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GEHA Health Insurance Coverage for Drug & Alcohol Rehab

Finding a rehab that accepts Government Employees Health Association, Inc. (GEHA) is important if you are struggling with substance use. With GEHA, you have access to the essential health benefits of marketplace plans, including mental health and substance use disorder treatment.
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If you or a loved one has a GEHA Health plan, you may be wondering if they cover drug and alcohol addiction treatment. Because GEHA offers a wide range of plans, your coverage may depend upon your specific plan. However, GEHA insurance plans should cover at least some of the costs of drug and alcohol rehab. On this page, you will learn about GEHA insurance coverage for substance abuse treatment and how to confirm what benefits are available under your specific plan.

What is GEHA Health Insurance?

Government Employees Health Association, Inc. (GEHA) is a medical benefit provider that exclusively serves current and former federal employees, military retirees, and their families. GEHA provides access to millions of health providers across the country, and it also provides telehealth access.

GEHA Benefits, Plans, and Coverage Levels

If you or someone you love is struggling with a drug or alcohol addiction, you may need to get help from an addiction facility. The right facility will be able to treat you for all your issues and will be able to offer you the level of comfort that you need.

GEHA Health Plans have a cap on the amount of coinsurance and deductibles that their clients have to face each year. Thus, if your plan covers specialty treatment, your out-of-pocket payments will not exceed the following amounts based on your plan:

  • Standard plan in-network: $5,000
  • Standard plan out-of-network: $7,000
  • High option in-network: $4,000
  • High option out-of-network: $6,000
  • HDHP option for individual plans: $5,000
  • HDHP option for family plans: $10,000

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.

Do GEHA Insurance Plans Cover Substance Abuse Addiction Rehab?

When you have a substance use disorder (SUD), treatment incredibly important to help you begin on your path toward recovery. Whether you are dealing with a drug or alcohol addiction, detox and rehab are instrumental in addressing your SUD. You may be wondering whether GEHA insurance plans cover rehab?

The Affordable Care Act (ACA) mandates that almost all health plans in the United States, including GEHA plans, cover at least some of the cost of addiction treatment. This is because rehab is considered to be a substance use disorder (SUD) treatment, which falls under the classification of mental and behavioral health services, which are considered to be an essential health benefit under the ACA.2 Consequently, most insurers must provide coverage in some capacity for this treatment type, as well as coverage for inpatient and residential mental and behavioral treatment and behavioral health services.3

Even if your GEHA Health Plan covers rehab, it may not cover the entire cost. How much is covered may depend upon your coverage type. Coverage may also vary depending upon the type of facility offering your rehab treatment.

What Types of Drug and Alcohol Addiction Treatment Does GEHA Cover?

Depending on the severity of your drug and alcohol addiction, you may require a certain level of addiction treatment. GEHA health may provide coverage for the following addiction treatment programs:5

  • Medical detox: In this program, you will be monitored during the withdrawal phase of your treatment. Clinicians will ensure your safety during this time.
  • Inpatient programs: This includes physician oversight and 24/7 monitoring until you complete the program.
  • Partial hospitalization programs (PHPs): This is a step down from inpatient treatment and includes coming to the facility most days of the week for most of the day. You will return home at night.
  • Outpatient programs: You’ll come to the facility for therapy regularly, usually once or twice a week unless it’s intensive outpatient treatment.
  • Intensive outpatient programs (IOP): These outpatient programs require that you attend treatment programs for longer and more frequent sessions than you would in a standard outpatient program.
  • Aftercare: Aftercare programs support sustained sobriety after more intensive rehab. There are many types of aftercare, including support groups, therapy, and community programs.

GEHA Mental Health Coverage

Mental health care is one of the 10 essential benefits required by the ACA.As a result, you can have confidence that your GEHA coverage will help you with both substance use and mental health needs.

It’s very common to have both a mental health diagnosis and an SUD, a situation known as a dual diagnosis. There are many common mental health concerns that are dually diagnosed with substance use disorder, including depressionanxiety, bipolar disorderattention-deficit hyperactivity disorder (ADHD), co-occurring disorders, personality disorders, and more.4

While being treated for dual diagnosis, you may participate in various types of therapy, including dialectical behavior therapy and cognitive behavioral therapy.

It’s important to treat your mental health concerns and your substance use at the same time since they often affect each other. Integrated treatment for both problems at once has been consistently shown to have a better outcome than treating only one issue or the other.Choosing a treatment facility that specializes in dual diagnosis can help you get the treatment you need.

Which Addiction Rehab Centers Take GEHA Insurance?

There are American Addiction Centers (AAC) rehabilitation facilities located throughout the United States, and some of them might work with GEHA to provide you with substance use treatment. As you familiarize yourself with your health insurance coverage through GEHA, take some time to think about which facility is going to work best for you. Some of AAC’s facilities include:

  • AdCare Rhode Island: Situated in Rhode Island, AdCare Rhode Island specializes in medically monitored withdrawal management, crisis stabilization, an outpatient program, and a complimentary informational session for families of those seeking treatment.
  • Desert Hope Treatment Center: This Nevada-based treatment center features individual and family therapy, medical detox, aftercare, and substance abuse programming specific to veterans and first responders.
  • Greenhouse Treatment Center: Based in Grand Prairie, Texas, Greenhouse Treatment Center features a family program, individualized treatment, medical detox, and treatment for co-occurring disorders.
  • Laguna Treatment Center: Laguna Beach is not too far away from Laguna Treatment Center, which utilizes 12-Step involvement, offers a family program and individualized treatment, and follows up with aftercare support.
  • Oxford Treatment Center: Located in Etta, Mississippi, Oxford Treatment Center has residential treatment (both short- and long-term), individualized treatment, medical detox, and a family program.
  • River Oaks Treatment Center: River Oaks Treatment Center is located near Tampa, Florida. This facility is home to addiction-focused healthcare in its inpatient residential program and outpatient therapy. A family program, medical detox, and aftercare support are also available as part of your treatment.

You can use our directory and filter by “insurance” to locate in-network facilities close to you if AAC is not in-network for you. There are rehabs near me that can provide the treatment you need. Check out the directory to find a list of other facilities and programs.

Addiction Treatment Length GEHA Health Plans Will Cover

Your GEHA Health Plan may only cover a certain amount of time in treatment. Some plans may cover the entire length of your treatment program while other plans may only cover a fraction of the duration of your treatment program. Length of stay at a drug and alcohol addiction treatment facility may be 30 days, 60 days, 90 days, or even longer.

If you are worried about whether GEHA will be private about your rehabilitation treatment, you should rest assured that your medical care will be confidential and that the billing for your care will be discreet.

Do Addiction Treatment Centers Need to Be In-Network?

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 facility that is in-network with GEHA. 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 Should I Do if GEHA Won’t Cover the Total Cost of Drug and Alcohol Rehab?

If you find that GEHA does not cover the type of rehab services you need, there still may be options for you to get treatment. Check with the facility you plan to go to and ask whether they have a payment plan arrangement. They may also offer financial aid, discounts, or sliding scale fees. To help pay for any amount not covered by insurance, you can arrange a loan from friends and family or take out a personal loan. Be sure to check all the different options because taking care of your health is of the utmost importance.

You can use your GEHA insurance plan to take advantage of getting addiction care today. To start on your path toward recovery, contact one of our admissions navigators; they will provide you with the information and support that you need.

Checking Your GEHA Health Plan Insurance Benefits

Knowing exactly what GEHA 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. For more information on GEHA insurance plans and to check what your plan covers, call , click here, or fill out the form below.

More Questions About GEHA Health Plans Insurance Coverage for Drug & Alcohol Rehab?

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Alternatively, you can visit our Frequently Asked Questions page.

Insurance Providers and Rehab Treatment Coverage Levels

Sources

  1. GEHA. (n.d.). Why GEHA?
  2. Healthcare.gov. (n.d.). Mental health & substance abuse coverage.
  3. Healthcare.gov. (n.d.). What Marketplace health insurance plans cover.
  4. National Institute of Mental Health. (n.d.). Substance Use and Co-Occurring Mental Disorders.
  5. National Institute on Drug Abuse. (2020, April). What are the treatments for comorbid substance use disorder and mental health conditions?
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