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Tufts Health Plan for Addiction Treatment

Choosing to get help and live a chemical-free life is a courageous step. The best thing about it is that you don’t have to do it alone. Many people wonder if their health insurance coverage can help with their recovery. Specifically, does Tufts Health Plan cover drug rehab?

The good news is that your healthcare coverage will have some benefits for addiction treatment and mental health. When the Affordable Care Act (ACA) was passed, it defined addiction and mental health coverage as essential benefits. This means that every long-term health plan must include at least some coverage for these programs.1 Knowing how to use your Tufts health plan for addiction treatment is an essential part of getting the help you need. This page aims to help you understand your healthcare benefits and how they apply to treatment programs.

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.


Does Tufts Health Plan Cover Addiction Treatment?

What kind of addiction treatment coverage can you get from your Tufts health plan? Tufts has partnered with Spectrum Health Systems to administer their substance use disorder (SUD) care.2

The plan specialists are available to help you find the treatment you need and encourage you to choose a treatment program near where you live. The coverage includes office visits, medications, and treatment programs.

How much coverage you receive from your Tufts health plan for rehab will depend on the specific insurance plan you have. Some options will include benefits both in-network and out-of-network, while others require you to stay within the Tufts network of providers.


How to Check Your Insurance Benefits?

Knowing exactly what your benefits are when it comes to your Tufts Health Plan mental health coverage is a vital part of getting the care you need. Fortunately, it’s easy to find out what your health insurance will cover. You can check your insurance benefits by logging in to your online Tufts Health Plan account. Through your account, you can review your insurance plan, check benefits, make payments, and more.4

You can also call Tufts directly using the telephone number on your ID card, or by looking up the appropriate phone number depending on your plan type.5 To get direct information about treatment options, you can also call Spectrum Health Systems and let them know you have a Tufts Health Plan.

Knowing your Tufts treatment coverage 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 Tufts plans and to check what your plan covers, call , click here, or fill out the form below.


What Are the Coverage Levels and Plans for Tufts Health Plan?

Tufts offers health plans in Massachusetts and Rhode Island. You might get your Tufts Health Plan through your employer, or you might qualify for coverage through Medicaid.6 In Massachusetts, you can also get health insurance plans through Massachusetts Health Connector, and you can review the Medicare Advantage plans offered through Tufts as well.

Tufts offers a variety of plan types.

  • Health Maintenance Organizations (HMOs): HMOs require a primary care physician (PCP) to coordinate care. These plans are less expensive and will offer coverage only for in-network providers.
  • Preferred Provider Organization plans (PPOs): PPOs have higher monthly premiums but give you the freedom to seek care from any doctor without a referral from a PCP. You can also receive out-of-network care, but you will pay higher out-of-pocket costs.
  • Advantage HMO and PPO plans through Tufts have a lower monthly premium but higher deductibles that must be met before the insurance company offers coverage.
  • Medicaid: Lower-income individuals and families may qualify for Medicaid coverage through MassHealth or Rhode Island Medicaid. You’ll get all the state Medicaid coverage benefits and may get extra coverage including eye care and specialist visits.7
  • Medicare Advantage: Massachusetts seniors might decide to purchase the Tufts Medicare Advantage Plan. This all-in-one alternative to Original Medicare offers an HMO style of coverage with additional benefits that Original Medicare doesn’t include. However, coverage only applies within the Tufts network.8

What Different Types of Addiction Treatment Does Tufts Cover?

Tufts’ health plans offer coverage for a wide range of addiction treatment options. They use an evaluation by a behavioral health specialist to determine which type of treatment makes the most sense for your situation. Options include inpatient, residential, medication-assisted, and outpatient treatment plans.9

  • Inpatient treatment may include detox and may transition to a residential treatment setting where you live at the treatment facility. You’ll receive intensive individual and group counseling and learn coping strategies to manage life without abusing substances.
  • Outpatient treatment allows you to live at home but spend several hours a week at the treatment facility. This may allow you to continue to work or go to school while attending treatment.
  • Partial hospitalization programs allow you to spend 4-6 hours a day at the treatment facility, 5 days a week, and go home at night. These programs are more intensive than outpatient treatment but less disruptive than living at a facility.

Do Treatment Centers Need to Be In-Network?

When you contact Tufts or Spectrum Health Systems for addiction treatment options, they will encourage you to find care close to home. This makes it more likely that the treatment they recommend will be in their network of providers.

The Tufts Health Plan has a broad network of contracted facilities, programs, and specialists throughout their covered areas. The staff can help you find the programs and services that you need.3

If you can’t find the Tufts therapy coverage you need in the network, Tufts specifically states they will help you access the care you need and get the best coverage available for that treatment. Keep in mind that certain types of insurance plans have more coverage outside the network than others.


What Should I Do if Tufts Health Plan Won’t Cover the Total Cost of Rehab?

While all health insurance plans have to include some treatment for addiction treatment, the benefits won’t necessarily cover 100% of the cost. Fortunately, there are other ways to pay for rehab. You might be able to check with the treatment program you’ve chosen to find out if they have scholarships or alternate payment arrangements. Or, you could take out a personal loan specifically for your treatment.

Here are some resources that can help you determine how to afford the treatment you need:

Choosing to get treatment for addiction is courageous, and we know you can succeed. With your Tufts health plan, you can receive coverage for your treatment program. If the coverage isn’t enough, there are alternative ways to pay for treatment. Either way, it’s essential to get the help you need to live a long, happy, and healthy life.


Sources

  1. Healthcare.gov. (n.d.). Mental health & substance abuse coverage.
  2. Tufts Health Plan. (2021). Treatment: Alcohol and Substance Abuse.
  3. Tufts Health Plan. (2021). Support + Assistance From Tufts Health Plan.
  4. Tufts Health Plan. (2021). Login or Register.
  5. Tufts Health Plan. (2021). Member Contact Information.
  6. Tufts Health Plan. (2021). Explore Our Plans.
  7. Tufts Health Plan. (2021). Medicaid Plans.
  8. Tufts Health Plan. (2021). Medicare Plans.
  9. Tufts Health Plan. (2021). Helpful Resources.

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