treatment: Inpatient rehab requires you to live in a rehab facility 24 hours a day, 7 days a week for a prescribed duration of time, most often from 30-90 days. While in inpatient treatment, you attend 1-on-1 counseling as well as group therapy to help overcome addiction and learn healthy coping mechanisms to get and stay sober.
  • 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.
  • 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 sobriety.

For more information on Tufts Health insurance plans 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 someone who can walk you through what is covered, all while you’re on the phone.

Does Tufts Health Cover Mental Health Care?

Tufts Health Plan provides a wide range of behavioral health and substance abuse 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) go hand-in-hand. 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 a co-occurring disorder, or dual diagnosis. 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, the company offers coverage for outpatient care services (including behavioral health and substance abuse treatment, medication, evaluation, and monitoring). Tufts Health is contracted with several hospitals to provide emergency, inpatient, and partial hospitalization for behavioral health and substance abuse/addiction care and treatment.5 Most Tufts Health plans 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 may not administer these services.7

How Long Does Tufts Health Cover Rehab?

There are many different types of policies and plans offered by Tufts Health, and each policy’s coverage varies. So, the length of time for treatment coverage will depend on your specific plan. 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 abuse, 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 in a calendar 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 Policy Does Not Cover Rehab?

As a Tufts Health member, at least some of your treatment should be covered by your insurance plan. If your specific insurance policy does not cover all of your rehab expenses, don’t let that keep you from getting into treatment and on the path to recovery. Cost should never keep anyone from getting sober. 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 covers, you have several options to help you pay for treatment, including:

  • Payment plans offered by the rehab center so you can pay back 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. They can help 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 In-Network vs. Out-of-Network Rehab Centers

Searching for a drug and alcohol rehab facility can be intimidating, especially when you see in-network and out-of-network and aren’t sure what those terms mean.

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 Tuft Health’s network can decrease your out-of-pocket expenses.

Tufts Health 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 may cover an out-of-network treatment facility, but you will need pre-authorization from the insurance company and a healthcare provider.9

Check Tufts Health Coverage 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 for you. Knowing ahead of time 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 on the phone. You may also use Tufts’ 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. Alternatively, you can call our helpline at to speak to an admissions specialist who can check your benefits while you’re on the phone.