Does MagnaCare Insurance Cover Alcohol and Drug Rehab?
If you’re struggling with addiction, it may feel overwhelming trying to sort out what your next steps may be. For many, seeking alcohol and drug rehab is the next step, as is determining whether your insurance will cover treatment. If you have a MagnaCare health plan, your treatment for substance use disorder and addiction may be partially or fully covered. New York, Pennsylvania, and Connecticut residents who hold a preferred provider organization (PPO) plan for MagnaCare insurance coverage may be able to find a covered facility in their area.1, First para
To check your MagnaCare insurance coverage, call the number on the back of your insurance card. Or to learn more information about your specific plan, including coverage details, you can ask the rehab facility of your choosing to help verify these details.
Check MagnaCare Insurance Coverage for Addiction Treatment
Sorting out your MagnaCare mental health insurance coverage can be complicated. Fortunately, there are things you can do to make it easier to check your coverage for addiction treatment. Plus, most health plans are required by the Affordable Care Act (ACA) to cover treatment for substance use disorders in some capacity.2
To check your coverage details, you have a few options, which includes:
- Calling the number on the back of your insurance card.
- Logging in to your MagnaCare web portal to view your summary of benefits and coverage.
- Calling the American Addiction Centers (AAC) helpline to speak to a person who can check your benefits while you’re o the phone.
- Entering your information in the form below to immediately check whether an AAC facility is in-network or not.
What Is MagnaCare?
After Dr. Anthony Bacchi saw how much unions were paying for certain medical services, he wanted to build a more economical health care solution, which resulted in the founding of MagnaCare in 1992.3 Over the course of its years, MagnaCare has expanded from its initial concept to what it is today: a variety of offerings.3 In addition to having a network of providers and offering health plans, it also offers health plan management and workers’ compensation solutions.3 In the late 1990s, MagnaCare also became an administrative services organization, processing and managing health care claims, and started to serve Casualty customers.3 Finally, in the 2000s, MagnaCare expanded its services to better serve members and clients, introduced medical management services, and extended customer support services.3
What Will MagnaCare Insurance Cover?
What your MagnaCare insurance plan will cover may vary based on the plan you have and where you’re located. Similarly, what your provider prescribes as a treatment method may vary. However, it is possible that you may be recommended one or more of the following treatment methods, which may be covered by your MagnaCare insurance plan.
- Inpatient/residential rehab—An inpatient or residential treatment program refers to care that involves an overnight stay at a facility or hospital for a period of time.4, Pg 14 “What types of treatment programs are available, Para 2
- Outpatient rehab/therapy—An outpatient rehab/therapy program refers to treatment that may be offered at a variety of locations, where the patient will visit and then return home for the evening.4, Pg 16, Para 2
- Intensive outpatient programs (IOP)—An IOP typically is more intensive than a traditional outpatient program, with a patient getting care approximately 9-20 hours each week.4, Pg 16, Para 3
- Partial hospitalization programs (PHP)—A PHP often involves care that’s incurred at a free-standing clinic or hospital where the patient is under care between 4-8 hours a day, but they get to go home at the end of the day.4, Pg 16, Para 1
These common treatment methods may be recommended by your provider for your addiction treatment, and they may be covered by your insurance. It’s always a good idea to check your benefits and verify coverage prior to seeking treatment to find out whether treatment would be covered.
Does MagnaCare Insurance Cover Mental Health Care?
The ACA mandates coverage for mental and behavioral health services in some capacity.2 Treatment for substance use disorders, which may include rehab, is included under this mandate. 2, first bulleted list Your exact plan details and coverage will vary, so it’s best to check your benefits and coverage to avoid unexpected medical costs.
This coverage mandate helps many struggling with addiction get the care they need. Those who need stand-alone heroin rehab or co-occurring disorder treatment can often get coverage for such treatment under a MagnaCare plan. A co-occurring disorder is when someone experiences two disorders simultaneously, which is not uncommon with mental health and substance use disorders.5, Para 2 Many mental health disorders can contribute to a substance use disorder and vice versa.6, First bulleted list As such, it’s generally best to treat both conditions at the same time.6, “Diagnosis and Treatment”, First sentence
How Long Does MagnaCare Insurance Cover Rehab?
How long MagnaCare insurance will cover rehab depends on a variety of factors, which include the plan you have, cost-sharing requirements, where you’re located, and where you receive care. It’s possible for you and another peer to both have a MagnaCare plan, but you may have different levels of coverage depending on your specific plan. Be sure to call the number on the back of your insurance card, call an AAC helpline, or enter your insurance information in the form below to verify your benefits.
Despite the variance in coverage, it’s important to note that most experts agree that staying in treatment for an adequate amount of time is essential to the success of your recovery. Research suggests that those receiving treatment for addiction need to remain in treatment for at least 3 months to curb or stop their drug use and that the best outcomes are typically related to longer treatment durations.7, Bullet #5
What if My MagnaCare Policy Does Not Cover Rehab?
In some cases, your MagnaCare policy may not cover all or part of your rehab costs. If that’s the case, you may be responsible for paying these costs out-of-pocket. However, you should not let the cost of getting care deter you from doing so. Getting treatment right now, and not pushing it down the road, is essential to your overall health.
Some rehab facilities may offer financing or scholarship options. Be sure to ask the facility at which you receive treatment if these options may be available to you to help offset some of the cost burdens of rehab care.
MagnaCare In-Network vs. Out-of-Network Rehab Centers
Whether a facility is considered to be in or out of our MagnaCare plan’s network will play a large role in how your plan covers bills you may incur. The term “network” is used to describe a group of facilities, suppliers, and providers that are contracted with your insurer to provide health care services.8 In most cases, obtaining care from an in-network provider will be covered at a higher percentage than an out-of-network provider, which translates to lower out-of-pocket costs for you. That’s why it’s recommended to check network coverage before receiving care. To do this, you can call the number on the back of your insurance card or call an AAC facility and ask a staff member to help verify your coverage.
There are a variety of plan designs that may be available to you from MagnaCare, depending on your situation. All of these plans are likely subject to the ACA’s mandate, which means that they must cover treatment for substance use disorders in some capacity.2 Here is a brief explanation of the plans that MagnaCare can offer:9, Choose from our wide range of affordable networks
- PPO: With a preferred provider organization (PPO) plan, you’ll typically receive more coverage if you use the plan’s network of providers, and will generally have to pay more to use providers outside of the plan’s network.10, How do different types of plans use provider networks?
- EPO: With an exclusive provider organization (EPO) plan, you’re typically only covered if you use providers within the plan’s network.10, How do different types of plans use provider networks?
- HDHP/CDHP: A high deductible health plan/consumer-driven health plan (HDHP/CHDP) is one with a higher deductible than most plans. This typically results in lower monthly premiums but means you’re on the hook for higher out-of-pocket costs as you must pay for more before you meet your deductible.11, First para
- POS: A point-of-service (POS) plan is a type of health plan that provides greater coverage if you use doctors within the network of providers and requires a referral to use providers outside of the network.10, How do different types of plans use provider networks?
To find out more about your specific plan design, call the number on the back of your insurance to talk to a representative.
- (n.d.). Who we serve.
- gov. (n.d.). Mental health & substance abuse coverage.
- (n.d.). Our story.
- Substance Abuse and Mental Health Services Administration. (2014). What is substance abuse treatment? (Original work published 2004).
- Substance Abuse and Mental Health Services Administration. (2020, April 30). Mental health and substance use disorders.
- National Institute of Mental Health. (March 2021). Substance use and co-occurring mental disorders.
- National Institute on Drug Abuse. (2018 January). Principles of drug addiction treatment: A research-based guide (third edition), principles of effective treatment.
- gov. (n.d.). Network.
- (n.d.). Networks and health plans that save you money.
- Health Insurance Marketplace. (May 2021). What you should know about provider networks.
- gov. (n.d.). High deductible health plan.