Prominence Health Plan Coverage for Drug and Alcohol Rehab

Prominence Health Plan is an insurance company providing a variety of health plans, including employer-sponsored group health insurance, Medicare Advantage, and self-funded administrative services.¹ Operating in Florida, Nevada, and Texas, Prominence Health Plan offers coverage for employers and individuals.¹

For eligible individuals, Prominence Health Plan offers Medicare Advantage (also referred to as Medicare Part C).² Medicare Advantage can help eligible individuals obtain Part A, Part B, and Part D Medicare coverage. However, plan designs can vary, so it’s important to review what options may be available to you.³

Prominence Medicare Advantage plans include:⁴

• $0 premiums.
• $0 primary care provider appointments.
• $0 virtual visits.
• $0 lab tests.
• $0 prescription medications.
• Dental, vision, and hearing aid coverage.
• Over-the-counter medications.
• Fitness perks.

Other employer-sponsored plans may include:^5,6,7

• Health maintenance organizations (HMO): With this type of plan, members typically must receive care from providers in-network to use their coverage plan.
• Preferred provider organizations (PPO): This type of plan presents cost savings to those who use doctors, hospitals, and other facilities within the plan’s network. Members can typically receive care outside the network at a greater cost.
• Point-of-service (POS): These plans combine the lower costs of an HMO plan with the flexibility of a PPO; Prominence POS plans operate with a three-tier benefits package.
• High deductible: High deductible health plans have low premiums but a high annual deductible. They can help employers manage high health care costs while offering flexibility to employees.

Your Prominence Health Plan will provide coverage that is specific to your health plan details. However, under the Affordable Care Act (ACA), there are essential health benefits that health plans in the United States must cover.⁸ One essential health benefit is mental and behavioral health, which means that drug and alcohol rehab treatment may be partially or fully covered under your PHP health insurance.⁹

Coverage specifications vary based on your plan, your location, and the facility at which you receive care. Be sure to talk to an insurance representative to confirm your coverage details before seeking treatment whenever possible to avoid surprise medical bills.

Several treatment types may be covered by your Prominence Health Plan, including:

• Medical detox: Medical detox is often the first step in addiction treatment. In this treatment, medical staff provides medication and support to mitigate withdrawal symptoms, helping a patient rid their body of a substance safely.
• Inpatient programs: Also referred to as live-in or residential programs, inpatient rehab involves a patient staying overnight in a facility for any number of days, weeks, or months to receive around-the-clock care and support in overcoming their addiction.
• Outpatient programs: With standard outpatient rehab, a patient comes to a facility a few times a week to receive care while living at home.
• Intensive outpatient programs: Typically designed for those who are transitioning out of inpatient care but still need more support, IOPs often involve a patient receiving treatment around 3 times a week for 2 to 3 hours each treatment session.
• Partial hospitalization programs: These programs are also referred to as day programs and involve patients meeting 5 to 7 times a week for several hours of the day to receive both medical and non-medical rehab treatment.
• Aftercare: Aftercare programs are designed to help patients maintain recovery by finding ways to prevent relapse and achieve a fulfilling life free from substance use. Aftercare may include ongoing counseling or treatment after attending inpatient or outpatient rehab.

The ACA mandates coverage for mental and behavioral health services in some capacity.⁹ Specifically, most health plans must provide some level of coverage for treatment of substance use disorders (SUDs), inpatient mental and behavioral health services, psychotherapy, and counseling.⁹

This mandated coverage makes it possible for those who need both stand-alone and co-occurring treatment to get the care they need. For the millions of Americans with co-occurring substance misuse and mental health disorders, treating both disorders may be an effective path to recovery.¹⁰ The ACA’s mandate helps make that possible by requiring that plans cover the cost of care.

What Rehab Centers Take Prominence Health Plan Insurance?

Finding a rehab center that takes your insurance policy can make it easier when accessing treatment and can provide comfort knowing that you are financially secure while you focus on your recovery. American Addiction Centers has rehab centers across the U.S. including the Desert Hope Treatment Center. Located in Las Vegas, Nevada, Desert Hope Treatment Center provides individualized rehabilitation treatment.

Do Rehab Centers Need to Be In-Network?

To ensure that your addiction treatment is at least partially covered by your Prominence Health Plan, it’s a good idea to select a rehab facility that is in-network. In-network simply means that your insurance company has a contract with the rehab. This generally translates to lower health care costs for you. If your plan does happen to cover out-of-network providers, it will likely do so at a lower rate, resulting in higher health care costs for you.

Does Prominence Health Plan Cover Private and Luxury Rehabs?

Some patients may prefer facilities with specific amenities such as private rehab or luxury rehab. These programs often come at a higher cost, but your Prominence Health Plan may provide some coverage. Whatever rehab you choose, verifying your benefits ahead of time can help you know what will and will not be covered.

How Much of the Rehab Cost Does Prominence Health Plan Cover?

How much of rehab is covered by your Prominence Health Plan will vary on several different factors, including your selected plan, where you live, the extent of care you need, and where you receive that care. Verifying your benefits ahead of time with your insurance company or rehab center can make a big difference in determining what your out-of-pocket costs—if any—will be.

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

Your health plan may not cover the cost of rehab, but you shouldn’t let this deter you from seeking treatment. If the cost of treatment isn’t covered, there are other options to help pay for your out-of-pocket expenses including crowdfunding, fundraising, loans, payment plans, and scholarships. Many facilities also offer sliding scale options which can help cover the cost of treatment.

Check Your Prominence Health Plan Coverage

Finding a rehab center to meet your unique needs and that is in-network with your Prominence Health Plan can feel overwhelming. The good news is, several rehabs may cover some, if not all, of the cost of rehab. Knowing exactly what is covered can provide you peace of mind so you can focus on what matters.

American Addiction Centers is dedicated to helping individuals struggling with drug or alcohol addiction connect with treatment programs and rehabs that can help them. To learn more about what your Prominence Health Plan covers, you can call the number on the back of your insurance card, verify your insurance online, or fill out the form below.

1. Prominence Health Plan. (n.d.). About us.
2. Prominence Medicare Advantage. (n.d.). Prominence Medicare.
3. Healthcare.gov. (n.d.). Medicare Advantage Plans.
4. Prominence Medicare Advantage. (n.d.). Find a great plan in your area.
5. Prominence Health Plan. (n.d). Plan options.
6. Healthcare.gov. (n.d.). Health insurance plan & network types: HMOs, PPOs, and more
7. Healthcare.gov. (n.d.). High deductible health plan (HDHP).
8. Healthcare.gov. (n.d.). Essential health benefits.
9. Healthcare.gov. (n.d.). Mental health & substance abuse coverage.
10. National Institute on Drug Abuse. (2018). Comorbidity: Substance use and other mental disorders.