One of the reasons that many people who struggle with addictions find it so difficult to get treatment for their problem is that it can be hard to find health insurance that covers substance abuse treatment. Like dentistry, treating addiction to drugs or alcohol was not previously considered something to be addressed by the health insurance industry.
The stigma of drug and alcohol addiction had some part in keeping insurers from covering it. However, since the passage of the Mental Health Parity and Addiction Equity Act and the Affordable Care Act, most health insurance plans now cover treatment for substance abuse.
Treatment for substance abuse can be expensive if it is not covered by insurance. Many patients need considerably more time than the typical 30-day stint in rehab. Some patients need to stay in treatment for a year or more.
They may also need help, such as intensive outpatient care, and they may need aftercare, such as spending time in transitional or sober living housing.
Using a Health New England insurance plan to pay for addiction treatment can ensure that a person gets the care they need for their substance use disorder by alleviating the cost of a rehab program.
Does Health New England Cover Addiction Treatment?
Health New England does cover at least some aspects of addiction treatment and there are many rehab centers that accept Health New England insurance plans.
This insurance carrier provides HMO, or health maintenance organization plans, and PPO, or preferred provider organization plans. Both health plans have small and large group plans and connector plans.
These are further subdivided into coverage tiers such as Wise, Essential, Premium, and Core, which are divided again into metallic tiers. HMO plans require that the patient use in-network health providers, but PPOs tend to be more flexible.
Does Health New England Cover The Cost Of Inpatient Drug And Alcohol Treatment?
Inpatient treatment is one of the most effective forms of addiction treatment and is often covered by Health New England insurance. Depending on your coverage tier, you may have a daily copay for inpatient drug rehab, while your Health New England policy will cover up to a certain dollar amount per day for treatment costs.
Does Health New England Cover The Cost Of Outpatient Addiction Treatment?
Outpatient drug rehab programs may also be covered by Health New England if they meet requirements for outpatient treatment coverage.
These could include:
- being in-network with your Health New England policy
- meeting hour requirements for outpatient programs
- submitting proof of medical need
- obtaining prior authorization for outpatient treatment for addiction
Does Health New England Cover The Cost Of Partial Hospitalization Programs?
Partial hospitalization programs (PHP) are the most intensive form of outpatient treatment for drug and alcohol abuse and are generally covered by Health New England plans. Copays, treatment lengths covered, and continued coverage after completing a PHP will vary according to your coverage tier.
Does Health New England Cover The Cost Of Intensive Outpatient Programs?
Health New England health insurance plans may also cover intensive outpatient programs (IOP), the next step in the continuum of care for addiction recovery. IOPs offer therapy, counseling, and case management similar to PHPs, but do not require medical supervision.
Health New England insurance may cover the cost of intensive outpatient treatment to help individuals stay on track with recovery goals and avoid relapse.
Does Health New England Cover The Cost Of Suboxone?
Suboxone is a brand-name prescription for buprenorphine, a medication used in opioid treatment programs to ease withdrawal symptoms such as cravings. Different Health New England insurance plans will provide varying levels of coverage for Suboxone.
Coverage amounts for the cost of Suboxone could be affected by:
- whether the medication is a preferred medication for your Health New England tier
- if Suboxone is supplied through a preferred retailer
- your individual Health New England policy
Does Health New England Cover The Cost Of Methadone?
Methadone is one of the first medications prescribed for treating opioid use disorders. Medication-assisted treatment (MAT) with methadone is often covered by Health New England. However, patients in MAT programs often have to show proof of medical necessity for this form of treatment.
Copay amounts for methadone with your Health New England plan will vary depending on your plan and by which form of the medication you are taking.
Does Health New England Cover The Cost Of Sober Living?
Sober living costs may be covered by Health New England. Whether this form of outpatient treatment for addiction is covered could be affected by the state you live in. Sober living homes may require residents to participate in outpatient treatment, and Health New England plans do cover this form of drug rehab.
How To Use Your Health New England Plan For Addiction Treatment
Finding addiction treatment using Health New England will most likely require a copay from the patient. The amount of copay depends on the patient’s plan.
The policies’ copays are different. If the patient has bought an HMO Wise plan through Health New England, for example, they’ll need to pay 10 percent copay after their deductible.
That means they have to pay 10 percent of what their treatment costs, and they have to pay it before Health New England pays the rest.
On the other hand, the PPO Essential 200 plan pays the full amount after the patient pays the deductible. This is for in-network providers.
If the health provider is out-of-network, there’s a 20 percent copay after the deductible. Health New England can also choose to reduce what they pay by as much as $500. This is called a reduction of benefit.
The patient will need to have their insurance benefits verified if they use an out-of-network provider.
A patient who uses a Massachusetts health insurance exchange can plug into Health New England Connector Group. These plans require different copays after the deductible, and the copay is a flat fee and not a percentage of the cost of the patient’s treatment.
List Of Health New England Plans By State
They are divided into high-deductible health plans, traditional deductible health plans, essential traditional deductible health plans, and premium health plans with no deductible.
Each level of Health New England insurance plan provides a metallic tier of plans, which include bronze, silver, gold, and platinum plans.
While tiers of coverage vary according to the level of plan, in general, the tiers are grouped according to the deductible a patient will have to meet and the amount Health New England will pay for different services.
Plans with a higher deductible may come with less overall coverage for addiction treatment services and higher copays, though this is not always the case. Plans with high monthly premiums may have lower or no deductible.
The best way to learn about a person’s specific Health New England coverage is to contact their insurance provider or speak to a treatment specialist.
Finding A Rehab Center That Accepts Health New England
A patient who lives in Connecticut, Massachusetts, or Vermont and is struggling with addiction to alcohol or drugs of abuse should contact us to find out which rehab centers accept their Health New England plan.
Most probably do, but there may be just one or two that is just right for the patient’s needs. We can assist in figuring out insurance coverage and finding addiction treatment using Health New England.
Treatment for addiction can be expensive, especially if a person needs long-term residential treatment. Even with a copay, using Health New England for addiction treatment will cost less than paying out of pocket.
For more information about using your Health New England plan to pay for addiction treatment, or to be connected with a list of rehab centers which might fit your needs, call us today.
Updated on July 27, 2020
Addiction Resource aims to provide only the most current, accurate information in regards to addiction and addiction treatment, which means we only reference the most credible sources available.
These include peer-reviewed journals, government entities and academic institutions, and leaders in addiction healthcare and advocacy. Learn more about how we safeguard our content by viewing our editorial policy.
- HealthCare.gov — Mental health & substance abuse coverage
- Health New England
- U.S. National Library of Medicine: Institutes of Health — Health Care Systems and Substance Abuse Disorders