Addiction treatment is covered under Medica’s behavioral health benefit. The goal of treatment is to give patients the tools they need to live a successful, fulfilling life in sobriety.
Medica is an insurance provider that offers plans in Kansas, Nebraska, North Dakota, South Dakota, Minnesota,Iowa, and Wisconsin. Medica has a combination of group, individual, family, Medicaid and Medicare plans to meet the needs of a wide range of potential customers. To comply with the Affordable Care Act, all of Medica’s insurance policies cover behavioral health services, including addiction treatment.
Medica Insurance Plans Overview
Medica offers several insurance plans for individuals and families that differ based on the main hospital or clinic system in the network. Some of these include:
- Medica Insure – Iowa and Nebraska
- Medica with CHI Health – Iowa and Nebraska
- Inspire by Medica – Iowa
- Medica Connect – Kansas
- Select by Medica – Kansas
- Altru Prime by Medica – Minnesota
- Medica Applause – Minnesota
- Engage by Medica – Minnesota and Wisconsin
- North Memorial Acclaim by Medica – Minnesota
- Medica Individual Choice – Wisconsin, South Dakota, North Dakota and Minnesota
In addition, Medica offers employer-sponsored health plans in North Dakota, South Dakota, Minnesota and Wisconsin. The provider also has Medicare plans for individuals to consider.
Within each of its plans, Medica further breaks down coverage based on metal levels. Each plan type has the following options:
- Gold – These plans have low deductibles and copays but a higher monthly premium.
- Silver – These plans have moderate premiums and moderate out-of-pocket expenses.
- Bronze – These plans have the lowest premium rate but the highest out-of-pocket expenses.
Among each of these plans, coverage varies significantly. Members will need to pay deductibles and copays before their insurance options kick in, but all of the plans across the board offer coverage of some type for addiction treatment services.
Does Medica Cover Drug And Alcohol Detox?
The first step in treatment for an addiction is often detox, which is withholding the addictive substance and allowing it to completely leave the body. Most Medica plans offer coverage for drug and alcohol detox after the patient has met an annual deductible and paid any required copays.
As drugs and alcohol leave an individual’s system, withdrawal symptoms develop. In detox, whether inpatient or outpatient, the patient receives support and medications to manage these symptoms. Medical staff monitors detox patients closely, ready to intervene if symptoms worsen or become life-threatening.
Does Medica Cover Inpatient Rehab?
Inpatient rehab is covered under all Medica insurance plans’ inpatient care services. When participating in an inpatient drug rehab program, all patients should expect to owe copays and any applicable deductible.
For instance, Iowa’s individual and family plans charge a $250 copay per day for the first five days of service for in-network treatment. Patients receiving treatment at out-of-network providers will owe a 30 percent coinsurance charge after meeting the deductible.
These charges are subject to each plan’s out-of-pocket maximum. In Iowa, that maximum is $5,000 for individuals for in-network services and $7,000 for individuals for out-of-network services. Plans for other states have similar fee structures.
Inpatient treatment takes place at a treatment center where the patient lives on-site while receiving care. A residential treatment setting allows the patient to live in an environment fully focused on sobriety, protected from most triggers that can lead to cravings. This setting also provides valuable emotional and medical support to help improve treatment outcomes.
Does Medica Cover Outpatient Rehab?
Most Medica plans cover outpatient rehab services. Covered outpatient treatment services include diagnostics and the treatment that takes place on an outpatient basis. This includes intensive outpatient programs and partial hospitalization programs.
Before insurance begins to cover outpatient treatment services, the patient must meet the deductible outlined in their plan. Many plans, especially individual and family plans, will have a coinsurance or copay to cover as well.
For example, patients with Inspire by Medica or Medica with CHI Health plans are responsible for a $1,000 deductible, a $30 copay for specialty care visits and a 30 percent coinsurance for many behavioral health services.
Outpatient services are helpful in the transition from the intensive setting of inpatient treatment to independent life in sobriety. Patients with milder addictions may also opt for outpatient treatment programs instead of inpatient treatment. During outpatient treatment, patients will live at home or in a sober living home while participating in therapy.
Does Medica Cover Medication-Assisted Treatment?
Prescription medications can help many patients manage the withdrawal symptoms that are common when breaking an addiction. Medica’s generous prescription drug plan means the prescriptions used in medication-assisted treatment may be covered. Patients should expect to pay copays for their prescriptions, such as these from Medica’s Minnesota insurance products:
- Generic prescriptions: $5
- Preferred brands: $35
- Non-preferred brands: $150
Common medications used for addiction treatment include Suboxone (buprenorphine, naloxone), Diskets (methadone) and ReVia (naltrexone), among others. These work either by preventing withdrawal, blocking the effects of the drug or by making the drug or alcohol less appealing to the individual, thus adding to the individual’s tools to prevent relapse.
Does Medica Cover Sober Living Houses?
No, sober living houses are not covered under most Medica insurance plans. Sober living houses give those who are in recovery a safe place to live that is in a controlled, drug-free environment, often in the early period of sobriety after successfully completing treatment. Patients typically pay for this out of their own pockets, because it is not a medically necessary intervention.
That said, sober living houses are often an important stepping stone back to regular life after addiction. Sober living houses give the time necessary to allow a person to learn to navigate triggers that always exist in normal daily life.
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In-Network Vs. Out-Of-Network Coverage
Medica’s insurance plans provide access to a broad network of providers within members’ geographic areas. However, for alcohol and drug addiction treatment, some individuals will find the best treatment program for their needs is located away from home. This means that the provider may not be within the covered network of providers.
When this occurs, individuals seeking addiction treatment can contact Medica to learn what their out-of-network coverage is. There is often still some coverage when patients travel outside of their insurance plan’s network, but the out-of-pocket costs are higher.
Patients can also ask the addiction treatment facility to perform what is known as a verification of benefits. This involves verifying whether the patient has coverage for a specific addiction treatment service. Individuals can call their chosen treatment facility to request this before checking in for treatment.
How To Find Drug And Alcohol Rehab Centers That Accept Medica
1) Contact Vertava Health for an immediate verification of benefits. Vertava Health 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.