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QualCare Insurance Coverage for Drug & Alcohol Rehab

Seeking addiction treatment is easier if you understand your healthcare benefits. On this page, we’ll explain how QualCare health plans cover substance abuse rehab. You’ll also learn how to find out what type of addiction treatment coverage you can expect with your insurance and more.


Does QualCare Cover Addiction Treatment?

When the Affordable Care Act (ACA) was passed, it mandated that all insurance policies include coverage for substance addiction treatment at a level equal to coverage provided for other medical conditions.1 This means that you can expect your QualCare mental health coverage to include substance abuse treatment benefits and coverage for treatment for other mental health disorders.1 However, QualCare may only cover some of the cost of drug and alcohol rehab, so make sure to check your insurance plan to see what is and is not covered.

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 QualCare Rehab Coverage

Of course, it’s best to know exactly what your insurance benefits will cover because all plans vary in what they cover. When you understand what QualCare covers, you will have peace of mind about going to rehab for drug or alcohol addiction treatment. Find out the answer to this question now by calling , clicking here, or filling out the form below.


What Are the Coverage Levels and Plans for QualCare?

QualCare offers healthcare solutions for individuals and families with providers and facilities in New Jersey, New York City, and Philadelphia.3 QualCare health has the following plans available:

  • Open Access Plan: With this plan, members can receive care from specialists without relying on a primary care physician (PCP) or referrals. Certain visits or treatments may require pre-authorization, however.
  • HMO Network: With an HMO, your primary care physician will assist with coordinating your healthcare and you will need a referral for specialty care. Also, you will stay primarily within the network of providers in the group.
  • Point of Service (POS): Members can receive services from both in-network and out-of-network providers.
  • Preferred Provider Organization (PPO): Members can choose providers either in or out of the network but will have to pay extra costs to see out-of-network providers.
  • Third-Party Administration (TPA): If you want to use self-insurance, QualCare can serve as a third-party administrator.

Do Rehab Centers Need to Be In-Network to Accept QualCare Insurance?

In-network rehab centers have a contract with QualCare. They’ve agreed to provide care at a discounted price, so you won’t have to pay as much for services. QualCare provides access to numerous providers from which to select.

Certain types of plans, as mentioned above, allow you to choose a provider who is not in the network, but you might have to pay some extra costs for services.6


What Different Types of Addiction Treatment Does QualCare Cover?

Several levels of treatment are provided during your rehab recovery journey. Treatment types that may be covered through your QualCare benefits include:2,7

  • Detox: Most treatment programs begin with a detoxification phase. Detox helps you during the initial phase of withdrawal from whatever substance to which you were addicted by helping clear the substance from your body while managing discomfort, pain, or more potentially dangerous risks.
  • Inpatient treatment is an intensive program and requires you to live in the treatment facility. You’ll receive assistance with detox along with counseling and coping skills that will help you when you return to your day-to-day life.
  • Outpatient treatment allows you to live at home and continue to work and manage your daily responsibilities while still receiving help with recovery. You’ll attend treatment for several hours a week.
  • Partial hospitalization programs (PHPs) have you spend all day in the treatment program but go home at night. You can expect to be in treatment for 4–6 hours each day, 5 days a week.

The type of treatment program that’s right for you will depend on your background, the substances you use, and how long you’ve struggled with addiction.10


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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