Insurance coverage is one of the primary considerations for those who are researching drug and alcohol rehab programs. Humana is well-known for offering diverse plan options, including specialized programs for the military and supplemental health insurance for Medicare recipients. It’s this variety that appeals to Humana’s more than 13 million customers throughout the U.S. What coverage for drug and alcohol rehab can Humana clients expect?

Does Humana Cover Drug and Alcohol Detox?

Drug and alcohol detox allows the body to rid itself of addictive substances. Without medical support, withdrawal is a potentially unpleasant process with some dangerous side effects, including:

  • Nausea and vomiting
  • Mood swings
  • Fever
  • Chills
  • Muscle cramps
  • Seizures

Going through detox in a controlled environment allows for the medical management of these side effects. Whether Humana will fully cover drug and alcohol detox depends on the particular plan a person has. Humana offers a diverse range of policy options, but insurance plans will likely cover at least some portion of treatment if the care is preauthorized and provided in-network.

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Does Humana Cover Inpatient Rehab?

Whether Humana covers inpatient drug and alcohol rehab depends on which Humana plan the insured carries. Like most insurance providers, Humana will cover essential services such as substance use disorder treatment most of the time.

Humana policies typically require the insured person to pay either a copay or coinsurance fee for treatment.

Multiple aspects factor into how much of the bill Humana will pay for drug and alcohol rehab. Every plan will be different based on:

  • Metal level
  • Category
  • Insurance type

Humana uses the metal rating system for some plans. The metal categories created as part of the Affordable Care Act help those shopping for insurance understand the cost brackets, such as:

  • Bronze – 40 percent
  • Silver – 30 percent
  • Gold – 20 percent
  • Platinum – 10 percent

These percentages are a rough indicator of what the insured person can expect to pay. People with bronze plans pay more than those with platinum policies. Not all Humana plans use this system, though.

Humana groups insurance plans into different categories, each with different benefit levels. Some group plans include:

  • Humana Simplicity
  • Total Health
  • Level Funded Premium
  • Self-Funded
  • High-Deductible Health
  • Copay Plans

Plan names and features may be different for those who purchase individual insurance policies. Humana’s Medicare supplement programs are named Humana Advantage or Choice, and the military plan is called TRICARE. The plan a person selects will determine what access to coverage for addiction treatment a person has.

Humana also offers different types of insurance models, such as:

  • HMO – Health Maintenance Organization
  • PPO – Preferred Provider Organization

For example, the Humana Simplicity HMO 16 Gold plan requires a $1,500 copay per day for the first three days for inpatient treatment. An insured patient would have to pay up to $4,500 out of pocket for each admission to a drug treatment facility. If that person stays longer than three days, Humana covers the remaining bill. If the same individual leaves the facility and then returns to rehab treatment a second time, it starts all over again.

The Humana PPO Benefit Plan for Illinois participants has a $400 per day copayment for the first three days, while the HMO copayment is $250 per day. Custom-designed plans may also be available through employers.

The Humana Choice PPO Medicare supplement plan lowers the copay amount to $318 dollars but extends it to the first five days. The cost for five days of inpatient rehab would be $1,580.

Some Humana PPO insurance policies include coverage for out-of-network facilities. It’s unlikely the HMO plans will offer this benefit unless the facility establishes an arrangement with Humana before admission.

Does Humana Cover Outpatient Rehab?

Humana does offer outpatient coverage, but that benefit will vary by metal level, plan type, and other factors. Out-of-network facilities are typically not covered, and it is likely that Humana will require preauthorization for both inpatient and outpatient drug and alcohol rehab.

Does Humana Cover Medication-Assisted Treatment?

Humana describes medication-assisted treatment plans using prescriptions such as Suboxone (buprenorphine and naloxone) or methadone as a step toward getting better. Humana offers coverage for medication-assisted treatment on policies that provide coverage for substance use disorders.

MAT allows people who are addicted to opioids like heroin or prescription painkillers a safer way to taper off the drugs. The medication acts in much the same way as an opioid but without the highs or dangerous withdrawal symptoms.

Does Humana Cover Sober Living Houses?

Aftercare can be an integral part of maintaining sobriety after completing an addiction treatment program. Sober living houses provide a safe environment for those recovering from a substance use disorder as they adjust to a life of sobriety.

Humana does have limitations on outpatient care. Humana may take it on a case-by-case basis, though. An addiction treatment facility will contact Humana to see if the plan in question pays for sober living, and the facility may be able to make an arrangement with Humana even if it’s not covered by the policy.

What Is The Difference Between In-Network And Out-Of-Network?

Humana maintains contracts with specific physicians and healthcare facilities. Part of this process is establishing pricing limitations for services like drug and alcohol rehab to allow insurance providers like Humana to control costs.

An in-network facility, whether it provides inpatient or outpatient care, has a contract with Humana that specifies a pricing agreement. In-network treatment is part of most Humana policies.

Out-of-network means the facility does not have an established agreement with Humana. That doesn’t mean the treatment center can’t make a payment arrangement, though. Each treatment program performs an insurance coverage verification that includes discussing payment options with insurance providers like Humana. The results will vary between programs and policies.

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How To Find Drug And Alcohol Rehab Centers That Accept Humana

1) Call Addiction Campuses for an immediate verification of benefits. Addiction Campuses can answer questions about insurance and addiction treatment and perform a no-obligation verification of insurance benefits on your behalf.

2) Contact the insurance provider by using the phone number on the back of the insurance card or by visiting the provider’s website. A representative will be able to match you to an in-network drug and alcohol rehab center.

3) Call the treatment center you or your loved one is interested in. The treatment center’s admissions team can answer questions about covered services.

Addiction Campuses accepts many forms of insurance. For a free, confidential verification of insurance benefits, call today.