Checking into rehab for help with your addiction issues can be quite scary, especially if you aren’t sure if your health insurance will cover your stay. Most insurance providers cover stays in treatment centers because they know that addictions can go hand in hand with other diseases. Covering the support that you need now can cut back on how much an insurer will need to spend on your health later. You can call us to learn more about using your insurance when you check in to our treatment center, but you can also keep reading to find out how the Tufts Health Plan works.
About Tufts Health Plan
Tufts Health Plan started as a nonprofit organization that opened in 1979 and began offering coverage for members two years later. Secure Horizons helped the organization start Medicare coverage in 1994, which also led to the organization offering PPO plans. Though initially affiliated with the Tufts University School of Medicine, it now insurers more than 1 million people in Rhode Island and Massachusetts. You can check out the different plans that are available to get an idea of what type of treatment coverage is available based on your plan.
Plans From Tufts
The plans that are available to you can depend on where you live. Residents of Rhode Island can sign up for plans through their employers and get Medicaid coverage. Those who live in Massachusetts can get an employer plan as well as both Medicare and Medicaid plans.
Some of the employer plans that are available include HMO, PPO and Advantage.
With an HMO plan, you need to see your primary care physician first. The doctor can then refer you to a treatment center that is in your network. If you visit a facility outside of your network, insurance likely will not cover your stay.
Members of a PPO plan do not need to get a referral from a doctor first. They can visit any doctor or treatment center that is part of their network and get coverage for the treatment that they need.
Advantage plans are available through Tufts as both HMO and PPO options. The concept behind these plans is that you pay less up front and get discounts for the health coverage that you need. You may need to pay a deductible or make a co-pay when you check in to a center.
If you have a Health Savings Account, you can join one of the Advantage Saver plans that are available, which include both PPO and HMO options. Though these plans have a higher deductible, they allow you to pay less each month for your premiums.
Tiered plans are also available for those who want to save money on their health insurance costs. As a new member, you get complete access to all the providers who work with Tufts.
Tufts Health Plan includes a CareLink option that is available to those who work for major employers in either Rhode Island or Massachusetts. You do not need to live in the company’s service plan to use this plan and can visit doctors and centers that are outside of that area too.
Employers can offer health insurance through the Cigna Out-of-Area PPO too. Tufts designed this plan for residents of both states who do not live in a coverage or service area.
Tufts Health Plan worked with Granite Health to design the Tufts Health Freedom Plan. Not only does this plan expand coverage to residents of New Hampshire, but it also includes options for those seeking behavioral health help, which is often required for those battling with addictions.
Some of the plans available from Tufts include Connector plans such as Tufts Health Direct. This is a public plan that is open to anyone in need of help. You can choose from different ConnectorCare options and get tax credits when you file next year.
Another option is Tufts Health Premier, which is an HMO plan that is open to both groups of people and individuals. It comes with various benefits that you can use to pay for addiction treatment.
A variety of plans are available for those on Medicaid too, including Tufts Health Together, Tufts Health Unify and Tufts Health RITogther.
Anyone who is at least 21 years of age but no older than 64 can sign up for Tufts Health Unify. This is a One Care plan designed for those who qualify for Medicare or Medicaid. You can contact a nurse 24/7 for help with health problems and get help customizing your plan.
With Tufts Health RITogether, you qualify for help if you meet the eligibility for Medicaid in Rhode Island. This plan allows you to see doctors in the state and get referrals to local treatment centers.
Tufts Health Together is only available for Massachusetts residents who qualify for MassHealth or Medicaid in the state. Not only does it cover the cost of routine doctors’ appointments, but it also covers prescription medications that you need and the cost of appointments with specialists.
Plans for Those on Medicare
If you qualify for Medicare in either Massachusetts or Rhode Island, you can opt for other plans from Tufts. The main option is Tufts Health Plan Medicare Preferred HMO, which includes Part A and Part B.
Those over the age of 65 might qualify for Tufts Health Plan Senior Care. This plan has various options and can cover both doctors’ visits as well as specialized care.
As Medicare does not cover everything, you might find yourself paying for some costs out of your pocket. Tufts Medicare Preferred Supplement is a special plan designed to help you cover those costs.
There is also Tufts Health Unify, which is open to anyone age 21 to 64. Members receive help managing their conditions and can seek help from providers in an extensive network.
How Much Do Tufts Health Plans Cost?
The amount that you pay for coverage through Tufts will depend on the plan that you choose. It also depends on your deductible, which tells you how much you need to pay upfront. Most plans include fixed co-payments that will never change. This tells you how much you need to put down when you arrive at a treatment facility. Tufts makes it easy to see how much you need to pay and what costs you share with the insurer. Most plans have a maximum amount that Tufts will pay each year too, which you can see in your benefits paperwork. Depending on your plan, you might pay the total amount for your treatment if you visit a facility outside of your network.
Check Your Benefits Before Seeking Treatment
An easy way to make sure that you don’t face any out-of-pocket costs is by looking at your insurance benefits. Tufts Health Plan has a toll-free number that you can call. As long as you have your ID number handy, you can speak with a specialist to see what your benefits cover and where you can go for help. If you have access to the internet, you can use the Tufts website to view your benefits. This also provides you with a list of doctors and centers in your network. You must register for a new account with an email address if you do not have one. The site will ask for your member ID.
As a veteran with a Tufts Health Plan, you may qualify for other programs that can help you get treatment for a drug or alcohol addiction. Inpatient respite is available, which allows you to get in-home help such as a nurse who checks on your daily. This can also cover the cost of a short-term stay in a treatment facility. The Veterans Administration also offers extra help for those who fought in war efforts, and includes their spouses. This program provides a maximum dollar amount per month for couples who qualify.
Can You Use Tufts for Addiction Treatment?
Substance abuse treatment is available for members of the Tufts Health Plan who need help. You typically need to make a co-pay when you arrive at the facility. Depending on the type of member or plan that you have, you may need to speak to your primary care physician first. Only after talking with your doctor about your concerns can you get a referral to a treatment center. It’s also helpful to contact Tufts to make sure that the company will cover the cost of your treatment.
Most of these plans cover addiction treatment through the behavioral services that are available. All public plans, plans for seniors and commercial plans include behavioral health assistance. You can use the website to get a referral form for your doctor or to view the payment policies, including how much you need to pay when you arrive. Behavioral health policies cover all aspects of outpatient treatment. It will pay for any tests that the facility needs to run and the cost of your weekly appointments.
Those who need more help may find that their plans cover the cost of inpatient treatment and hospitalization too. If you have a difficult time avoiding substances and want to focus on your sobriety, this type of treatment might be best for you. Inpatient coverage is available for those with co-occurring disorders such as anxiety and depression as well as those who suffer from an eating disorder. Doctors working in the facility can identify the reasons for your substance abuse and develop a treatment plan. You also receive coverage for the monitoring that they need to do and your initial evaluation.
A Tufts Health Plan can help you get help when you need it. If you or someone with this type of plan has an overdose, it can cover the cost of the ambulance ride to the hospital and the time spent there. It can also cover the cost of sending you to a treatment center. Those addicted to opioids may require more extensive treatment and the supervision of a medical doctor.
The only thing your plan may fail to cover is the help that you get from outside of the network or area. This includes a treatment center in a different state or a doctor who recently left the network. If you have any concerns about your coverage, you should contact Tufts first.
What Are the Benefits of Tufts Health Plans for Addiction Treatment?
There are many benefits to using a Tufts Health Plan to pay for addiction treatment. Your plan will cover the cost of the medical detox that you might need, which helps you reliably start your recovery. If you need additional help that outpatient rehab cannot offer, it will cover the cost of an extended stay in a center, which can last for a weekend up to a full month. The plans cover both inpatient and outpatient treatment options and any long-term management or help that you might need. Tufts does not charge a co-pay or fee for any reversal medications that members may need.
Health insurance can cover some or all of the costs needed to get help with any medical problem, including the addictions that you have to drugs or alcohol. Tufts Health Plan is one of the leading providers of insurance for residents of Massachusetts, Rhode Island and New Hampshire. Call us today to make sure that your plan covers the type of addiction treatment that you need, or reach out to Tufts Health Plan to check on your benefits and coverage.