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EmblemHealth Insurance Coverage for Drug & Alcohol Rehab

EmblemHealth is a not-for-profit health insurer that provides insurance plans to more than three million people in the New York tristate area.1 EmblemHealth includes ConnectiCare, AdvantageCare Physicians, WellSpark under its umbrella of companies.1

If you have EmblemHealth insurance and are looking for drug and alcohol addiction treatment, you likely have some questions about what is covered by your insurance policy and what out-of-pocket expenses you can expect. Does EmblemHealth cover addiction treatment? The quick answer is yes; EmblemHealth will cover at least some of your addiction treatment but read on to learn more about EmblemHealth’s coverage of substance use disorders (SUDs).


Does EmblemHealth Cover Addiction Treatment?

Does EmblemHealth cover addiction treatment? Yes, EmblemHealth does provide at least some coverage for inpatient and outpatient alcohol and substance abuse treatment services, although the amount of coverage 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 Affordable Care Act (ACA) requires that insurance companies provide some degree of coverage for mental health treatment, which includes substance use disorder (SUD) treatment (including coverage for drug and alcohol addiction), so EmblemHealth does cover addiction treatment.2 EmblemHealth insurance may cover a part of the cost of a rehab program, if not all of it.

When seeking rehabilitation from an addiction to drugs or alcohol, it’s always important to check with your insurance provider to see what’s covered under your plan. 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.

Check Your EmblemHealth Rehab Coverage

It’s always best to be sure about what your healthcare benefits entail. You don’t want to be caught by surprise with unexpected financial costs. You may wonder if EmblemHealth covers alcohol and drug rehab, and the only way to really have the answer is to check your EmblemHealth health plan coverage.

Knowing exactly what EmblemHealth plans cover can give you peace of mind while you or your loved one is in substance abuse recovery program. You can do the work of getting and staying sober without worrying about unexpected costs or financial struggles. You can check your EmblemHealth coverage by calling , click here, or fill out the form below.


What Different Types of Addiction Treatment Does EmblemHealth Cover?

Getting the proper addiction treatment is essential for your recovery effort. The type of treatment plan you need will depend on the severity of your addiction and where you are in the journey to well-being. You might start out at one level of treatment and work way to another level, then continue until you don’t need treatment.

Some of the treatment programs you can expect to be covered through EmblemHealth include:7,8

  • Detox services: In some cases, you may need assistance when detoxing from drugs and alcohol, which can potentially be uncomfortable, painful, or even life threatening. Medical detox helps you safely withdrawal from drugs and alcohol, as you’ll receive around-the-clock medical supervision. You might also be given medications to help minimize withdrawal symptoms.
  • Inpatient or residential care: Inpatient/residential live-in treatment centers provide drug and alcohol rehab while you live onsite at the facility. Most inpatient programs last anywhere from 15–90 days, depending on the program you’re in and your individual needs.
  • Partial hospitalization (PHP): Partial hospitalization programs give you the opportunity to live at home while attending treatment during the day.
  • Intensive outpatient program (IOP): Intensive outpatient programs involve attending treatment programs a few evenings a week. In an intensive outpatient program, you can live at home and even go to work during the day.
  • Outpatient treatment: Individuals who have completed inpatient treatment often attend outpatient treatment for ongoing support on their journey to sobriety. You live at home and spend 10–12 hours a week at the treatment facility for therapy and support.

Do Rehab Centers Need to Be In-Network To Accept EmblemHealth?

In-network providers have a contract with the insurance carrier to offer services at a set price. This means that your out-of-pocket expenses will typically be lower than if you choose an out-of-network facility. In some cases, you may even be responsible for the full cost of rehab if you choose an out-of-network facility.

Whenever possible, try to choose a rehab treatment facility that is in-network with EmblemHealth. If you are unable to find an in-network provider or prefer a facility that is out-of-network, you may be able to work out a payment plan with the facility so you can pay back the cost of treatment over time.

What Are the Insurance Coverage Levels and Plans for EmblemHealth?

EmblemHealth’s health plans vary depending on if the plan is standard or non-standard. Plans include the following:3

  • EmblemHealth Platinum: This plan is best for those who need care frequently. Deductible: $0 individual/$0 family.
  • EmblemHealth Gold: This plan is best for those who need care frequently but want to pay a lower price. Deductible: $600 individual/$1,200 family.
  • EmblemHealth Silver: This plan is best for those who go to the doctor for regular visits. Deductible: $1,300 individual/$2,600.
  • EmblemHealth Bronze: This plan is best for those who don’t go to the doctor often and want to save money. Once the deductible is met, Emblem pays half of covered benefits. Deductible: $4,700 individual/$9,400 family.

In addition to those plans, EmblemHealth also has additional plans including:4-6

  • Enhanced Care: This plan is EmblemHealth’s state-sponsored Medicaid Managed Care plan. There is no monthly premium payment. Eligibility factors may include low-income children, families, and individuals; pregnant people; people with disabilities.
  • Medicare Advantage and Medicare Part C: These plans are meant to provide personalized and affordable healthcare for some people including those 65 and older and some younger people with disabilities. Plans include EmblemHealth VIP Value, VIP Essential, Part B Saver, and VIP Go.

American Addiction Centers (AAC) 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.


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