AvMed Insurance Coverage for Addiction Rehab

One of Florida’s oldest and largest not-for-profit health plans, AvMed provides various health plans including Medicare Advantage, individual and family, and employer groups. AvMed is offered only in Florida. They are headquartered in Miami and have offices throughout the state. You can get AvMed insurance through the Health Insurance Marketplace, through an employer, or directly through the insurance company.⁷

AvMed has a wide variety of plans and coverage options. There are Entrust plans offered through the marketplace at the bronze, silver, and gold tiers, along with catastrophic coverage. Each tier has several different plan options with different monthly premiums. In general, your out-of-pocket costs will be lower at the higher tiers, but your monthly premium will be more expensive.⁸

There are also Point-of-Service (POS) plans, which combine some aspects of a Health Maintenance Organization (HMO) with a Preferred Provider Organization (PPO). You have a primary care physician, but you may be able to get out-of-network benefits as well. AvMed offers HMO plans as well. Under an HMO, you’re limited to fewer providers and aren’t likely to receive coverage outside the network. However, this plan is less expensive when it comes to monthly premiums and out-of-pocket costs.

When doing an AvMed provider search for care, you can use the AvMed provider directory to find treatment through an AvMed provider list.

You can get Medicare Advantage plans through AvMed. Medicare Advantage is a full replacement for original Medicare and with AvMed you gain additional benefits, such as SilverSneakers fitness program, vision and dental, and more.⁹

So, can you use your AvMed insurance coverage for addiction treatment? Yes, you can! The specific details and how much the insurance pays for will depend on your plan and the provider you choose. However, there are options to help you pay if your insurance doesn’t cover the full cost.

Does AvMed cover drug and alcohol rehab? Thanks to the Affordable Care Act (ACA), all long-term health insurance plans must provide at least some coverage for mental health and addiction recovery. It’s considered an essential health benefit.¹ AvMed offers its behavioral health benefits through Optum. Using the Optum website, you can access a substance abuse disorder hotline, find a provider to help you get the treatment you need, and browse mental health resources.²

The treatment options include detoxification, residential treatment, outpatient rehab, medication-assisted treatment (MAT), and more. Optum provides a toll-free number to call to reach a licensed clinician to evaluate your situation and help you create the care strategy that’s right for you.³

The amount of coverage you have can vary widely based on your state of residence, whether the facility is in- or out-of-network, the length of your stay, and your insurance plan level. The cost of drug and alcohol addiction treatment will vary from person to person and will also depend on the rehab center, the type of program attended, and specific services received.

Does insurance cover alcohol or drug rehab? As previously mentioned, AvMed does offer at least some coverage for addiction treatment through Optum. The details will vary depending on your insurance plan and the available providers in your area. There are a variety of treatment options available.¹⁰

• Medical detoxification is often the first step to any rehabilitation program. Depending on what drugs you’ve been using, this may be a brief process, or it might have to be medically supervised. From there, you should go to either inpatient or outpatient treatment.
• Inpatient addiction treatment is either long-term or short-term and requires you to live at the rehab facility. While there, you’ll work on the issues that led you to addiction and learn healthy coping strategies and ways to stay clean. This may be followed by an outpatient or transition program.
• Outpatient addiction treatment allows you to live at home and continue to work and do your daily routine. However, you’ll attend treatment meetings regularly where you’ll receive counseling, coping skills, and support as you move forward with your recovery.
• Partial hospitalization programs (PHPs) are more intensive than outpatient treatment but still allow you to live at home. You’ll spend the day in treatment and sleep overnight at home. Generally, a PHP will meet 4-6 hours a day, five days a week.
• Intensive outpatient programs (IOP): Intensive outpatient programs require you to attend treatment programs/meetings a few times a week. You may live at home and work during the day and then attend required treatments in the evenings. These programs are often preferred for people who are unable to take time off work.
• Sober living: Sometimes referred to as transitional living arrangements, halfway houses, or recovery residences, sober living homes offer an in-between option for individuals after completing a treatment program and before returning to their homes and lives.
• Aftercare: Aftercare describes any ongoing or follow-up treatment for substance abuse that occurs after an initial rehab program. Aftercare goals include maintaining recovery and strategies for preventing relapse.

When an individual needs treatment for a substance use disorder (SUD) and another mental health issue, it is called dual diagnosis. Dual diagnosis treatment is often covered by insurance, at least to some extent, and programs that treat dual diagnosis may include treatment for anxiety, depression, and post-traumatic stress disorder (PTSD).

While in treatment, you may participate in various types of therapy, including individual and group therapy. In addition, your treatment facility may offer cognitive behavioral therapy and dialectical behavior therapy. AvMed may cover all or some of the costs of therapy during addiction treatment.

When choosing a treatment center, Optum recommends finding providers that use evidence-based practices and have a track record of success with clients. Credentials are important, they provide a list of trusted providers.⁴

Some AvMed plans offer limited out-of-network coverage, while others only cover in-network providers. You’ll want to contact the insurer directly to confirm whether out-of-network addiction treatment is included in your plan.⁵

You may find that your AvMed therapy coverage doesn’t cover the complete cost of your rehab program. The insurance program may cover some of the cost but leave you with out-of-pocket expenses as well. If you can’t afford these, there are alternatives. For instance, some programs offer scholarships, or you might be able to get a loan specifically for your treatment costs. Here are some resources that can help:

• How to Pay for Rehab Without Insurance
• Frequently Asked Questions: Paying for Rehab
• How Much Does Rehab Cost? The Cost of Different Addiction Treatment Programs

Knowing exactly what AvMed plans cover can give you peace of mind while you or your loved one is in rehab. You can do the work of getting and staying sober without worrying about unexpected costs or financial struggles. You can use the directories tool to find AvMed addiction rehab. Or, for more information on AvMed insurance plans and to check what your plan covers, call , click here, or fill out the form below.

1. Healthcare.gov. (n.d.). Mental health & substance abuse coverage.
2. AvMed. (2021). AvMed Benefits and Programs.
3. Optum. (2021). What types of treatment programs are available?
4. Optum. (2021). Provider search.
5. AvMed. (2021). Individual and family plans.
6. AvMed. (2021). Login.
7. AvMed. (2021). About us.
8. AvMed. (2021). Summaries of benefits and coverage.
9. AvMed. (2021). Medicare HMO.
10. National Rehabs Directory (2020). What are the different types of addiction treatment programs?

Rehabs.com strives to provide you with the most updated information on each carriers’ addiction insurance coverage, but policy changes and errors do occur. Please check with your insurance carrier directly to confirm coverage levels.