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Humana Insurance For Addiction Treatment Coverage

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Few can argue that insurance plans are crystal clear to them, and with good reason. Many of us do not fully know what our plans cover, what they don’t, and how our benefits can apply to any given medical need. At Harmony Ridge Recovery, we are keenly aware of this common problem. To address it and set your mind at ease, we will thoroughly explore Humana insurance and its coverage. We will outline the differences among different plans, which programs it tends to cover, and what costs you might expect. If these issues concern you and may affect your willingness to seek rehab, please read on.

Two seniors, a man and a woman, during a therapy session indoors.
While Humana insurance has broad appeal, it often sees use in covering health services for seniors – including rehab, psychotherapy, and counseling services.

Humana Insurance - All You Need To Know

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First, let us start with the basics and work our way to Humana rehab coverage. Doing so should hopefully help you better grasp Humana’s offerings, how they may benefit you, and how different plans may impact your final costs for different Harmony Ridge Recovery programs.

Humana Inc. is a for-profit health insurance company, founded in 1961. It is one of the largest health insurance providers in the United States, offering coverage to over 20 million Americans. Despite its for-profit model, Humana has collaborated with US government agencies, most notably with the Centers for Disease Control and Prevention (CDC).

Since the Medicare Prescription Drug, Improvement, and Modernization Act, better known as the Medicare Modernization Act (MMA), Humana’s plans which offer rehab coverage have become largely synonymous with Medicare in the public consciousness. For this reason, its general popularity aside, Humana is a very common health insurance provider for drug rehab for seniors.

Humana products

In total, Humana offers an array of health insurance plans. Those largely fall into 4 distinct categories:

  • Medicare
  • Dental
  • Vision
  • Employer Group

Products within each group would be too many to list here, however; for 2022 alone, Humana has announced an additional 72 plans among its offerings. As per the announcement, those include:

  • 42 Non-SNP MAPD
  • 3 MA Only
  • 27 Special Needs Plans

Here, we will focus on Humana rehab coverage specifically. If you wish to explore other plans for other types of coverage, you may visit their official website linked above.

Rehab coverage – Humana Medicare

For drug rehab specifically, Humana offers Medicare plans. These are as follows:

  • Medicare Part A, also known as hospital insurance. For drug rehab, such plans will cover hospital care costs.
  • Medicare Part B, also known as medical insurance. For drug rehab, these plans will cover doctors’ expenses. In combination, Part A and Part B make up Original Medicare.
  • Medicare Part C, better known as Medicare Advantage. These plans are required by law to offer all the benefits of Original Medicare.
  • Medicare Part D, which consists of prescription drug plans.

That being said, there are many individual plans within each group, with each covering different services and coming with different premiums, deductibles, and so forth. Humana rehab coverage will also vary somewhat among different plans. For a closer exploration of such plans and their coverage, you may visit Humana’s Medicare coverage page.

A close-up of a person signing a contract with a pen on a wooden table.
If you’re exploring your insurance options, remember to thoroughly check each plan available before making your final choice.

Medicare eligibility

Unlike more general insurance plans, Humana Medicare plans are thankfully easy to calculate eligibility for. To be able to enroll in such plans you must be eligible for Medicare, for which the medicare.gov calculator initially lists two criteria:

  • Date of birth; most people become eligible for Medicare at 65 years of age
  • Having worked for at least ten years, during which you have paid Medicare taxes

Those aside, such factors as the following might make you eligible for Medicare earlier:

  • Pre-existing conditions
  • Illness
  • Disabilities

For specifics in this regard, we strongly encourage you to consult the related US government’s official websites and resources.

Medicare costs

Finally, each Medicare plan’s costs will differ based on its type and individual scope. In turn, costs will also affect Humana rehab coverage – so this complex subject bears noting.

Medicare plan costs will generally change over time, making tracking them slightly harder. Still, as of 2021, their costs were as follows.

Part A

As one part of Original Medicare, Part A covers hospital care costs, which can become considerable over time. As of 2021, Part A came with:

  • Typically no monthly premiums.
  • An annual deductible of $1,484 for in-patient hospital stays, and varying coinsurance payments for days 61 to 90 and after day 91.
  • 20% copay for Medicare-approved durable medical equipment (DME).
  • $185.50 coinsurance payment for days 21 to 100 for a skilled nursing facility stay, after which the beneficiary pays for all costs.
  • 20% copay for mental health services connected with a hospital stay.
A doctor and a patient discussing as the doctor looks through the patient’s records.
On its own, Medicare Part A plans will cover hospital care costs – but Part A is a part of Original Medicare, which also covers doctors’ services costs.

Part B

The other part of Original Medicare, Part B handles medical coverage for doctors’ services, outpatient care, and so forth. As of 2021, Part B came with:

  • A typical monthly premium of $148.50, which may increase based on income and late enrollment penalties.
  • A $203 annual deductible.
  • 20% copay for most doctor services while hospitalized, DME, outpatient therapy, mental health condition diagnoses, and outpatient services after the deductible.

Parts C and D

Unlike Original Medicare, Parts C and D are offered by private insurance companies contracted by the federal government. Both Humana rehab coverage and costs will vary too greatly across different plans to cover in full here.

Still, the following characteristics bear noting:

  • Part C and D plans vary in cost, coverage, deductibles and copays. Still, some Part C plans come with $0 premiums.
  • Both parts come with a late-enrollment penalty.
  • Part D’s premium may vary based on your income.

As with all such information on costs, please note that all of the above are subject to change in 2022 and beyond. Always remember to verify these costs with your insurance provider.

In-Network Vs. Out-Of-Network Insurance Healthcare Providers

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In-network healthcare providers are businesses that have contracts with your insurance company. These contracts allow the company to provide its members with discounted rates to the services of that healthcare provider. These contracts also benefit the provider by allowing it to be on the referral list of any doctor who is treating a patient with said provider. Thus, the insurance company gets to save money while the healthcare provider gets more business. It’s a win-win.

Out-of-network healthcare providers do not have a contract with your insurance company. Therefore, when you receive a service from a healthcare provider that doesn’t accept your insurance, you are paying full price rather than a discounted price. Many insurance companies only offer its benefits to patients of companies that are within their network.

What Types of Programs Does Humana Cover?

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With the above in mind, we may now explore which programs Humana plans will typically cover. Medicare does explicitly cover rehab and physical therapy costs, but some distinctions must be made as regards plan types and program duration.

Inpatient programs

First, Original Medicare explicitly covers inpatient programs. It will cover a considerable amount of costs for any such program for inpatient drug rehab in WV and beyond.

However, costs will vary considerably based on each benefit period. Days 1 to 60 come with a plain deductible; days 61 to 90 come with coinsurance; days after 90 come with higher coinsurance up to your “lifetime reserve days” (60 in total); days after 150 (at most) come with no coverage and must be paid by you.

A crop of doctors over a blue background, as one holds medical records.
Original Medicare, and thus Humana, covers inpatient programs which often present the initial stage of rehabilitation from substance addiction.

Intensive Outpatient Programs

As a category of outpatient programs, Humana does cover virtually any intensive outpatient program West Virginia offers. As a category of outpatient programs, intensive Outpatient Programs (IOPs) are covered by Original Medicare as well. In fact, IOPs  align with Humana’s criteria better than Outpatient Programs (OPs):

“To be eligible, your doctor must certify that you have a medical condition that needs intensive rehabilitation. You must also require continued medical supervision and coordinated care from your doctors and therapists.”

Sober living

Finally, Humana rehab coverage unfortunately doesn’t typically extend to sober living homes. Some plans might, on a case-by-case basis and depending on your sober living WV program, but chances are typically slim.

While sober living homes are often an integral part of recovery, there is a very specific reason why insurance usually doesn’t cover them. American Addiction Centers (AAC) explains this as follows:

“Through the Affordable Care Act (ACA), insurance providers must cover 10 essential benefits, which include treatment for substance use disorders. While sober living homes are designed to help people recover from addiction in a safe and supportive environment, they are not considered treatment facilities.”

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The first step toward achieving recovery is to reach out to one of the rehabs in WV that can get you on the track to recovery. Our admissions team is available 24 hours a day, 7 days a week, 365 days a year. Give us a call today!

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What Is Addiction Treatment?

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Addiction treatment is a rehab program for people who suffer from alcohol and drug misuse. People also use addiction treatment to help treat their mental disorders.

There are several different forms of addiction treatment programs. The format of addiction treatment you choose will depend on the intensity of your addiction and your personal needs.

Inpatient Addiction Treatment
Inpatient addiction treatment is a rehab program in which the people suffering from addiction live in a treatment facility 24 hours a day. The length of time that a person receives inpatient treatment varies on the severity of their addiction. It also depends on the type of inpatient rehab program they are in.

Residential inpatient treatment is a casual community-like rehab program that requires its patients to stay at their treatment facilities. This can be for a period of up to six months. Other people in inpatient treatment go to regular inpatient rehab. Regular inpatient rehab is a rehab program with some hospitalization services and restrictive 24/7 monitoring.

While regular inpatient treatment is more intense than residential inpatient rehab, it is shorter in time. This is because regular inpatient rehab programs tend to only go for a few weeks.

When it comes to inpatient treatment programs, the level of health insurance coverage that you’ll receive depends on where you live, the type of Humana health plan you choose, and your treatment facility. Sometimes a health maintenance organization (HMO) will only cover treatment services whose treatment centers have a contract with the HMO and an agreement with Humana.

If the treatment facility you choose is within Humana’s network, it does not need to be local to receive coverage. Take note, though, that Humana will require you to pay your copay and perhaps your deductible out-of-pocket. You should also know that Humana requires the doctors of addiction treatment patients to refer them to a facility prior to Humana paying for any sort of treatment.

Outpatient Addiction Treatment
Outpatient addiction treatment is a rehab program that only requires its patients to go to a facility for treatment during the day. At night, people in outpatient treatment get to spend their time in the comfort of their own homes.

Similar to when dealing with inpatient addiction treatment, the amount of coverage your Humana insurance will provide you will depend on where you live, the health insurance plan you choose, and the treatment facility. Humana will only cover your outpatient treatment program if it is at a facility within the network.

Overall, Humana insurance for outpatient addiction treatment is less than that of inpatient addiction treatment. Still, though, you will have to pay the copay and deductible out-of-pocket when using Humana insurance for outpatient treatment.

Detox
Detox programs are rehab programs that focus on cleansing their bodies of all alcohol and substances. To do this, the patients must stop taking the substances that they are addicted to and withstand any withdrawal symptoms they may experience as a result.

Some detox programs allow their patients to take medication to help them cope with their withdrawal symptoms. Humana insurance covers a variety of inpatient and outpatient detox programs. Your level of Humana detox coverage depends on where you live, the health plan you choose, and the treatment facility.

Mental Health
Mental health is a person’s emotional, psychological, and social well-being. Examples of mental health disorders include depression, anxiety, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD). When a person has a mental disorder, he or she should seek out mental health treatment. Like all treatment programs, this costs money. Luckily, Humana does provide coverage for mental health treatment.

According to Humana’s Preferred Provider Organization (PPO) Plans, you must first pay the deductible and copay for your treatment services before receiving your health benefits. When it comes to inpatient mental health services, Humana will cover 80% of the costs as long as the treatment facility is within Humana’s network. When it comes to out-of-network inpatient mental health treatment services, Humana will pay for 50% of the costs.

For outpatient mental health treatment services, Humana only requires its members to make a $30 copay when meeting with therapists. Humana will then cover the rest of the cost.

Dual Diagnosis Treatment
Someone with a dual diagnosis has both a substance use disorder and a mental health disorder. Dual diagnosis treatment gained traction after medical professionals began to notice that many people who suffer from addiction also have a mental disorder. There are both inpatient and outpatient dual diagnosis rehab centers.

If you can prove your doctor diagnosed you with both an addiction and a mental illness, your insurance should cover some of the costs. Ultimately, though, the level of coverage that your Humana insurance will have for your dual diagnosis treatment will depend on the insurance plan that you choose.

Some dual diagnosis rehab centers will make you pay for all your treatment services upfront. Then your insurance provider will reimburse you later. Most dual diagnosis treatment centers will work with your insurance though.

Co-Occurring Disorder Treatment

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Co-occurring disorders are disorders in which there are illnesses that contribute to or come as a result of an addiction. Dual diagnosis disorders differ from co-occurring disorders. Dual diagnosis disorders always include some combination of a mental or physical disorder. For example, a dual diagnosis disorder could include depression and alcoholism.

Co-occurring disorders, on the other hand, are ones in which a variety of different types of diseases can be included with a substance use disorder. Essentially, as long as one of the two disorders within a co-occurring disorder is a substance use disorder, the other disorder can theoretically be anything. There are variations in the types of disorders included in dual diagnosis and co-occurring disorders. Most people use both of these terms to refer to someone that suffers from a mental illness and addiction.

When treating a dual diagnosis disorder, the level of coverage that Humana insurance will provide depends on your insurance plan. You should be able to receive a good amount of coverage for your co-occurring disorder treatment, though.

Therapy
When it comes to outpatient counseling with a therapist, as long as you pay your copay, Humana health insurance will take care of the rest. Inpatient counseling will cost you more if it is out-of-network than if it is in-network.

Alcohol And Drug Rehab
For Humana to cover a large portion of the cost of your alcohol and/or drug rehab, the rehab must be specified as covered and be medically necessary. Other things that factor into whether or not Humana will cover a large portion of the cost of your rehab include the plan that you choose, where you live, any legal requirements, and the type of drug and/or alcohol addiction that you are going to rehab for.

If for some reason your Humana plan does not have substance abuse treatment coverage, you can purchase a separate substance abuse treatment plan. Humana provides its members with the opportunity to purchase a separate substance abuse treatment plan because it is required by law to provide its members with some sort of alcohol and substance abuse treatment coverage.

Most Humana plans offer substance abuse treatment coverage for inpatient detox, outpatient detox, inpatient rehab, outpatient rehab, and treatment for addiction to prescription medications.

How to Check Your Humana Rehab Coverage?

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That said, AAC concludes the above by correctly suggesting that “it’s always best to check with your insurance directly to verify your plan’s specific coverage”. Sober living homes in particular aside, it is indeed always best to check your coverage in advance to secure a successful, uninterrupted recovery.

A close-up of a pile of papers, labeled “accepted”.
As Humana rehab coverage can vary by plan and provider, it is always best to check with all parties involved in advance.

To do so, you largely have three options:

  • Contact Humana. Even if their official resources feel sufficient, contacting your insurance provider directly is always the safest option.
  • Consult your treatment providers. Beyond your own coverage, some treatment providers may not accept Humana – albeit rarely.
  • Explore additional resources. After contacting Humana and your treatment providers, you may want to explore additional resources as well. AAC offers extensive help in this regard as well, should you need it.

What If the Full Cost of Rehab Isn’t Covered By Your Insurance?

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Still, as highlighted above, not all rehab programs may be covered in full by all insurance plans. There may be duration limitations, varying deductibles and copayments, and more. In such cases, you will typically need to explore such self-financing options as:

  • Self-pay
  • Personal loans
  • Medicaid

If you do choose Harmony Ridge Recovery for a West Virginia rehab program, we accept Humana and will help explore your coverage and self-financing options in full. We also proudly accept Medicaid and are among the few Medicaid-approved facilities in West Virginia.

Can a Family Member Pay For Your Treatment?

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Yes, absolutely. In cases where Humana rehab coverage does not extend to your treatment needs, self-financing options will typically include payment by family members. To reassure them that the funds are being used as intended, you will often have the option to arrange for direct payments to your treatment providers.

These arrangements might vary across treatment providers, however. As such, we strongly suggest that you verify this option with yours beforehand. If you choose Harmony Ridge, we are happy to review payment options and will help you make the needed arrangements.

A black-and-white close-up of a father and son hugging outdoors.
It is not uncommon for family members to want to pay for their loved ones’ addiction treatment, but it does require some prior arrangements.

Which Health Insurance Providers are Accepted at Harmony Ridge?

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If Humana rehab coverage concerns you, or you may want to explore other insurance options, Harmony Ridge accepts all major insurance providers, including:

As we’ve highlighted, exact coverage can differ quite significantly. To explore your coverage and our programs, we welcome you to contact our teams at (855) 942-3797 for a full review of both. Our representatives are at your disposal 24/7, and will always strive to offer you peace of mind as professionally and discreetly as possible.

Which Addictions Can Be Treated?

Thankfully, all known addictions can be treated with the proper rehabilitation process. Still, much like insurance plans, addictions can differ very notably from one another. The most crucial differentiator is often the exact substance one is addicted to.

At Harmony Ridge, we are fully aware of this fact and the different needs each addiction comes with. Therefore, we treat a wide array of addictions.

Cocaine addiction

A powerful and often dangerous illicit drug, cocaine is highly addictive. To address this, we offer extensive cocaine addiction rehab services.

Fentanyl addiction

A potent painkiller, fentanyl still sees considerable misuse which leads to addiction. As detox from it can be difficult, we offer thorough fentanyl detox treatment services which West Virginia continues to trust.

Heroin addiction

One of the most addictive illicit substances, heroin grips the brain and kindles dependence. With this in mind, and Humana rehab coverage in order, our heroin rehab centers come fully equipped to treat this kind of addiction.

Ambien addiction

Approved by the FDA to treat sleeping disorders such as insomnia, Ambien still sees misuse which can lead to addiction. For this reason we are proud to offer extensive Ambien rehab services.

An assortment of medicinal drug blister packs.
Among other prescription drugs, Ambien can be very potent if used properly but fuel addiction if used for prolonged periods or misused.

Barbiturates addiction

A type of depressant drugs, barbiturates typically see use as treatment for sleeping disorders. Prolonged use and misuse might fuel addictions, however, making barbiturates rehab a necessity.

Benzodiazepine addiction

Better known as “benzo” then as its medical name, benzodiazepine is another type of depressants. Much like barbiturates, they do come with addiction risks which may necessitate benzo rehab.

Marijuana addiction

Often an illicit substance used recreationally, but also one with medical uses and legal status in some states, marijuana can also fuel addiction through prolonged use. To address this, we proudly offer marijuana rehab West Virginia has trusted for years.

Stimulants addiction

A broader category of drugs and substances, stimulants come in both medical forms which treat ADD and similar disorders, such as Adderall, and illicit forms used recreationally. Our stimulants addiction rehab center does make this distinction, but treats addiction to both types effectively and thoroughly.

Opiate addiction

Opiates are a subcategory of opioids, which continue to spearhead the nationwide opioid epidemic. Our opiate rehab center comes fully prepared to help tackle this public health emergency with due diligence. Thankfully, Humana rehab coverage typically extends to all such services.

Meth addiction

A common illicit drug, Methamphetamine is more often abbreviated as “meth” and is notoriously addictive. At Harmony Ridge we operate the meth rehab center West Virginia trusts to cater to this common and often dangerous addiction.

How to Apply for Rehab with Humana?

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To get started with rehabilitation, you will typically have to consult your primary care physician (PCP) for an assessment of your case. They will in turn seek authorization to refer you to appropriate substance abuse treatment providers, and often handle your claims.

A doctor and a patient discussing indoors.
Your primary care provider should help you seek appropriate rehab programs and guide you through the process.

Alternatively, you may contact treatment providers yourself – especially if you also want to verify your coverage. Their representatives and admission managers will help explore your options, and often contact Humana on your behalf to verify your benefits. Such services are always strictly confidential, and are often free of charge. If you do so, your treatment providers may make arrangements at your request to begin the admissions process.

Get Started With Humana Rehab Coverage at Harmony Ridge Recovery

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At Harmony Ridge Recovery Center, we provide the best treatment possible for all of our members. With detox and treatment programs that treat addictions to substances ranging from alcohol to benzodiazepines, we’ve got you covered.

To learn more about Humana insurance and its benefits, you can contact us at any time.

Insurance coverage can be a very complex matter, between obscure terminology and an array of factors which inform final costs. With so much information to keep track of, it’s often nearly impossible to fully know your benefits and their applications. Unfortunately, this may sometimes cause confusion during early consideration phases – or worse, discourage you from seeking treatment.

With this in mind, we hope you found this article informative and helpful in demystifying your coverage. If you would like to know more and explore your options, or feel ready to begin your journey to a new life with Harmony Ridge Recovery, please feel free to contact us today. With discretion, empathy, and unwavering professionalism, we will answer your questions and set you on course to the addiction-free life you deserve.

References:

https://www.humana.com/

https://press.humana.com/news/news-details/2021/Humana-Expanding-Medicare-Advantage-Health-Plans-in-2022-to-Address-Beneficiaries-Most-Important-Needs-Delivering-Predictable-Affordable-and-Understandable-Health-Care/default.aspx#gsc.tab=0

https://www.humana.com/medicare/what-does-medicare-cover

https://www.medicare.gov/eligibilitypremiumcalc#eligibility

https://www.humana.com/medicare/medicare-part-a-b-c-d-cost

https://www.humana.com/medicare/rehab-physical-therapy-coverage

https://rehabs.com/insurance-coverage/sober-living-homes/

https://www.humana.com/medicare/medicare-explained

https://rehabs.com/insurance-coverage/humana/

FAQ

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What Medicare plans are available to me?

Human offers four insurance groups when it comes to drug rehab: Medicare Part A (hospital insurance), Medicare Part B (medical insurance), Medicare Part C (Medicare Advantage), and Medicare Part D (Prescription drug plans). Each group is comprised of many individual plans which cover different services. Of course, each plan comes with its own deductibles, premiums, etc. To find the details of individual plans, you may want to contact Humana directly. You can do so through their website or by calling 1-800-787-3311 directly.

Who is eligible for Humana Medicare insurance plans?

There are two criteria upon which eligibility for Humana insurance is calculated: Date of birth and employment duration. This is practically the same as the requirements for Medicare itself. You become eligible at 65 years of age, and you have to have worked for at least ten years while paying Medicare taxes. It is possible to gain eligibility earlier than that if you have pre-existing conditions, disabilities, or illnesses. If you need more specific information, you may want to visit the US government’s Medicare website.

What are Humana Medicare costs?

The costs involved in Humana Medicare insurance plans depend on the insurance group.

For Part A, you can expect no monthly premiums, an annual deductible of $1,484 for in-patient hospital stays, varying coinsurance payments after day 91, a 20% copay for Medicare-approved DME (durable medical equipment), a 20% copay for mental health services during your hospital stay, and a $185.50 coinsurance payments for days 21 to 100 for your stay in a skilled nursing facility.

Part B will handle medical coverage for outpatient care, doctor’s services, and similar. It comes with a monthly premium of around $150. The exact amount depends on your income as well as any penalties due to late enrollment. This part also comes with a $203 annual deductible and a 20% copay for most doctor services, DME, mental health diagnoses, outpatient therapy, and any outpatient services after the deductible.

Parts C and D are quite complicated, and determining their coverage and costs is practically impossible to do on average. The only thing that is consistent is that both parts come with a late-enrollment penalty and that Part D’s premium varies based on your income.

What types of programs do Humana insurance plans cover?

Humana insurance plans will provide coverage for both inpatient and intensive outpatient programs. To qualify for coverage, however, your doctor must provide you with a certification that intensive rehabilitation is necessary and that you require continued medical supervision.  The doctor does not need to be a part of the Humana network but they have to be a licensed practitioner that is also recognized by Humana.

Does Humana cover alcohol rehab?

Yes! Alcohol rehab is explained under the behavioral health component of Humana insurance plans. The plan itself may cover MAT (Medication-Assisted Treatment), counseling/therapy, as well as inpatient/outpatient treatment. However, the exact coverage depends on your plan. Before you enroll in any of the alcohol rehab programs, it is in your best interest to check the exact specifics of your health insurance plan.

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