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Does Humana Cover Rehab for Addiction?

Last Updated: February 15, 2022

Authored by Nena Messina, Ph.D.

Reviewed by Michael Espelin APRN

Humana insurance helps millions of Americans access the healthcare they need, including substance abuse treatment. Insurance plans are available in every state as well as Washington D.C.

Does Humana cover rehab? Addiction treatment centers can be costly, and those with Humana insurance can expect it to cover some of the costs. The coverage level varies depending on the plan; therefore, members should verify their coverage and find Humana rehab facilities to see what addiction services it pays for.

Does Humana Cover Rehab?

Humana health coverage for drug rehab is available to most 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 the company pay for their addiction treatment in full.

Like all insurance providers, Humana rehab centers have their restrictions. Therefore, users should take the time to speak with their insurance company about their coverage before they become set on a specific rehab center or type of treatment.

Humana Insurance Policy And Substance Abuse Coverage

When the 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 purchase a secondary addiction recovery coverage plan.

Does Humana cover rehabilitation in full? Again, it will depend on the particular plan. However, in most cases, the insurance covers only a part of the treatment cost. 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.

IV detox at a humana drug rehab facility.

Inpatient

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

Outpatient

Outpatient drug or alcohol rehab is generally less intensive than inpatient services. As a result, the provider will often grant coverage to a more extended period of outpatient therapy than inpatient services. Patients go to the facility for treatment but return home each day. To get Humana insurance coverage for alcohol rehab, the treatment center must meet specific requirements.

Prescription Drugs

Often, 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.

Aftercare

Insurance coverage for drug rehabilitation extends beyond the time at a facility. Insured individuals can access aftercare services that help them abstain from drug or alcohol abuse. It 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 schedule appointments and fill prescriptions.

Group And Individual Health Insurance

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

Their group insurance offerings are the most extensive.

Types Of Group Plans 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: It has Open Access and Traditional HMOs. Open Access has higher monthly premiums but grants access to more providers.
  • 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 group insurance that is best for drug rehab. Users have to work with the plan they have to get the help they need.

Finding Humana Rehab Facilities

When it comes to drug or alcohol rehabilitation, many services require preauthorization. It means that the user must see a doctor and have them help put in a request with their health 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.

In-Network And Out-Of-Network Rehab Coverage

As with most insurance providers, different plans will have specific providers listed as in-network for each insured person. Which Humana rehab centers 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 the company.

Doctor and businessman discussing insurance conditions.

Out-of-network providers are those who have yet to make a deal with Humana. It means that if someone with health insurance wants to see them, they will either need to pay for everything out-of-pocket or pay a higher percentage of treatment than they would with someone in-network.

It 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 Humana rehab facilities will provide the same level and quality of care.

Humana Drug Coverage

Addiction treatment requires the use of medications to reduce withdrawal symptoms or cravings. Medication-assisted therapy is a vital part of substance abuse treatment, so most insurance plans will cover it. However, the exact drugs that are covered will change between policies. As such, users must verify their individual health insurance policy to know more about Humana drug coverage and what medications they will access for 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

Each of the above-listed drugs has different formulations and doses. Therefore, before filling a prescription, the patient should work with their doctor or pharmacy to check that it is covered.

Verify Coverage And Start Treatment

One of the obstacles to seeking treatment is the cost of rehabilitation and recovery. However, if someone has a Humana insurance policy, drug rehab is likely covered at least in part. All the insured needs to do is verify coverage and find the right providers. With this help, it is possible to get clean without paying too much out of pocket.

Frequently Asked Questions

Does Humana Cover Therapy?

Yes, it does. Substance abuse treatment never ends at the detox stage, as addiction influences mental health too. In addition, around half of people with some mental health disorder take drugs or alcohol to cope with it. It makes it evident that addiction recovery requires a complex approach, including psychotherapy. Humana insurance covers addiction therapy because it is an essential part of treatment.

Does It Cover Mental Health?

With the introduction of the Affordable Care Act, mental health services are considered essential health benefits. Therefore, like any other insurance provider, it will cover mental health therapy, including psychotherapy, counseling, and others.

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Page Sources

  1. Sample certificates for employer coverage. Humana. 2019. https://www.humana.com/employer/products-services/medical-plans/sample-certificates
  2. HMO vs. PPO: Which one is right for you? Humana. 2019. https://www.humana.com/health-and-well-being/hmo-vs-ppo
  3. HealthCare.gov, Mental health & substance abuse coverage. https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage/

Published on: October 2nd, 2019

Updated on: February 15th, 2022

About Author

Nena Messina, Ph.D.

Nena Messina is a specialist in drug-related domestic violence. She devoted her life to the study of the connection between crime, mental health, and substance abuse. Apart from her work as management at addiction center, Nena regularly takes part in the educational program as a lecturer.

Medically Reviewed by

Michael Espelin APRN

8 years of nursing experience in wide variety of behavioral and addition settings that include adult inpatient and outpatient mental health services with substance use disorders, and geriatric long-term care and hospice care.  He has a particular interest in psychopharmacology, nutritional psychiatry, and alternative treatment options involving particular vitamins, dietary supplements, and administering auricular acupuncture.