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Does AvMed Cover Inpatient Alcohol and Drug Rehab Programs?

On this page, you will learn about AvMed health insurance coverage for substance abuse treatment and how to confirm what benefits are available under your specific plan.
If you or a loved one are experiencing a medical emergency, call 9-1-1 immediately.

Provider Overview

AvMed Inpatient Drug Rehab Centers in Florida

When in need of an addiction treatment rehab center, it’s crucial to know what types of treatment are available to help. It is also vital to understand your AvMed insurance benefits so that you know what is available to you. Some people may not seek the treatment they need because they assume they won’t have access to AvMed rehabilitation coverage. However, AvMed rehab insurance works with Optimum to provide users with robust behavioral health services.1

What is AvMed Insurance?

AvMed offers Marketplace plans that are ideal for individuals and families who are self-employed, unemployed, or do not have a health insurance plan through an employer. From its beginning in 1969 as a company focused on providing physicals for airline pilots, AvMed has grown to serve more than 290,000 Floridians. The company offers Medicare Advantage plans, individual and family plans, and plans for employers7.

You can have a rehab facility of your choice check your AvMed network coverage to see if your insurance plan is in-network with them. Another way to verify your AvMed rehab coverage is to call the number on the back of your insurance card and speak to a representative.

What Will Avmed Cover?

Before you consider what AvMed insurance benefits will cover, it’s important to know what types of services are available for substance use disorder. You will need to consult with an admissions navigator to understand the exact program(s) necessary for your situation. Some of the treatments that are effective in helping people with a substance use disorder include:2

  • AvMed For Inpatient or residential treatment: This type of treatment program is a good place to start for those with severe addiction. It may involve medically assisted detox treatment.
  • AvMed For Partial hospitalization program: This program is a step down from full inpatient treatment. You will go home at night but spend much of the time in rehab treatment.
  • AvMed For Intensive outpatient programs: In this type of program, you will attend treatment on an outpatient basis, but you will attend quite frequently.
  • Avmed For Outpatient therapy: A regular outpatient therapy program involves a less intensive approach and works well for people who need less monitoring.

Does AvMed Cover Inpatient Mental Health Facilities?

If you suspect you might be dealing with a mental illness along with substance use disorder — known as a co-occurring disorder — a comprehensive treatment approach will be essential to your overall recovery efforts. Co-occurring conditions are more common than you might think.3 A strong correlation exists between mental health and substance use disorder, but researchers aren’t quite sure if one of these issues necessarily leads to the other.3 The most important thing to keep in mind is that with an AvMed mental health treatment plan, you can receive treatment for both issues simultaneously.

Some people might be concerned about getting treatment for both conditions at once. They may question whether or not AvMed covers drug rehab and mental health. AvMed insurance benefits must follow the guidance under the Affordable Care Act, which stipulates that insurance providers must give essential benefits to the insured.4 Mental health and substance use disorder services are considered essential, and so they’ll be covered to the same extent as stand-alone rehab services will be.4

When you have AvMed coverage, you can rest easy knowing that both conditions can be treated in tandem. It’s also important that you do treat them simultaneously because they interact with each other. For example, if you are dealing with mental illness, you may use substances to block out mental health issues.3 A person might relapse after completing detox treatment if they don’t get help for the mental illness that influenced their behavior.

How Long Does AvMed Cover Inpatient Drug Rehab centers?

You might be wondering how long you will be in an inpatient drug rehab center. Additionally, you probably are concerned about whether AvMed will cover the full extent of your treatment regimen. While treatment times vary from person to person, most researchers agree that for more effective outcomes, you should stay in treatment for at least 3 months.5

Addiction is a complex and chronic disease; you may want to consider ongoing AvMed drug rehab to help you stay on track. For example, after you complete the 3-month initial inpatient stay, you could transition to an outpatient AvMed rehab program. Your outpatient treatment may be intensive, or you might participate in sessions once a week. Consulting with a trained admissions navigator will give you the best insight as to what is best.

The length of time covered for AvMed substance abuse treatment coverage will depend on your plan and the policy tier. You can check your tier level and plan information by calling the number on the back of your insurance card.

What if My Avmed Policy Does Not Cover an Inpatient Drug Rehab Centers?

AvMed drug treatment programs are sometimes offered on a scholarship or financial aid basis, meaning even if you’re worried about not having insurance coverage or wondering about the costs, you may still be able to get treatment.

Other payment options for obtaining addiction rehab treatment when your insurance won’t cover services include setting up a payment plan with the facility. You can check for cash discounts or sliding scale fee programs too. Crowdfunding is another option. Whatever you do, be sure to move ahead with seeking the treatment you need and not delay it.

AvMed In-Network vs. Out-of-Network Alcohol and Drug Rehab Centers

In-network doctors, facilities, and providers are those that have a contract with the insurance company to provide services at a reduced rate. Certain insurance plans specify that you must use in-network providers for insurance to cover the costs. You can search for drug treatment providers within AvMed’s network by accessing this site.

If you choose to go with an out-of-network provider, your costs will vary depending on your plan and tier level. For example, a point-of-service plan may incur the following costs for out-of-network substance abuse services:6

  • Inpatient services: You pay 40% co-insurance after the deductible. Prior authorization is needed, and the residential stay is limited to 20 calendar days per year.
  • Outpatient services: You pay 40% co-insurance after the deductible. Prior notification is required.

How to Find AvMed-Covered Alcohol and Drug Addiction Treatment Programs?

You can find AvMed drug detox treatment nationwide in most instances. Take the first step in your recovery by verifying your insurance. Contact American Addiction Centers (AAC) and we will give you an immediate answer about your AvMed insurance rehab coverage.

AAC’s addiction rehabs in Florida, River Oaks Treatment Center and Recovery First Treatment Center, are among some of the nation’s best treatment facilities. You can contact someone today to discuss getting started with treatment. Call our helpline at .

How to Read Your Insurance Provider Card
  • 1Insurance Provider Name
  • 2Policy Member's Full Name
  • 3Policy Membership/Subscriber ID
Local Alcohol Rehab Near Me
Local Opioid Rehab Near Me
  1. (2021). Behavioral health benefits.
  2. National Institute on Drug Abuse. (2020). Types of treatment programs.
  3. National Institute on Drug Abuse. (2018). Comorbidity: substance use disorders and other mental illnesses.
  4. gov. (n.d.). What Marketplace health insurance plans cover.
  5. National Institute on Drug Abuse. (2020). Principles of effective treatment.
  6. (n.d.). Summary of benefits and coverage.
  7. AvMed. (2019). About Us.

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