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.
