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Does Oscar Health insurance cover Alcohol and Drug Rehab?

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If you struggle with substance use, you may feel alone, but the truth is you’re not. In fact, in 2018, the Substance Abuse and Mental Health Services Administration (SAMHSA) found that 8.1 million Americans had at least one illicit drug use disorder, and 14.8 million Americans struggled with alcohol use disorder.1, p. 37-38

Breaking free from substance use is challenging, but with the right treatment, you can enter recovery. How can you afford to go to rehab? If you have Oscar Insurance coverage, you can use your health insurance to pay for some or all of the cost of treatment.

Understanding how to use your coverage is challenging, and every individual plan is different. To learn more about the details of your Oscar Health insurance, you can call the phone number on the back of your insurance card or contact American Addiction Centers (AAC) anytime. We can help you verify your insurance and answer any questions you have about rehab.

This guide will help you understand how to use your insurance to get substance use treatment. You deserve a happy, healthy life without addiction.

What is Oscar Health?

Oscar Healthcare was started in 2012 and is the first insurance plan built around a technology platform.2, first paragraph Oscar Health aims to give Americans access to affordable, high-quality care that fits into a busy lifestyle.2, second paragraph Over 1 million people use Oscar, and the coverage is available in 22 states.2, quick facts

Despite its recent start, Oscar is now the third-largest for-profit health insurer based on membership for the individual market in the United States, and also offers small group plans and a Medicare Advantage option.2, What we’ve accomplished

Oscar Health Plans

If you’re looking for an Oscar health plan, you have 3 different options. Oscar offers small group health plans for employers, so you might be able to get coverage through your job.3, employers tab The employer health plans are offered in partnership with Cigna.3, employers tab The company also has a Medicare Advantage plan, so if you qualify for Medicare and live in a state where Oscar operates, that’s another option.3, Medicare tab

Once you’ve enrolled, the Oscar app will help you access care more efficiently and give you information about your options.3, Medicare tab Finally, you can get an individual plan through Oscar, which is sold through the insurance Marketplace in each state where Oscar is available.3, You & Family tab For behavioral health, which includes substance use treatment and mental health treatment, Oscar partners with Optum Health to find the right treatment options for your needs.3, You & Family tab

Can you rely on your Oscar Health coverage to help pay for addiction treatment? You can, because the Affordable Care Act (ACA) requires all long-term health insurance plans to cover 10 essential health benefits.4, first paragraph These benefits include mental health and substance use treatment, which means your coverage will pay at least some of the cost of the care you need.4, fifth bullet

Since the details will vary by plan, be sure to check the specifics before you commit to a treatment program.

What will Oscar Health insurance cover?

Substance use treatment is highly personalized because there’s no single treatment plan that works for everyone. Your doctor will ask a variety of questions about what substances you use, how often, your use triggers, and what your home environment is like. It’s important to be honest because your answers will determine the recommended treatment plan.

There are a variety of treatment options and the most common are:5,6

  • Inpatient rehab. Inpatient care is a type of addiction treatment where patients live at the treatment center full-time and receive 24/7 care. This level of support allows them to stay focused on their recovery without any distractions. Inpatient care can provide a fresh start for those struggling with addiction, and it helps them get away from familiar environments or triggers that could lead them to relapse.
  • Outpatient rehab. With outpatient treatment, you can continue to live your daily life while getting help for substance abuse. Outpatient sessions include substance use education, individual and group counseling, and teaching participants how to cope without using substances. This can be a starting point for your recovery journey or a continuation after graduating from inpatient treatment.
  • Intensive outpatient programs (IOP). IOPs, or Intensive Outpatient Programs, are recovery programs that follow a set schedule and routine. They usually provide more intensive treatment than regular outpatient programs while still allowing you to live at home. In addition to helping you develop the skills needed to abstain from substance use, IOPs also offer courses specifically designed to address the issues that can trigger substance use.
  • Partial hospitalization programs (PHP). PHPs offer daily structure and intensity comparable to inpatient/residential facilities; however, you return home during the evenings. PHPs may give one-on-one therapy, group therapy, family meetings, and treatment for coexisting mental health issues. PHP treatment may include one-on-one therapy, group therapy, family meetings, and treatment for coexisting mental health issues.

Regardless of your treatment program, the most important thing is to finish it completely. Many people are tempted to quit when they start to feel better but then don’t have enough practice with their new habits to stay substance-free in times of pressure. When you complete your full program, even if it contains multiple treatment options, you give yourself the best chance at long-term recovery.

Does Oscar Health Insurance Cover Mental Health Treatment Facilities?

It’s common for those who misuse substances to also struggle with their mental health, a situation known as a co-occurring condition. In fact, research shows that 50% of those who misuse substances also have a mental health diagnosis.7, second paragraph

Common co-occurring mental health issues include post-traumatic stress disorder (PTSD), attention deficit hyperactivity disorder (ADHD), depression, anxiety, bipolar disorder, personality disorders, and more.7, second paragraph

When you’re working to overcome substance use, it’s important to get treatment for your mental health at the same time. Studies show that treating both in an integrated way gives you a far better chance to overcome them compared to working on only one or the other.8, first paragraph

Will your Oscar Health behavioral health coverage help you with mental health as well as substance use treatment? It will because the ACA includes both mental health and substance use in the list of 10 essential health benefits.4, fifth bullet

You’ll want to make sure you understand the specific Oscar Health mental health benefits included with your plan, so be sure to review your coverage details before you commit to a program. The admissions navigators at AAC are happy to help you.

How Long Does Oscar Health Insurance Cover Rehab?

How long is substance use treatment? It’s a common question, but the answer is different for everyone. Your specific treatment program will be based on your unique needs. Research shows that most people need at least 90 days to make significant changes in their substance use, including stopping use.9, fifth point That’s why many rehab programs are at least three months long.

However, your specific treatment program might be longer than 3 months and might combine multiple programs. What’s important is that you complete the entire process to give you the best chance at long-term recovery.

Does Oscar Health insurance coverage have limits on substance use treatment? Every insurance plan will focus on helping cover the medically-necessary care recommended by your doctor. There might be other limits or requirements depending on your plan, so be sure to verify your coverage by calling the phone number on the back of your insurance card or contacting AAC by phone or online.

We’re available 24/7, and our admissions navigators can review your insurance coverage in just a few minutes. They’re also available to answer any questions you have about the treatment process.

What if my Oscar Health policy does not cover rehab?

As you look over your Oscar Health rehab coverage, you might find that your insurance only covers part of the cost of the treatment you need, and you have to pay the rest. Or you might be interested in a treatment center that’s not part of the Oscar Health providers network, so you have to pay the full cost yourself.

Don’t let the cost of substance use treatment stop you from getting the care you need. There are many ways to pay for rehab, and your insurance plan is only part of the picture. You might be able to find a program that offers a sliding scale of fees depending on your financial situation, or perhaps you can set up a payment plan for the portion of the treatment you have to pay. Some treatment centers offer scholarships, or you might be able to borrow money from friends and family to pay for treatment.

One thing you know for sure is that when you’re free from substance use you’ll be more focused, productive, and better able to manage your financial obligations.

The key is to get the treatment you need as soon as possible. Substance use has serious long-term consequences legally and for your health, and it’s important to get free before it’s too late.

Oscar Health In-Network vs. Out-of-Network Rehab Centers

When you look through the treatment available with Oscar Health rehabilitation coverage, you’ll notice that some treatment centers are “in-network” while others are “out-of-network.” What does that mean?

All insurance plans have a group of doctors and medical centers that agree to treat members for a lower price in return for the plan referring members to see them.10, p. 1 What’s a Provider Network This group is known as the provider’s network.10, p. 1 What’s a Provider Network

If you see doctors and attend treatment centers within the network, you’ll pay less out-of-pocket.10, p. 2, Why do some plans… However, depending on the plan, you may pay the full cost of treatment if you want to go to an out-of-network provider.10, p. 2, Why do some plans…

The best way to keep your costs down is to focus on Oscar Health drug rehab centers that are within the network. That will let you maximize your insurance coverage and pay less yourself. However, if you are really interested in attending an out-of-network treatment program, don’t let the cost stop you. As we mentioned earlier, there are a variety of ways to pay for the treatment you need.

How do you know if a treatment center is in-network for Oscar Health rehab insurance? You can call the number on the back of your insurance card or contact AAC anytime. We can review your insurance coverage and help you understand your options.

Check Oscar Health Insurance Coverage for Addiction Treatment

Using your Oscar Health coverage for substance use treatment is easy. You simply have to review your plan details and choose a treatment program, and we can help.

When you contact AAC by phone or online, we can review your insurance details in just a few minutes. Our Admissions Navigators can answer any questions you have about substance use treatment and help you understand your treatment options.

You deserve a happy, healthy life free of substances. By getting the right treatment, you can get there. Contact us today to take the first step.