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Oscar Health Insurance Coverage for Drug and Alcohol Rehab

Oscar Health provides health care to nearly 530,000 people in 19 states. If you have an Oscar Health plan, drug and alcohol rehab treatment should be at least partially covered by your insurance policy. You can learn more about your specific coverage by calling the number on the back of your card or verifying your insurance below.

What Is Oscar Health Insurance?

Oscar Health was founded in 2012 and launched its first individual health plans in 2014.1 Oscar began offering plans in the small group health insurance market in 2017 and Medicare Advantage plans in 2020.1 As of 2021, Oscar provides insurance to covered members across 19 states:2

  • Arizona
  • California
  • Colorado
  • Florida
  • Georgia
  • Illinois
  • Iowa
  • Maryland
  • Michigan
  • Missouri
  • Nebraska
  • New York
  • North Carolina
  • Ohio
  • Oklahoma
  • Pennsylvania
  • Tennessee
  • Texas

Oscar plans include Platinum, Gold, Silver, and Bronze, each of which offers a different level of coverage, in addition to providing coverage in some capacity for essential health benefits.3

  • Platinum: These plans provide the highest level of coverage, with Oscar covering 80% of costs and members covering the remaining 20%.3 Platinum plans have the lowest deductible option, but the highest monthly premium and may be best for members who are having a major procedure, managing a chronic condition, or taking multiple brand-name medicines.3
  • Gold: These plans also provide a high level of coverage but are not as comprehensive as a Platinum plan. Gold plans have higher premiums and lower deductibles, and Oscar covers 80% of costs while members cover the remaining 20%.3
  • Silver: These plans offer moderate levels of coverage, with moderate premiums and deductibles. They are often a good option for members in generally good health who are not expecting to need high levels of care. Oscar covers 70% of costs with silver plans, and members cover the remaining 30%.3
  • Bronze: These plans offer the lowest level of coverage and have low premiums but higher deductibles.3

Oscar also offers a Medicare Advantage plan in certain parts of the country to Medicare-eligible individuals.4

Does Oscar Health Cover Drug and Alcohol Rehab Treatment?

Like many other health plans in the U.S., Oscar Health plans are legally required by the Affordable Care Act (ACA) to provide some level of coverage for mental and behavioral health services, including drug and alcohol rehab.5,6 This means that if you have an Oscar Health plan, you may be able to have your rehab covered under your insurance.

Several treatment types may be covered by your Oscar Health insurance plan, including:7,8

  • Medical detox: Sometimes a patient’s continuum of care includes medical detox, although it is not always necessary. In medical detox, a patient is under supervision to help manage withdrawal symptoms, which can range in duration and intensity.
  • Inpatient program: Inpatient rehab provides intensive, structured therapy in a home-like setting, providing patients the resources they need to manage their addiction. Inpatient rehab can range from a few days to weeks or months.
  • Outpatient program: With outpatient rehab, patients live at home and attend treatment during the day. Outpatient rehab includes several therapies, including individual and group counseling.
  • Intensive outpatient program (IOP): IOPs typically involve a patient receiving treatment for addiction and recovery for a set number of hours to provide more support than standard outpatient rehab.
  • Partial hospitalization program (PHP): For patients who need more support than standard outpatient programs provide, a PHP may be recommended. In a PHP, patients receive care for several hours per day and return home in the evening.
  • Aftercare: Aftercare programs provide ongoing counseling or treatment after attending rehab. The goals of aftercare programs are to help patients maintain recovery.

Check Your Oscar Health Rehab Coverage

Finding a rehab program that is in-network with your Oscar Health plan can be overwhelming. The good news is, insurance typically covers some of, if not all, the cost of rehab. Knowing what is and isn’t covered can give you peace of mind. You can call the number on the back of your insurance card, verify your insurance online, or fill out the form below to check your coverage.

What Rehab Centers Take Oscar Health Insurance?

If you would like to know whether your Oscar Health plan may cover the full or partial cost of treatment at an American Addiction Centers (AAC) rehab center, you can check your coverage online, sign up for text support, or contact us at 24 hours a day.

Do Rehab Centers Need to Be In-Network?

Depending on your Oscar Health plan, you may need to choose an in-network provider for coverage to kick in. An in-network provider is one under contract with your Oscar Health plan to provide care.9 Generally, care received at in-network providers is more affordable than care obtained at out-of-network providers, because out-of-network providers are not contracted with your insurance company. Keep in mind if you cannot find an in-network rehab center, you still have options such as grants, loans, payment plans, scholarships, and more.

Does Oscar Health Cover Mental Health Treatment?

Yes, Oscar Health covers mental health treatment for members. The ACA’s essential health benefits mandate requires almost all health plans to cover mental and behavioral health services, which include substance use disorder (SUD) treatment, inpatient mental and behavioral health treatment, and behavioral health services treatment, in some capacity.5,6 This means that you may be able to attend stand-alone rehab for a mental health disorder or substance use disorder, or rehab for a co-occurring disorder, with a limit on your out-of-pocket costs.

Beyond the ACA’s mandates, Oscar Health takes it one step further to ensure covered individuals can prioritize their mental health. Oscar Health provides covered plan recipients with access to talk therapy, group counseling, inpatient and outpatient rehab, and coverage for medications.10 Those who have individual/family Marketplace plans and Medicare Advantage plans may also enjoy a wider mental health provider network, making it easier to get the care you need.10

Does Oscar Health Cover Private and Luxury Rehabs?

There are times when private rehab or luxury rehab might be the best option for your needs. These programs may come at a higher cost, but your Oscar Health insurance may provide some coverage. Whatever rehab you choose, verifying your benefits ahead of time can help you know what to expect in terms of coverage.

How Much of the Rehab Cost Does Oscar Health Cover?

Oscar Health coverage varies depending on the specific plan you have and the treatments you receive. Generally, health insurance provides financial protection when you need to access healthcare, including addiction treatment. In addition to your monthly premium, you may also be responsible for additional costs such as a deductible, copayment/coinsurance, and an out-of-pocket maximum.11

What Should I Do if the Cost of Rehab Is Not Fully Covered?

In some cases, the cost of attending rehab may not be fully covered under your Oscar Health plan, but you shouldn’t let this deter you from getting the care you need. Seeking treatment for drug or alcohol use is a priceless investment in yourself. If the cost of treatment isn’t covered, there are several options to help pay for your out-of-pocket expenses such as crowdfunding, fundraising, loans, payment plans, and scholarships.

Learn More About Your Options for Drug and Alcohol Rehab

AAC is dedicated to helping those struggling with addiction connect with the treatment programs and rehabs that can help them. If you want to learn more about addiction treatment or have questions about your Oscar Health coverage, contact us at to speak to an admissions navigator.

 

More resources about Oscar Health Insurance Coverage for Drug and Alcohol Rehab: