Does Anthem Insurance Cover Addiction Treatment?

Anthem offers a wide range of medical and mental health solutions for its members.² They operate as an independent licensee of the Blue Cross and Blue Shield Association, meaning members can access services in the following states:²

• California
• Colorado
• Connecticut
• Georgia
• Indiana
• Kentucky
• Maine
• Missouri
• Nevada
• New Hampshire
• New York
• Ohio
• Virginia
• Wisconsin

As of 2022, Anthem is now Elevance in California and Nevada. Anthem lets you select from different types of individual or family plans when accessing substance use treatment. These plans are categorized as follows:³

• Health Maintenance Organization (HMO). An HMO plan enables you to receive services from Anthem’s network of doctors. You also may need to choose a primary care physician from the HMO network with certain plans. This physician provides general care and if you need a specialist, they will give you a referral.
• Preferred Provider Organization (PPO). A PPO plan allows you to choose your care inside or outside of a provider network. If you decide to use out-of-network providers and facilities, you have to pay extra. The use of in-network providers will be covered by your health insurance. With a PPO plan, you don’t need a referral to visit a doctor.
• Higher Deductible Health Plan (HDHP). This type of plan is ideal for people who don’t anticipate incurring many health expenses in the upcoming year. It costs less per month but has a higher deductible.
• Catastrophic Plans. Sometimes a catastrophic health plan is best if finances are limited. This plan will help protect you in case of a large, unexpected illness or accident.
• Exclusive Provider Organization (EPO). With this type of plan, you will work with a select network of care providers. You can also see a specialist without a referral if they are in the network.
• Point of Service (POS). When you have this plan level, you can go outside the network, but it may pay less in benefits.

If you are over the age of 65, you may wonder about Medicare and whether you can get an Anthem Medicare plan.⁴ Anthem health insurance works with Medicare Advantage Plans. When selecting this option, you can receive all three parts—A, B, and D.⁴ Additionally, you can get supplemental Medicare to fill in any gaps not covered by your insurance.⁴ If you opt for Original Medicare, you can access basic health coverage and benefits, such as hospital stays and check-ups.⁵

You may wish to verify your insurance benefits with the facility before seeking rehab to ensure that your insurance is accepted for addiction treatment coverage. You can also call the number on the back of your insurance card—which displays your policy number—to find out where you can go to find treatment for a substance use disorder. Sometimes, traveling to another location might be the best decision in order to get the Anthem drug rehab care you need.

When seeking mental health and substance abuse treatment, it’s helpful to understand your options and rights for coverage. Fortunately, you don’t have to worry about being denied service due to a substance use disorder. The ACA mandates that insurance providers cover treatment for mental health and substance abuse.⁶ These services are considered essential benefits that all Marketplace insurance plans must include.⁶ Some of the specific mental and behavioral health essential benefits that are covered include the following:⁷

• Psychotherapy and counseling for behavioral health.
• Inpatient services.
• Substance use disorder treatment.

You may wonder what type of addiction treatment is the right one for you. Do you need inpatient rehab or outpatient care care, or maybe a bit of both? The level of treatment you need depends on many factors—what substances you were using, how long you used them for, how much you were using, and so on. A health professional will go over the specific addiction treatment options you may need when you begin your recovery. Some of the different types of rehab treatment programs they may discuss with you include:

• Inpatient or residential rehab treatment program. At an inpatient treatment program, you’ll receive around-the-clock rehab, including detox services and therapy.
• Outpatient rehab. During outpatient therapy, you will participate in treatment about once or twice a week.
• Intensive outpatient programs (IOP). IOP treatment takes place on an outpatient basis, but you attend therapy more regularly.
• Partial hospitalization programs (PHP). This program is similar to an inpatient program, except you go home at night.

Your Anthem insurance coverage for drug rehab treatment varies depending on your plan level and the type of service you receive. Plans typically cover outpatient services, including office visits for substance use issues. A coinsurance cost would apply if you use an in-network provider. In most cases, you would not be covered if you select an out-of-network provider. Inpatient services are also usually covered. A copay and coinsurance cost would apply for each admission. Like outpatient services, if it’s out-of-network, it is not covered.

It’s always a good idea to verify your insurance first before going to a rehab facility. This can help save you time and hassle.

It’s best not to put off seeking help for a substance use disorder. The first step is to verify your insurance. Finding the right treatment type for your individual needs is simple with an Anthem insurance plan, and you can begin your journey to recovery using Anthem’s addiction rehab coverage. Reach out for assistance by checking your Anthem mental health and substance abuse coverage. You have options with Anthem health insurance, and your well-being is worth it.

To find out more about drug or alcohol addiction treatment and what your insurance policy covers, please contact a caring American Addiction Centers (AAC) representative free at .