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How Much Will Centene Help Cover Drug Rehab?

By law, Centene must offer the same coverage for substance abuse treatment as it does for other medical treatments covered under a specific policy. The amount of coverage varies by policy and provider. 

Centene Corporation 

Centene, Inc. is a publicly traded company that offers health care coverage through government-sponsored and privately insured programs through the federal health care marketplace. It also contracts with other organizations to provide case management software, correctional insurance, health and life management, and other services.

It is a large corporation that is listed in the top 100 companies in the United States, per the Fortune 500 rankings, according to its total revenue.

Medicaid

coverage benefits

Centene serves Medicaid members in select states.

Medicaid is a government-funded program of insurance benefits for individuals with extremely low-income levels. The qualifications for Medicaid coverage vary from state to state, depending on the state’s definition of the poverty level. Individuals at or below the poverty level in each state can qualify for Medicaid coverage.

Medicaid does offer coverage for the treatment of substance use disorders, but it is not accepted by many rehab organizations. If you have Medicaid, you must confirm if a rehab facility accepts it before enrolling.

There are often no deductibles or copays with Medicaid. In many situations where Medicaid is accepted, it may cover 100 percent of the charges; however, the state can impose out-of-pocket expenses based on the person’s income level. Out-of-pocket costs are typically minimal when they are charged.

When people with Medicaid are treated by a provider that does not accept it, they can expect to receive a bill for the full amount of charges. You can check with the Substance Abuse and Mental Health Services Administration’s treatment provider locator to find out what rehab centers in your area accept Medicaid.

According to the company’s website, the list of states where Medicaid is currently served by Centene includes:

  • Arizona
  • Arkansas
  • California
  • Florida
  • Georgia
  • Illinois
  • Indiana
  • Kansas
  • Louisiana
  • Maryland
  • Mississippi
  • Missouri
  • Nebraska
  • Nevada
  • New Hampshire
  • New Mexico
  • New York
  • Ohio
  • Oregon
  • South Carolina
  • Texas
  • Washington
  • Wisconsin

Service in Iowa is expected to begin on July 1, 2019.

Medicare

Centene offers services to more than 400,000 Medicare subscribers.

Medicare is a government-funded insurance program designed for individuals over the age of 65 and people with specific disabilities. Medicare offers hospitalization coverage through Part A, outpatient treatment through Part B, supplemental insurance through Part C, and medication coverage through Part D.

Medicare typically pays for 80 percent of expenses related to addiction treatment. Supplemental coverage through Part B helps individuals to cover some of the remaining 20 percent of costs of rehab and related services.

According to its website, Centene offers Medicare Advantage plans (Part B) in the following states:

  • Arizona
  • Arkansas
  • California
  • Florida
  • Georgia
  • Illinois
  • Indiana
  • Kansas
  • Louisiana
  • Mississippi
  • Missouri
  • New Mexico
  • New York
  • Ohio
  • Oregon
  • Pennsylvania
  • South Carolina
  • Texas
  • Wisconsin

Joint Medicare and Medicaid Coverage

Centene participates in joint Medicare/Medicaid coverage programs for individuals who qualify for both in six states.

  • California
  • Illinois
  • Michigan
  • Ohio
  • South Carolina
  • Texax

Insurance Marketplace

Centene offers affordable insurance for individuals who may not qualify for Medicaid or other coverage through the marketplace that was developed through the Affordable Care Act.

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The services provided through its Ambetter services are primarily silver-tier health care plans. Silver-tier plans cover up to 70 percent of health care expenses, leaving the other 30 percent to be covered by the client.

Because the Affordable Care Act states that the insurance policy must provide the same level of coverage for drug rehab services as it does for medical services, the coverage under this plan would be similar for rehab as it is for the medical services provided under the plan.

This plan is offered in the following states, according to the Centene website:

  • Arizona
  • Arkansas
  • California
  • Florida
  • Georgia
  • Illinois
  • Indiana
  • Kansas
  • Mississippi
  • Missouri
  • Nevada
  • New Hampshire
  • New York
  • North Carolina
  • Ohio
  • Pennsylvania
  • South Carolina
  • Tennessee
  • Texas
  • Washington

Tricare

Centene offers managed health care programs through Tricare for United States Armed Forces military personnel, military veterans, and their spouses and dependents. This is a civilian care component of the military health system benefits.

Correctional Systems

Centene offers health care and staffing services to government agencies and the correctional system.

Non-Essential Services

Insurance does not cover many non-essential services given in rehab that are not directly related to the treatment of addiction. These may include:

  • Housekeeping services
  • Gourmet food
  • Treatments that are not approved for substance abuse, such as massage therapy
  • Private rooms

Check with Centene to find out what interventions and services are covered under your particular plan.

Sources

(2019) Transforming the health of the community, one person at a time. Centene Corporation. Retrieved March 2019 from https://www.centene.com/

(2019) Who Made the List? Fortune Magazine. Retrieved March 2019 from http://fortune.com/fortune500/list/

(August 2016) Cost Sharing Out of Pocket Costs. Medicaid.gov. Retrieved March 2019 from https://www.medicaid.gov/medicaid/cost-sharing/out-of-pocket-costs/index.html

SAMHSA Behavioral Health Treatment Services Locator: Home, Substance Abuse and Mental Health Services Administration. Retrieved March 2019 from https://findtreatment.samhsa.gov/

(2019) Medicaid. Centene Corporation. Retrieved March 2019 from https://www.centene.com/products-and-services/state-and-national-solutions/medicaid.html

(2019) M(2019) Medicare. Centene Corporation. Retrieved March 2019 from edicare. Centene Corporation. Retrieved March 2019 from https://www.centene.com/products-and-services/state-and-national-solutions/medicare.html

Affordable Care Act (ACA). Healthcare.gov. Retrieved March 2019 from https://www.healthcare.gov/glossary/affordable-care-act/

(2019) Browse Services by State. Centene Corporation. Retrieved March 2019 from https://www.centene.com/products-and-services/browse-by-state.html

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