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Priority Health Insurance Coverage for Drug and Alcohol Addiction Rehab

Looking for drug or alcohol addiction rehab can be overwhelming. Fortunately, Priority Health plans typically cover all or a portion of drug and alcohol detox and treatment costs. To verify the details of your insurance plan, call .
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Priority Health Insurance Coverage for Drug and Alcohol Addiction Rehab

Priority Health Insurance offers coverage for a range of healthcare services, including mental health and substance use disorder treatment. If you or a loved one are struggling with drug or alcohol addiction and seeking treatment, Priority Health Insurance may be able to help cover some or all of the cost of rehab.

In this article we’ll talk about what Priority Health Insurance is, addiction rehab and treatment coverage, the types of plans and levels of care they offer, rehab facilities that accept Priority Health Insurance, and how to verify your health insurance coverage for treatment.

What Is Priority Health?

Priority Health is a nonprofit health benefits company that works to improve the health and lives of one million members across Michigan.1 It is one of the largest health plans in Michigan and offers health insurance plans for individuals, families, employers, and Medicare and Medicaid plans for those who qualify.1

Priority Health Insurance Plans

Priority Health offers various insurance plans based on where the individual lives, the types of coverage they are looking for, and the type of policy they are seeking. Priority Health insurance providers are separated into two tiers (Tier 1 and Tier 2); the main categories of Priority Health insurance plans include:2-5

  • PPO plans: PPOs allow members to seek care from out-of-network providers (usually at a higher cost than in-network providers) and to schedule appointments without PCP referrals.
  • HMO plans: Members must receive care from in-network providers and choose a primary care physician (PCP) to coordinate their care.
  • POS plans: A mix between an HMO and a PPO, POS plans have members select a PCP within a specified network for healthcare, though members can choose to seek care outside of the network if they are willing to pay higher costs.
  • Medicare plans: Mostly for individuals aged 65 and older and those with certain disabilities, Medicare plans are government-funded.
  • Medicaid plans: Medicaid plans are government-funded and are primarily available to low-income individuals, the elderly, children, pregnant women, and those with disabilities. 

Does Priority Health Insurance Cover Addiction Treatment?

In most cases, at least a portion of drug rehab services and expenses related to addiction treatment should be covered under a Priority Health Insurance plan. The Affordable Care Act (ACA) requires that most insurance policies—including government-funded plans (Medicaid and Medicare) and Health Insurance Marketplace plans—cover SUDs to some extent.6,7

Coverage may vary between Priority Health plans, but treatment for alcohol and drug rehab may be delivered at a variety of levels, such as outpatient, intensive outpatient, and inpatient. The plan you have will dictate the level of coverage you have, meaning how much you will be responsible for paying in out-of-pocket costs such as co-pays and deductibles. Always check to make sure the program or provider that you are considering accepts your Priority Health plan.

What Length of Addiction Treatment Will Priority Health Cover?

The length of addiction treatment will vary based on the substance of misuse, how long the substance has been misused for, and if the individual has co-occurring disorders. A typical length of stay may be 30 days, 60 days, or 90 days. Longer treatment times are generally considered most effective, even though each patient’s individual needs vary.

Because there are many different types of policies and tiers of coverage, the length of time covered by your Priority Health insurance policy will depend on your specific plan. You can look up your plan information online or call the number on the back of your insurance card to learn more about what your specific plan covers for drug and alcohol rehab.

Types of Addiction Treatment Covered By Priority Health

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 treatment process.

Some of the treatment programs that may be covered by Priority Health include:

  • Detox: During a detox program, clinicians will assist you as you go through the withdrawal stage of recovery. Medically managed detox ensures that you are comfortable and safe as you go through any uncomfortable, painful, or potentially dangerous withdrawal symptoms.
  • Inpatient treatment: Inpatient rehab is also known as a “residential program” since patients will stay overnight and be under medical supervision.
  • Partial hospitalization program (PHP): A partial hospitalization program provides therapy and treatment most days of the week for several hours a day.
  • Outpatient therapy: Outpatient rehab may be intensive or just once a week, depending on your situation. It allows you to obtain treatment while living at home.
  • Intensive outpatient program (IOP): An intensive outpatient program involves attending a treatment program a few nights each week. In an IOP, patients can live at home while they maintain their work and school schedules.
  • Aftercare: Any continuing or follow-up care (upon completion of inpatient or outpatient treatment) is considered aftercare. This may include outpatient care, sober living, support groups, and/or behavioral therapy.

Addiction Rehab Facilities that Take Priority Health Insurance

Under all Priority Health plans, specialist treatment visits are covered. So, if an individual needs treatment for an SUD, it will be classified as a “specialist visit.” Additionally, if you have Medicare, there may be additional options. There are rehab facilities around the country that accept Medicare for coverage of alcohol or drug addiction treatment.

American Addiction Centers (AAC) has AdCare treatment centers that accept Medicare. AdCare provides an integrated system of care with a nationally recognized hospital facility in Worcester, Massachusetts, an inpatient treatment center in North Kingstown, Rhode Island, and a network of outpatient offices located throughout Massachusetts and Rhode Island.

American Addiction Centers also runs the following treatment centers:

There are various treatment programs for individuals struggling with drug or alcohol addiction, so don’t give up if the first program you check out doesn’t meet your individual needs. There are a number of rehab facilities that can provide the treatment you need. Using our rehab directory can help you identify these facilities and programs–simply search by location and filter by public or private insurance

How to Pay for Out-of-Pocket Costs Not Covered by Priority Health

If your Priority Health insurance policy does not cover all your rehab expenses, it’s important not to let that stop you from getting treatment. You don’t have to use insurance when you decide to check into rehab. The total of these out-of-pocket costs can vary based on many factors, but some treatment programs may have one or more options to help you afford recovery help, such as:

  • Payment plans: Rehab programs may offer payment plans where you arrange to spread out the total cost over regular payment installments, to make the financial burden more manageable. Be sure to look at interest rates and other details of the plan.
  • Sliding fee scale: Programs may offer a sliding fee scale, where the treatment costs will vary based on the individual’s income—if you make less money, you will have lower costs. This may only be an option if you pay entirely out-of-pocket.
  • Scholarships: Programs may offer rehab scholarships where you can potentially receive treatment at a discounted cost or no cost at all.

Make sure to do thorough research when looking for treatment so that you can find one that meets your financial needs. There are also low-cost and no-cost/free treatment options for those who qualify.

Here are additional resources that can provide more information about other ways to pay for rehab with or beyond what Priority Health covers:

Verify Your Priority Health Rehab Coverage

Before deciding on a rehab center, check your Priority Health policy benefits to determine which costs will be covered by your insurance plan and which will be out-of-pocket for you. You can call the phone number on your insurance card or log in to your account on Priority Health’s website to determine how much you may need to cover in terms of copays and any deductible that must be reached before coverage kicks in for the services you need.

Knowing exactly what Priority Health plans cover alcohol and drug addiction treatment 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 Priority Health plans and to check what your plan covers, call , check your insurance, or fill out the form below.

Sources

  1. Priority Health. (n.d.). About us.
  2. Priority Health. (n.d.). Priority Health insurance plans.
  3. Priority Health. (n.d.). Small business health insurance: West MI Partners brochure.
  4. Priority Health. (n.d.). Small business health insurance: Southeast MI Partners brochure.
  5. U.S. Centers for Medicare and Medicaid Services. (n.d.). Get started with Medicare.
  6. Abraham, A. J., Andrews, C. M., D’Aunno, T., Friedmann, P. D., Grogan, C. M. & Humphreys, K. N., (2017). The Affordable Care Act Transformation of Substance Use Disorder TreatmentAmerican journal of public health, 107(1), 31–32.
  7. Centers for Medicare and Medicaid Services. (n.d.) The Mental Health Parity and Addiction Equity Act (MHPAEA).
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