Does Tufts Health Plan Cover Addiction Treatment?
For people suffering from drug or alcohol use disorders, it is crucial to get help as soon as possible. When addictions are left untreated, they tend to progressively get worse over time. Quality addiction treatment programs, however, can help people stop abusing drugs and alcohol and rebuild their lives. One of the biggest impediments to treatment for most people is the perceived cost. However, individuals who are covered by Tufts Health Plan have access to affordable addiction treatment. Tufts Health Plan offers comprehensive addiction treatment coverage, which means that recovery is often only a phone call away.
Tufts Health Plan
Tufts Health Plan is a non-profit health insurance company based in Massachusetts. It is a subsidiary of Tufts Associated Health Plans, Inc, and it is closely affiliated with the Tufts University School of Medicine. As of January 1, 2020, Tufts Health Plan was merged with Harvard Pilgrim Health Care, making it the second-largest health insurer in Massachusetts. The merger also considerably expanded Tufts Health Plan’s vast network of treatment providers. Today, Tufts Health Plan serves more than 2.4 members throughout Massachusetts, Connecticut, Maine, Rhode Island, and New Hampshire.
Tufts Health Plan offers members a vast range of medical benefits, with a strong emphasis on behavioral healthcare benefits. This means that all plans with Tufts Health Plan include strong coverage for substance use disorder treatment and mental health disorder treatment.
Addictions Covered by Tufts Health Plan
Tufts Health Plan covers all diagnosed substance use disorders. It does not matter what a person’s drug or substance of choice was. If a physician has diagnosed them with a substance use disorder, they are eligible for covered addiction treatment. Substance use disorders are generally diagnosed based on two conditions: 1) a person has experienced negative consequences as a result of their substance abuse, and 2) they find it difficult if not impossible to stop abusing drugs or alcohol. Addictions covered by Tufts Health Plan include but are not limited to:
- Benzodiazepine addiction
- Prescription stimulant addiction
- Heroin addiction
- Alcohol addiction
- Prescription opioid addiction
- Crystal meth addiction
- Marijuana addiction
If you suspect you suffer from a drug or alcohol addiction but have not received an official diagnosis, that is okay. Tufts Health Plan will generally arrange for clients to be evaluated by an approved physician who can make a diagnosis and recommend a course of treatment.
Tufts Health Plan and Substance Addiction Treatment Services
Tufts Health Plan covers a wide range of addiction treatment services. The specific services required by a person’s addiction depend on what stage of the recovery journey they are on. During the initial first few weeks of recovery, a person’s needs are likely to be different than later on. Tufts Health Plan recognizes that addiction recovery is a process and that individuals in recovery generally make use of a variety of different treatment services during the course of treatment. Services covered by Tufts Health Plan include:
- Outpatient rehab
- Inpatient rehab
- Individual therapy, group therapy, and family therapy
- Medication management
- Psychiatric services
- Medication-assisted treatment (MAT), including methadone and Suboxone
- Opioid overdose reversal medications (naloxone)
Tufts Health Plan Coverage Levels
Tufts Health Plan offers a wide variety of distinct coverage plans to meet the needs of its members. These plans include Medicaid and employer-based plans. Massachusetts residents also can enroll in Medicare plans through Tufts Health Plan.
Employer-based plans through Tufts Health Plan include:
- HMO. Care is coordinated through a primary care doctor. Their job is to prefer members to treatment providers.
- PPO. Members do not need a referral from their doctor to see a treatment provider.
- Advantage HMO and PPO. Members pay low premiums but have higher deductibles, copayments, and coinsurance fees.
- Advantage Saver HMO and PPO. These plans have high deductibles but the lowest monthly premiums of all plans.
- Tiered plans. These low-cost plans provide members with access to Tufts Health Plan’s full provider network.
- CareLink. This plan is for employees of large companies in Massachusetts and Rhode Island only, though it is open to people living outside of the Tufts Health Plan service area.
- Cigna Out-of-Area PPO. This plan is for employees of small to medium-sized companies in Massachusetts and Rhode Island only, though it is open to people living outside of the Tufts Health Plan service area.
- Tufts Health Freedom Plan. This plan is the result of a partnership between Tufts Health Plan and Granite Health, providing excellent behavioral health services in the New Hampshire area.
Tufts Health Plan also offers the following two Connector plans for individuals and small groups. These include:
- Tufts Health Direct. This public plan provides low-cost coverage and induces federal premium tax credits.
- Tufts Health Premier. This plan includes affordable HMO coverage.
Medicaid plans offered through Tufts Health Plan include:
- Tufts Health Together. This plan covers visits to doctors, specialists, and even prescription medications.
- Tufts Health RITogether. This plan is for residents of Rhode Island, and its benefits include those of Rhody Health Partners, Rhody Health Partners Expansion, and Rite Care.
- Tufts Health Unify. This is a combined Medicare-Medicaid plan intended for individuals between the ages of 21 and 64 only.
Medicare plans offered through Tufts Health Plan include:
- Tufts Health Plan Medicare Preferred HMO. This is an expanded Medicare plan that offers more coverage than Medicare Parts A and B.
- Tufts Health Plan Senior Care Options. This plan is designed to meet the needs of seniors 65 and older.
- Tufts Medicare Preferred Supplement. This plan is designed to meet “gaps” in Medicare and helps people cover coinsurance and deductibles.
- Tufts Health Unify. This is a Medicare-Medicaid One Care plan that is intended for individuals between the ages of 21 and 64. It offers access to a vast network of providers and a dedicated care manager.
What Will Tufts Health Plan Pay For?
Given the vast range of health plans offered by Tufts insurance, it can be difficult to say what any particular person will be covered for. All health insurance plans with Tufts Health Insurance cover addiction treatment. However, plans can differ in terms of how long they provide coverage for. More comprehensive plans have lower out-of-pocket expenses, but they may have more expensive premiums.
While in some cases Tufts Health Plan will cover the entire cost of addiction treatment, it is more common for members to have to pay a small share of expenses. These costs usually come in the form of deductibles, copays, and coinsurance. A deductible is an amount of money, always specified by the plan, that a person must pay themselves before their insurance will begin paying for treatment. Copays are flat fees that policyholders pay when they engage in a treatment. Coinsurance fees are always paid when a person receives a treatment, but they are percentages of the cost of treatment rather than flat fees.
It is also important to mention that plans may have distinct coverage levels for out-of-network service providers. Some plans, in fact, offer no coverage whatsoever to individuals who make use of out-of-network rehabs. Even plans that do offer out-of-network coverage generally provide fewer benefits than they do for in-network rehabs. Making use of an in-network rehab, such as NuView Treatment Center, is the best way to reduce any possible out-of-pocket expenses.
Outpatient Rehab with Tufts Health Plan
Tufts Health Plan offers comprehensive coverage when it comes to outpatient treatment. Outpatient treatment has a far higher likelihood of being approved than long-term inpatient treatment, for instance. Because there is no residency requirement, outpatient treatment is considerably cheaper than other treatment options. This flexible type of rehab is also evidence-based and highly effective.
Clients attend outpatient rehab regularly, either once a week for less acute programs or more frequently when it comes to more acute outpatient programs. Treatment involves a diverse array of therapeutic methods, such as group therapy and cognitive-behavioral therapy. Outpatient rehabs also employ physicians who can prescribe medication and offer medication-assisted treatment. Clients are supported through skill-building workshops as they work to rebuild their lives in the outside world.
Outpatient programs run the gamut from acute treatment programs to highly flexible programs. Many individuals benefit from progressing through multiple programs as they build their confidence in sobriety. Making use of an outpatient rehab on a long-term basis in this way is also associated with significantly lower rates of relapse. Levels of care offered by outpatient programs include:
- Partial hospitalization programs (PHPs)
- Intensive outpatient programs (IOPs)
- Outpatient programs (OPs)
- Aftercare planning
Does Tufts Health Plan Cover Medication?
Yes, Tufts Health Plan provides comprehensive coverage for medication. In fact, enrolling in an outpatient treatment center is often the best way to get access to the medication you need. Physicians employed at an outpatient rehab can prescribe appropriate medications, while the rehab center can work with your insurance plan to ensure that these treatments are covered.
It is common for people with substance use disorders to require medications. Medications may be prescribed to treat physical health problems that have cropped up as a result of years of active substance abuse. Even more common is for clients to suffer from comorbid mental health disorders that require pharmaceutical treatment. In fact, half of all people with substance addictions suffer from mental health conditions, such as anxiety, depression, ADHD, or obsessive-compulsive disorder. Getting the proper medication for dealing with these conditions can reduce symptoms and therefore reduce the likelihood of a relapse being triggered.
Medication-assisted treatment is a commonly utilized treatment modality at many rehabs, especially for individuals suffering from opioid or alcohol addiction. Medication-assisted treatment, or MAT, combines behavioral therapy with medications. These medications, which include Antabuse, buprenorphine, Suboxone, and methadone, reduce cravings and mitigate withdrawal symptoms. MAT therapy is an effective and evidence-based treatment method that is covered by Tufts Health Plan.
Tufts Health Plan and the Affordable Care Act
Tufts Health Plan operates in the United States, so it must operate in accordance with the Affordable Care Act. The Affordable Care Act, sometimes known simply as the ACA, radically changes how health insurance companies operate, especially in the realm of behavioral health. Not only has the ACA caused more US citizens to be insured than ever before, but it has also dramatically improved the quality of insurance coverage they receive.
One of the most important changes is due to the Affordable Care Act specifying certain treatments as “essential health benefits.” Addiction treatment and mental health treatment are both considered “essential health benefits.” In practice, this means that all health insurance plans must offer some degree of coverage for these services. While the extent of such coverage, and the associated fees, differ considerably from plan to plan, all plans come with some degree of benefits.
The Affordable Care Act also enforces a policy known as parity. Parity means that services for physical health problems cannot have a different fee schedule from services related to behavioral health. For example, if seeing a doctor for a physical check-up requires patients to pay a $20 copay, then parity requires seeing a doctor for a mental health problem to have the same copay requirement.
Lastly, the ACA ensures that individuals with addictions cannot be discriminated against. In the past, health insurance companies regularly denied people coverage if they had “pre-existing conditions” that would likely require expensive treatment down the road. The Affordable Care Act says that substance use disorders are not pre-existing conditions. This means that no health insurance company can deny coverage to an addicted person, no matter how severe their condition is.
What Does Tufts Health Plan Cover For Me?
Navigating the fine text of your health insurance plan can be difficult. However, it is likely to be especially overwhelming for people who are in the grip of a substance use disorder. You may recognize the need for addiction treatment but find yourself struggling to determine exactly which services you’re eligible for, how to go about getting them, and even which rehabs are considered in-network. Calling up your health insurance representative, whose number is generally listed on the back of your Tufts Health Plan card, can help you begin answering these questions.
However, if you are certain that you need treatment, the best course of action is calling an in-network rehab directly. NuView Treatment Center is a rehab that is in-network and comprehensively covered by the vast majority of plans with Tufts Health Plan. Our staff is familiar with the details of all health insurance plans offered through Tufts, and we have experience negotiating coverage with insurance companies. During our free and confidential consultation, we will determine your treatment needs, assess your coverage levels, and get you connected to a program that suits your needs. Contact us today at (310) 984-1730.
Outpatient Treatment at NuView Treatment Center
NuView Treatment Center is Los Angeles’ preeminent outpatient rehab. Located in West Los Angeles, our rehab offers modern facilities, evidence-based treatment services, and highly trained and compassionate staff. Regardless of how severe your substance use disorder is, we will work with you to ensure that you get control of your life back. Our staff work with clients to help them develop the coping tools they need to get sober and stay sober while working on various skills and behaviors necessary for building a fulfilling and joyful life in sobriety.
We believe that addiction recovery is best achieved through individualized attention. Our staff exercises compassion while formulating individualized treatment plans for every client who walks through our doors. These individualized plans help clients tackle their own unique set of underlying issues, build on strengths while working on weaknesses, and develop skills for long-term sobriety. Each plan incorporates a range of evidence-based therapeutic approaches, including CBT and group therapy. What all plans have in common, however, is compassion.
NuView Treatment Center is a one-stop-shop for recovery. Our rehab includes every level of care, including partial hospitalization programs, intensive outpatient programs, outpatient programs, and aftercare planning services. Whether you are struggling to function in your life or simply require a bit more support, we have a level of care suitably for your needs.
Recovery is possible for those who reach out for help. It is affordable as well since NuView Treatment Center is in-network with most Tufts insurance plans. If you’re ready to make a change and get your life back on track, contact NuView Treatment Center today.