Tufts Health Plan Coverage for Drug and Alcohol Rehab Treatment Near Me
Tufts Health Plan was initially founded as a nonprofit organization in 1979, and now is a nationally recognized health insurance company headquartered in Massachusetts.1 Serving Massachusetts, Connecticut, and Rhode Island, Tufts Health Plan provides health insurance to approximately 1.17 million members.1 It is one of the only Massachusetts health plans that participate in Medicare, Medicaid/subsidized markets, and commercial health insurance markets.1
The many different health plans offered by Tufts Health Plan company will vary in coverage, cost, and network. Despite this, if you have a Tufts Health Plan, it’s likely that your health plan will fully or partially cover inpatient alcohol and drug rehab centers, as many will be in the Tufts the network of 51,000 providers and 110 hospitals.1 To verify your benefits and coverage, you should call the number on the back of your insurance card. You may also be able to work with a facility to check your coverage.
What Will Tufts Health Cover?
Every Tufts Health Plan will vary based on the specific plan that you have. Each health plan will have its own deductibles, premiums, out-of-pocket-maximums, copays, and networks, which will affect your coverage levels. Despite these differences, every health plan must provide coverage for 10 essential health benefits, as mandated by the Affordable Care Act (ACA). One of those 10 health benefits is mental and behavioral health services.2 This means that treatment for a mental health or a substance use disorder must be covered fully or partially under your plan.
While the treatment path you may be recommended will vary, the following is a list of common addiction treatments that may be covered by your plan:3
- Inpatient or residential rehab: For those who need intensive or around-the-clock care, inpatient or residential rehab is typically what is recommended. This treatment involves a patient staying in a facility for a few days or weeks (inpatient) to a few months (residential) and receiving care.3, “How are behavioral therapies used to treat drug addiction?”
- Outpatient rehab or therapy: For those who don’t need intensive care and who are well on their way to recovery, outpatient rehab or therapy may be the recommended treatment. With outpatient rehab or therapy, a patient travels to a facility to receive therapy or other treatment, and then returns home after.3, “How are behavioral therapies used to treat drug addiction?”
- Intensive outpatient programs (IOPs): For those who maybe don’t need as intensive care as a partial hospitalization program or an inpatient or residential rehab program, but need more structure than a traditional outpatient program, an IOP is often recommended. This type of program often involves a patient attending hours of treatment at least twice a week.4 (under section after conclusion)
- Partial hospitalization programs (PHPs): For those who need more intensive treatment than is provided by outpatient or IOPs, but not as much care as is provided by inpatient or residential treatment, PHPs may be recommended. PHPs often involve structured day programs that last for a few hours, and the patient attends these programs at least a few days a week but returns home each night.5
It’s important to note that the treatments outlined above may not be what’s right for you, and they may not be fully or partially covered by your Tufts Health plan. Your provider will decide what type of treatment is best for you, and your facility can help you determine whether your treatment will be covered by insurance.
Does Tufts Health Cover Mental Health Treatment Facilities?
Under the ACA, mental and behavioral health services must be covered in some capacity under your health plan.2 Whether treatment is fully or partially covered depends on your plan, where you live, and whether the facility is an in- or out-of-network provider.
Specifically, your health plan must provide some level of coverage for the following mental and behavioral health services:2
- Behavioral health treatment, including therapy
- Substance use disorder treatment
- Inpatient care for mental and behavioral health
This mandated coverage allows millions of Americans who are struggling with mental health or substance use disorders to get treatment, including those who may suffer from both, which is known as a co-occurring disorder. According to the National Institute of Drug Abuse (NIDA), 7.7 million Americans have a co-occurring disorder.6 Coverage for standalone rehab and co-occurring disorder treatment falls under this mandate. If you do have a co-occurring disorder, treating both disorders simultaneously is essential for your long-term recovery.
How Long Does Tufts Health Cover Inpatient Drug Rehab Centers?
Because no two paths to recovery are the same, there isn’t a standardized approach to treatment. Similarly, there isn’t a standardized approach to the costs and coverage of inpatient drug rehab. However, longer treatments are typically more effective than shorter treatments. Research show that treatment should last at least 3 months for it to be as effective as possible and for negative outcomes to be reduced.7, (Numbered list number 5) Your provider or facility of choice will work with you to determine how long your treatment may take. And the length of your treatment, facility, and level of health coverage will determine how long your plan will cover inpatient drug rehab treatment.
From there, you can call your insurance provider at the number on the back of your insurance card to check your benefits. You may also be able to work with your care facility to determine what your coverage may be. If you attend an American Addiction Centers (AAC) facility—there are many nationally recognized facilities in the northeastern United States that work with Tufts Health Plans—a staff member can verify your benefits for you.
What if My Tufts Health Policy Does Not Cover Inpatient Alcohol and Drug Rehab Centers?
If your Tufts Health plan doesn’t fully or partially cover the costs of inpatient drug and alcohol rehab centers for treatment, you will likely be responsible for paying for your stay. However, there might be financing or scholarship opportunities available to you. It’s important that you get care no matter the cost, as delaying care may only cause your condition to worsen.
Be sure to talk to an AAC representative or call the helpline to ask about what private pay, special financing, or scholarship opportunities may be available. These payment options can help lessen the burden of paying for the costs of rehab out of pocket, which can help you get on the path to recovery today.
Tufts Health In-Network vs. Out-of-Network Inpatient Rehab Centers
Whether you attend an in- or out-of-network inpatient drug rehab center will greatly affect the cost of your treatment. Typically, in-network providers are those who are covered at a higher level under your health plan, because they’re approved vendors by your insurer. In most cases, out-of-network providers aren’t covered under your health plan. If they are, the coverage level is usually a minimal percentage in comparison to in-network providers. That’s why it’s so important to choose an in-network provider whenever you can. You can call the number on the back of your insurance card or sign on to your online insurance portal to find out whether an in-network facility is near you.
How to Find Tufts Health Covered Inpatient Alcohol and Drug Rehab Centers?
Tufts Health Plan works with a network of over 51,000 healthcare providers and 110 hospitals across the three states it serves. This means that it’s likely that there’s an in-network rehab center near you where you can receive covered inpatient alcohol and drug rehab treatment.
AAC has a variety of accredited facilities across the country, including the following nationally recognized treatment facilities:
If none of these best-in-nation treatment centers are what you’re looking for, you can click here to find a directory of AAC facilities near you. You can also call the AAC helpline and speak to a representative who can help you find a center where you can be treated. You can also call the helpline to verify your benefits or to immediately check your coverage.