Does Humana Insurance Cover Rehab? Addiction Coverage

Last Updated: June 3, 2020

Humana health insurance helps millions of Americans access the healthcare they need, including substance abuse rehabilitation. Humana insurance plans are available in every state as well as Washington D.C. Users should verify their Humana insurance coverage to see what drug rehab services it pays for.

Does Humana Insurance Cover Rehab?

Humana health insurance coverage for drug rehab is available to the majority of people with a plan through the company. According to the Affordable Care Act, substance use disorder treatment is a standard part of healthcare, and it must be covered to the same degree as other essential health services. However, that does not mean that users will have the option to simply walk into the rehab of their choice and have Humana pay for their treatment in full.

Humana Insurance Policy And Substance Abuse Coverage

When Humana insurance coverage extends to rehab, it covers five aspects of substance abuse recovery services:

Insured individuals who do not have coverage under their primary plan can opt to purchase a secondary substance abuse coverage plan. Under any plan, drug rehab is only covered if it is determined to be medically necessary.

Detox

Detoxification is sometimes needed when the insured has been using a substance that can cause deadly withdrawals. When this is required, a Humana insurance policy for drug rehab will cover the hospitalization, medications, and therapies that are part of the detox treatment. It is up to the doctors supervising the patient to determine if detox is vital to treatment or not.

ptient in the inpatient drug rehab

Inpatient

Inpatient drug rehab is done at a residential facility where the patient receives around-the-clock care. Users must check their Humana health insurance for rehab to find out how long their stay can be while still being covered and what requirements the facility must meet to be covered. Insured individuals should also keep in mind that sometimes these facilities offer additional therapies and other features that are not considered medically essential, and therefore, Humana is unlikely to cover them.

Outpatient

Outpatient drug rehab is generally less intensive than inpatient services, and Humana will often grant coverage to a longer period of outpatient therapy than they will inpatient services. Patients go to the facility for treatment but return home each day. To get Humana insurance coverage for drug rehab, the facility will need to meet certain requirements.

Prescription Medications

Oftentimes, prescription medications will be part of the substance abuse rehabilitation process. However, which medications are covered and under which circumstances vary significantly by Humana insurance policy. Users should verify their rehab coverage in advance of getting any prescription medication filled.

Aftercare

Humana insurance coverage for rehab extends beyond the time at a facility. Insured individuals can access aftercare services that help them abstain from substance abuse. This often includes support with 12-step meetings and individual counseling coverage. They also offer 30 days of extra assistance from their representatives after active rehabilitation ends, helping users with things like scheduling appointments and filling prescriptions.

hands guarding paper humans

Humana Group And Individual Insurance

Humana offers group and individual plans of varying types, as well as Medicare plans. Their coverage extends to all parts of the United States. However, not all products are in each region. For example, individual insurance plans are only available in 20 out of 50 states.

Their group insurance offerings are the most extensive. Types of group plans offered by Humana include:

  • PPOs: Plans with high premiums but low deductibles, resulting in less to be paid out of pocket. They also tend to be more flexible when it comes to seeing out-of-network providers.
  • HMOs: Humana has Open Access and Traditional HMOs. Open Access has higher monthly premiums, but grants access to more providers.
  • Humana Classic: Premiums are higher, but there are fewer restrictions on seeing providers. Copays and deductibles are used in this plan, as well as coinsurance.
  • Point of Service: This plan allows the insured to choose to pay more for an out-of-network provider while still benefiting from some coverage.
  • High Deductible Health Plan: The user pays lower premiums but must meet a high deductible before the company’s coverage kicks in.
  • Coverage First: This plan covers healthcare costs in full until a certain threshold is met. After this, the user must meet a deductible before full coverage starts back up.

There is no specific Humana group insurance that is best for drug rehab. Users just have to work with the plan they have to get the help they need.

man signing a document

Humana Insurance: Preauthorization To Get Rehab Coverage

When it comes to drug rehab, many services require preauthorization. This means that the user must see a doctor and have them help put in a request with their Humana insurance for substance abuse treatment to get specific services covered. Humana Behavioral Health is the division that manages these approvals.

Preauthorization is not required for Medicare Advantage Private Fee-for-Service members and services provided by nonparticipating health care providers for Medicare Advantage PPO members. However, it is needed for all others.

Some of the services that need to be preauthorized include:

  • Inpatient hospitalization
  • Partial hospitalization
  • Residential treatment
  • Electroconvulsive therapy
  • Applied behavioral analysis
  • Transcranial magnetic stimulation

In-Network And Out-Of-Network Rehab Coverage

As with the majority of insurance providers, Humana insurance plans will have specific providers who are listed as being in-network for each person insured. Which providers are in-network will depend on where the insured individual is located. Usually, when a provider is in-network, they have negotiated reduced rates with Humana.

This can make it hard for people seeking substance abuse treatment to access the specific facility they are interested in. However, the chances are good that there will be a drug rehab facility within the Humana network that will provide the same level and quality of care.

Substance Abuse Treatment Drugs Covered By Humana Insurance

The exact drugs that are covered will change between policies. As such, users must verify their Humana individual health insurance policy to know what medications they will be able to access substance abuse treatment.

The covered drugs include:

  • Acamprosate
  • Antabuse
  • Bunavail
  • Buprenorphine
  • Buprenorphine/Naloxone
  • Chantix
  • Disulfiram
  • Evzio
  • Lucemyra
  • Naloxone (Narcan)
  • Naltrexone (Vivitrol)
  • Nicotrol
  • Suboxone
  • Zubsolv
  • Zyban

Verify Humana Coverage And Start Treatment

If someone has a Humana insurance policy, drug rehab is likely covered at least in part. All the insured needs to do is verifying coverage and find the right providers. With this help, it is possible to get clean without paying too much out of pocket.


Page Sources

  1. Prescription Drug Guide: Humana Medicare Employer Plan Formulary. Humana. 2019. http://apps.humana.com/marketing/documents.asp?file=3449173.
  2. Sample certificates for employer coverage. Humana. 2019. https://www.humana.com/employer/products-services/medical-plans/sample-certificates.
  3. HMO vs. PPO: Which one is right for you? Humana. 2019. https://www.humana.com/health-and-well-being/hmo-vs-ppo.

Published on: October 2nd, 2019

Updated on: June 3rd, 2020

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