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How Much Will Humana Help Cover Drug Rehab?

Humana covers drug rehab services, and the exact amount of coverage varies according to the particular plan.

No Individual Insurance Plans

Humana remains one of the biggest publicly traded insurance providers in the United States.

The company was formed in 1961 and took on the name Humana in 1974. It was placed in the top 50 companies in the Fortune 500 rankings, according to its generated revenue even though it cut a substantial portion of its business in 2018. 

Humana insurance announced in 2017 that it was going to withdraw from the federal health care marketplace established by the Affordable Care Act. It still offers some group health care plans and supplemental plans associated with Medicare and Medicaid. Humana insurance formally stated on its website that as of 2018, it no longer offers individual health care plans.

Rehab Coverage

Even though Humana no longer actively participates in the marketplace established by the Affordable Care Act, it must abide by the regulations set forth by the law. This means that any insurance policies and coverage the company offers under group plans, Medicare, and Medicaid must include coverage for behavioral treatments and mental health treatments that is equivalent to the coverage it provides for other general medical conditions.

The treatment of substance use disorders (addiction) is included under this stipulation.

Group/Employer Plans

Humana offers some high-deductible insurance plans for group insurance. These allow the cost of the policies to be low for employees of the company providing the insurance benefits. Employees can combine these plans with the use of a health savings account (HSA). They can apply pre-tax money toward these expenses.

Some of the basic plans include:

  • Coverage First plans, which cover basic health care expenses and hospitalization costs.
  • Portrait plans, which have established in-network deductibles, ranging from $1,000 to $2,500 per person. After the deductible is met, they will typically pay 80 percent of covered expenses.
  • Autograph plans, which have higher deductibles ($2,000 to $5000).
  • Monogram plans, which have even higher deductibles ($7,500 or more).

Again, the extent of treatment coverage for substance use disorder treatment (drug rehab) must be equivalent to the extent of coverage for other medical conditions provided under each plan. Typically, these plans cover 80 percent or less of the expenses.

Medicare and Medicaid

insurance options humana

Medicare is a plan of government-funded health insurance for people 65 and older and people with certain types of disabilities at any age.

Medicare recipients have options through the Humana Medicare Advantage programs that offer them coverage in a specific provider network at lower rates. Medicare typically only pays 80 percent of the charges. There is also supplemental optional insurance provided by Humana that covers a portion of the costs that Medicare does not traditionally cover (Part C).

Humana also offers a Medicare Part D plan to cover prescription medications. It has also participated with the Wal-Mart Corporation to provide a preferred prescription drug plan for elderly individuals. Humana’s Medicare coverage is limited to 22 states.

You can find the available plans on their website by searching for available plans within your zip code.

Medicaid coverage applies to individuals with extremely low incomes as designated by the state guidelines. In addition, some individuals with disabilities may qualify for Medicaid.

General Principles of Addiction Treatment Coverage

Humana insurance plans must abide by the designations set forth by the Affordable Care Act. While all plans will offer some level of coverage for rehab, the specific services covered will vary according to the particular plan.

These plans will typically provide coverage for:

  • Medical detox
  • Inpatient treatment when it is shown to be medically necessary
  • Outpatient treatment, including therapy, medications, and other treatments that are deemed medically necessary and fit Medicare specifications regarding their appropriateness for substance use disorder treatment.
  • Follow-up care

The exact amount of coverage for rehab depends on the plan in question, but it must be equivalent to the type of coverage that the policy offers for the treatment of other medical conditions.

Important Considerations 

Medically necessary treatments for addiction have established research evidence to support their use for the direct treatment of substance abuse. They cannot be used just for the convenience of the provider or client, and they must be less expensive than alternative treatments that provide the same benefits. 

This means that services that do not contribute to the treatment of addiction, such as alternative therapies and interventions that do not have research evidence, will most likely not be covered under the policy. Medications are typically covered when they have research support that indicates they directly treat the condition.

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What Treatment Providers Accept Humana?

Humana’s network of treatment providers will accept those who have their group plans.

Not every rehab facility will accept Medicare or Medicaid, and individuals on these government-funded assistance programs need to choose treatment providers that take this form of insurance.

You can search Humana’s website for providers that accept your specific plan. Alternatively, you can use the Substance Abuse and Mental Health Services treatment locator to find facilities that take your insurance within your general area.

Before enrolling in rehab, confirm that the facility accepts your particular plan. Get specifics on the exact level of coverage, so you won’t have any surprises regarding what you have to pay out of pocket.

Sources

(2019) Shop for Plans. Humana.com. Retrieved March 2019 from https://www.humana.com/

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

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

(February 2017) Humana Plans to Pull Out of Obamacare’s Insurance Exchanges. The New York Times. Retrieved March 2019 from https://www.nytimes.com/2017/02/14/health/humana-plans-to-pull-out-of-obamacares-insurance-exchanges.html

(2019) Small Business and Group Medical Insurance. Humana.com. Retrieved March 2019 from https://www.humana.com/employer/products-services/medical-plans

(2019) Get Started with Humana Medicare, Humana.com. Retrieved March 2019 from https://shop.humana.com/medicare/ad/navigate-ctrl-page?kc=0300015873&cm_mmc=PPC-Joint-DR-Google-_-BR-Joint-_-Headline-_-_k_EAIaIQobChMI-bfw1fma4QIVyB-tBh20aAAEEAAYASAAEgI0LvD_BwE_k_&gclid=EAIaIQobChMI-bfw1fma4QIVyB-tBh20aAAEEAAYASAAEgI0LvD_BwE&dkey=nav&msc

(December 2018) Medical Necessity Definition in Health Insurance. Verywell Health. Retrieved March 2019 from https://www.verywellhealth.com/medical-necessity-1738748

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

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