How Much Will HealthNet Help Cover Drug Rehab?

Medically Reviewed

HealthNet insurance plans include coverage for drug rehab and addiction treatment services at some level.

As a subsidiary of Centene Corporation, HealthNet has an extensive network of service providers within its coverage area.

HealthNet Specifics

HealthNet is a health insurance company offering Medicare, Medicare Advantage, Medi-Cal, and private health insurance coverage for more than five million members in Arizona, California, and Oregon. The company offers a wide network of providers and doctors in which to choose.

Every health insurance plan sold on the federal marketplace must provide coverage for 10 “essential health benefits” as dictated by the Affordable Care Act (ACA). Mental health, behavioral health, and substance abuse treatment fall under these essential benefits that must be covered at the same rate as other surgical and medical services. This has to includeboth outpatient and inpatient behavioral health and mental health treatment programs, counseling and therapy, and drug addiction treatment services like rehab.

Each specific plan will vary in the amount and types of services covered. Insurance coverage can vary widely from state to state and between coverage areas.

Medicare, Medi-Cal, And Supplemental Medicare HealthNet Insurance Plans

HealthNet offers both federal and state-funded insurance plans through Medicare and Medi-Cal. They also offer private health insurance plans for individuals and families, some of which are provided through employers as group insurance plans.

Plans will differ depending on which state you reside. Medi-Cal plans are only offered in the state of California, for example, as Medi-Cal is the state-funded Medicare program in the Golden State. HealthNet offers Medi-Cal, Medicare Advantage, and Medicare supplement plans for qualified individuals.

HealthNet’s Medicare Advantage plans provide coverage for seniors ages 65 and older. Supplemental Medicare plans through HealthNet can help to fill the gap between traditional Medicare and additional coverage needs. These plans are private health insurance plans, often called MediGap coverage, which can offset customary medical expenses, such as copays and coinsurance amounts not covered by Medicare itself.

Children, regardless of their immigration status, as well as low-income adults, families with children, people struggling with disabilities, and older adults may qualify for a HealthNet Medi-Cal plan that is often free or very low cost.

Private HealthNet Insurance Plans

HealthNet plans will be different in each state as far as what is offered. In general, there are usually four “metal” tiers available:

  • Platinum
  • Gold
  • Silver
  • Bronze

Generally speaking, the platinum plans offer the highest level of coverage with the lowest deductibles and highest monthly premiums, while the reverse is true of the bronze plans. Out-of-pocket costs will be highest for bronze plans (outside of the monthly premiums) and lowest for platinum plans.

Co-insurance is the percentage you will pay out of pocket for services. For instance, if your coverage covers 80 percent and the co-insurance amount is 20 percent, you will be responsible for that 20 percent of the cost of the services up until your annual deductible is reached. At that point, services are generally covered close to or at 100 percent.

In California, HealthNet also offers the following types of plans:

  • HMO (health maintenance organization): Services are covered when offered through an in-network provider. You will often need to obtain a referral for specialty services like drug rehab.
  • PPO (preferred provider organization): Services are offered for the lowest rates when provided by an in-network provider. Services can be obtained through out-of-network providers for a higher rate. Often, specialists do not require a referral if they are in the PPO network.
  • HSP: With PureCare HSP, covered services are obtained through the network without needing a referral. Out-of-network services are not included with the exception of specific services covered by HealthNet.
  • EPO (exclusive provider organization): Services must be obtained through a provider within the designated network.

A HealthNet insurance representative can offer detailed information about your specific plan, coverage options, costs, fees, and covered services.

HealthNet Covered Services

Under a HealthNet insurance plan, coverage can vary based on the specific plan, where the coverage is provided, and the level of coverage. Often, drug rehab services that are covered, at least to an extent, will include the following:

  • Detox
  • Crisis intervention
  • Evaluation
  • Medication management
  • Counseling and behavioral therapies
  • Outpatient services
  • Intensive outpatient care
  • Partial hospitalization programs
  • Residential treatment programs

In many cases, in order for HealthNet insurance to cover drug rehab and associated services, prior authorization must be obtained, and the services must be determined to be “medically necessary.”

You will likely need to contact the administrator at the HealthNet Customer Contact Center on your insurance ID card to find an independent provider association (IPA) that is contracted through your network or a participating provider. They will then do an evaluation and draw up a treatment plan.

Drug Rehab Coverage

Rehab services that are deemed medically necessary will often be covered through HealthNet insurance after the treatment plan is reviewed and authorized. Services that may not be included are often referred out to community providers.

For more information on your coverage and how to use it to pay for drug rehab, contact HealthNet directly. Trained staff at drug rehab facilities can help you navigate insurance and payment information as well.

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