Medica provides coverage in seven distinct states and offers a wide variety of insurance plans for employers, families, and individuals. For individuals who suffer from drug or alcohol addictions, Medica offers members the resources of treatment services they need in order to make a full recovery. Moreover, they support members over the long term as they rebuild their lives in sobriety. Medica insurance plans offer coverage for multiple addiction treatment modalities, from talk therapy to outpatient programs. The exact nature of such coverage, however, depends upon the details of one’s specific Medica insurance plan.
Can I Afford Rehab?
Many people with substance use disorders struggle for years, even decades, before finally getting help. In fact, many people never seek help. Research published by the Substance Abuse and Mental Health Services Administration suggests that only 11% of people with drug or alcohol use disorders get the help they need. Unfortunately, left untreated, addictions tend to get progressively worse. Over time, they can damage health, destroy relationships, cause debt and job loss, and even lead to life threatening overdoses.
By making use of a high quality clinical addiction treatment program, individuals can not only recover — they can learn how to lead meaningful and happy lives in sobriety. When most people think of rehab, though, the first thing that comes to mind is the cost. While most rehabs do cost money, comprehensive health insurance plans in general foot the majority of the bill — sometimes all of it. Individuals who are insured through Medica have access to a wide variety of treatment providers that are cost-effective and sometimes even fully covered by Medica.
The goal of addiction treatment is to help clients develop the coping tools they require in order to succeed in sobriety. Given that worsening addictions are linked to a wide variety of other physical and mental health problems, it is certainly within Medica’s interest to provide the best possible coverage for addiction treatment and prevent these problems from worsening.
Medica Health Insurance
Medica is a non-profit health insurance company. It operates in Minnesota, Kansas, Iowa, Nebraska, North Dakota, Missouri, South Dakota, Wisconsin, and Oklahoma. More so than many health insurance providers, Medica takes a vested interest in the needs of the communities it serves. The Medica Foundation, which offers millions of dollars in grant money yearly, runs a wide variety of community-based initiatives and programs to create sustainable improvements in the lives of its members. Much of the work the Medica Foundation engages in involves combating the opioid epidemic currently devastating the country.
Types of Medica Insurance Plans
Medica offers many insurance plans that are employer-based. In addition, it offers countless plans designed for individuals and families. These plans differ from one another based on location. Each individual and family plan is structured around the main clinic or hospital system in the network. These insurance plans include:
- Medica Connect — Kansas
- Select by Medica — Kansas
- Inspire by Medica — Iowa
- Medica with CHI Health — Iowa and Nebraska
- Medica Insure — Iowa and Nebraska
- Medica Applause — Minnesota
- North Memorial Acclaim by Medica — Minnesota
- Engage by Medica — Minnesota and Wisconsin
- Medica Individual Choice — South Dakota, North Dakota, Minnesota, and Wisconsin
Each plan includes three distinct levels of coverage that members can choose from: gold, silver, and bronze. While all coverage levels provide addiction treatment coverage, the extent of such coverage and the out of pocket fees differ considerably.
Medica Bronze
Medica’s Bronze plans are by far the most economical for most people. They have lower premiums, but individuals who require treatment have higher out of pocket expenses to pay.
Medica Silver
Medica’s Silver plans have somewhat higher premiums than the bronze plans. However, the out of pocket expenses are considerably less steep.
Medica Gold
Medica’s Gold plans have the highest premiums but the most comprehensive coverage. They also have the lowest out of pocket expenses of all of Medica’s plans, including very low deductibles.
Medica and Outpatient Rehab
The vast majority of Medica’s health insurance plans provide coverage for outpatient rehab. Outpatient rehab includes a wide range of services, including diagnostic services, evaluations, talk therapy, and skills training. Outpatient rehabs covered by Medica include multiple levels of care designed to help people of different addiction severity levels. These levels of care include:
- Partial hospitalization programs (PHPs)
- Intensive outpatient programs (IOPs)
- Outpatient programs (OPs)
- Aftercare planning
The flexibility of outpatient rehabs makes them ideally suited for individuals who have families or work commitments who cannot afford to move into a residential treatment facility. They are also often recommended to individuals who have recently graduated from an inpatient treatment center. Making use of an outpatient rehab can help these individuals acclimate to life in the outside world while continuing to receive vital support from recovery programs.
Individuals also benefit from long term coverage from Medica. Because outpatient rehabs are considerably cheaper than residential programs, health insurance companies are likely to provide coverage for longer lengths of time. This also considerably improves a person’s likelihood of staying sober following treatment. Research shows that individuals who make use of clinical addiction treatment programs for longer have significantly lower rates of relapse down the line.
Out of Pocket Expenses with Medica
The out of pocket expenses that an individual is required to pay when they attend outpatient rehab depends upon a range of factors. The most important factors are their location, the specific rehab they attend, and the specific plan they are covered by. Perhaps the single most important factor is whether the rehab they attend is within Medica’s network of service providers. While some Medica plans offer some degree of coverage for out of network rehabs, coverage is always best with in network rehabs, such as NuView Treatment Center.
Before Medica begins covering the cost of treatment, a policyholder must meet a pre-specified deductible. A deductible is an amount of money that clients are responsible for paying before insurance will cover the remaining costs of treatment. The dollar amount of a deductible depends upon a person’s specific plan, with cheaper plans often having higher deductibles.
Most plans with Medica also require clients to pay coinsurance fees and copays when they enroll in rehab or use other medical services. Coinsurance is a percentage of the cost of treatment. Copays, on the other hand, or flat fees that an individual pays when they begin treatment.
As an example, an individual who is insured through Inspire by Medica or Medica with CHI Health plans must pay a $1000 deductible before their insurance will kick in. Once it is done, they will be required to pay a 30$ copay when they see a specialty provider. Behavioral health services, including many rehabs, entail a 30% coinsurance fee. These numbers can vary from plan to plan, however.
Medica and Medication Assisted Treatment
Medica provides coverage for medication-assisted treatment (MAT) with the vast majority of its health insurance plans. Medication-assisted treatment utilizes a combination of prescription medications and behavioral therapy to help people recover from drug or alcohol addiction. It is most commonly recommended for individuals who are dealing with opioid withdrawal or alcohol withdrawal. Certain medications can help manage withdrawal symptoms for these drugs, and they can also reduce the cravings associated with withdrawal.
Medica offers a generous prescription drug plan that covers the majority of the cost of these pharmaceuticals. In general, however, patients are responsible for paying copays for their prescriptions. These copays differ, however, depending on the brand of the medication a person is prescribed.
- Name brand medications: $35 copay
- Generic prescriptions: $5 copay
- Non-preferred brands: $150 copay
Medications most frequently prescribed during medication-assisted treatment at an outpatient rehab include Suboxone (buprenorphine and naloxone), methadone, naltrexone, among many others. It is important to recognize, however, that these drugs do not cure addictions; rather, they help people get more out of the behavioral therapies that outpatient programs offer.
In-Network Coverage with Medica
Medica’s health insurance plans provide coverage based on a policyholder’s geographic location. Medica has connections to thousands of providers throughout the United States. The service providers and rehabs that are deemed in-network depend upon the location of the individual client. However, in many cases, drug or alcohol addiction requires specialized care. For this reason, Medica often expands in-network coverage to locations far outside of a person’s geographic location.
NuView Treatment Center, for instance, is in-network with most Medica health insurance plans. As one of Los Angeles preeminent outpatient rehabs, NuView Treatment Center is often considered in-network even for individuals who live on the other side of the country.
Many Medica health insurance plans offer some degree of coverage for out of network providers, but this coverage is significantly lower than the coverage provided for in network rehabs. In many cases, Medica plans offer no coverage whatsoever for facilities that are outside of their approved network — often because they do not meet contemporary standards for evidence-based treatment.
Find a Rehab Near Me That Accepts Medica
It can be difficult to determine what your insurance benefits are. This is especially true for individuals whose brains are foggy due to years of substance abuse. The process of determining coverage levels, finding a rehab, and arranging to have it paid for by Medica can seem intimidating for anyone — and even more so for people with substance addictions. If you have specific questions about your coverage, it is often helpful to call your assigned health insurance representative. This number is frequently printed on the back of your health insurance card.
Another option is to contact NuView Treatment Center. Our outpatient facility is within Medica’s network of service providers, so you are guaranteed to be covered. Even if another facility turns out to be a better fit for your needs, we will advocate on your behalf to help you navigate your insurance plan. After a confidential and free evaluation over the phone, we will immediately connect you to the services you need. Contact us today at (323) 307-7997.
Outpatient Rehab at NuView Treatment Center
NuView Treatment Center, located in Los Angeles, is the Westside’s preeminent outpatient rehab. We specialize in evidence-based treatment for substance use disorders as well as the mental health disorders that often accompany addiction. Utilizing behavioral therapies ranging from CBT to DBT, our highly trained and compassionate staff are prepared to meet the needs of individuals suffering from addictions at all levels.
We believe at NuView Treatment Center that addiction treatment should be handled on an individual basis. Rather than approaching treatment using a one-size-fits-all method, we devise individualized treatment plans for all clients. During this process, clients work on identifying their unique set of triggers, develop new coping tools, and work on restructuring their lives in the outside world. After all, recovery is about more than just quitting drugs and alcohol — it’s about developing a joyful and fulfilling life in sobriety.
Our outpatient programs are ideal for individuals approaching addiction treatment for the first time as well those individuals transitioning from more acute programs. NuView Treatment Center handles every level of care, including partial hospitalization programs, intensive outpatient programs, outpatient programs, and aftercare planning. Medica generally provides comprehensive coverage as clients gain independence and progress from intensive outpatient programs to more flexible ones.
If you are covered by Medica and you are ready for a new way of life, contact NuView Treatment Center today.
Frequently Asked Questions
The preauthorization process for addiction treatment under Medica depends on the specific type of coverage and plan. Generally, if addiction treatment is available as part of your coverage, you must contact your provider or local health plan to get approval before beginning any level of care. Depending on the type of treatment you seek, additional paperwork and medical records may need to be filed and reviewed before approval. Once all materials have been submitted, the preauthorization process typically takes no more than a few days for approval or denial. If you seek treatment outside your coverage plan, contact your provider for more details about the preauthorization process.
Depending on the services needed, additional costs may be associated with treatment. Depending on the type of coverage provided, some people may be responsible for a co-payment or coinsurance charges. Medica's website details the various plans offered and any related co-payments and coinsurance that apply.
Medica does provide coverage for medications related to addiction treatment. Medica's coverage includes prescription medications and over-the-counter products that can help treat a wide variety of addictions, such as opioids, alcohol, nicotine and other substances. Medica covers many different types of medications used in the treatment of addiction, including naltrexone, buprenorphine, methadone and others. Medica also covers comprehensive behavioral health services, including counseling and therapy for addiction treatment. If you're enrolled in a Medica plan, you'll have access to all the help and support you need to manage your addiction and make progress towards recovery.
Medica insurance may cover addiction treatment, depending on the plan. Generally speaking, Medica plans must meet certain criteria to provide coverage for addiction treatment. These requirements include:
- The patient must be diagnosed with a substance use disorder by an authorized provider and exhibit signs of medical necessity as determined by their doctor.
- The patient must be enrolled in an FDA-approved addiction treatment program.
- The services must be medically necessary and appropriate for the individual's condition.
- Treatment must meet accepted standards of care determined by the medical provider or insurer.
- The cost of treatment must be, at most, what is considered reasonable and customary.
- A qualified professional, such as an addiction counselor or therapist, must provide the treatment.
In addition to these requirements, Medica plans may also require prior authorization for certain services related to addiction treatment. This means the patient and their provider must request approval from the insurance company before receiving coverage.
At NuView Treatment Center, we accept most major health insurance plans. To find out if your specific Medica Health Plan is accepted, please call our office at 323-307-7997. Additionally, you can fill out this verification of insurance benefits form. Our staff will be more than happy to answer any questions you may have and help determine the best plan for your treatment.
