CareSource Health Coverage for Substance Abuse Treatment

Headquartered in Dayton, Ohio, CareSource was founded in 1989 as a nonprofit organization with a mission to provide low cost insurance to underserved and low income residents of Ohio.

Today, CareSource is the largest Medicaid plan in Ohio, and the second largest in the U.S. CareSource offers health insurance plans to two million members in Arkansas, Georgia, Indiana, Kentucky, Ohio, North Carolina, and West Virginia.

They offer Medicare plans, Medicaid plans, and Health Insurance Marketplace plans. CareSource plans utilize a network of doctors, nurses, mental health professionals, and other healthcare providers to serve their members and keep costs low.

With an emphasis on diversity, equity, and inclusion, CareSource supports and sponsors community projects, such as food banks and food distribution programs, community wellness day events, and summer health camps for children. They also give grants to social service agencies that support projects focused on reducing poverty and homelessness.

Does CareSource Cover Drug Rehab and Addiction Treatment?

All of the plans CareSource offers fall under the Affordable Care Act (ACA) so they all have at least some coverage for 10 essential health benefits, including mental health and addiction treatment.

Substance abuse treatment options will differ according to the type of policy chosen, and copays may apply. Sometimes limitations on certain services will apply. That’s why it’s important to verify coverage before you commit to a treatment program. Depending on your plan you may also need a referral from your doctor and/or preauthorization to get the coverage you need.

CareSource Health Insurance Plans

CareSource offers individual and family plans through the Health Insurance Marketplace plans, Medicaid plans, and other specialty options. Not all plans are available in all states.

Individual and family plans are divided by “metal tier”, which helps you understand how much coverage they offer. A Bronze plan will have the lowest monthly premium but only cover 60% of the cost of care. A Gold plan has a higher premium and covers 80% of the cost of care. A Silver plan is in the middle and covers 70% of care.

Medicaid plans are available from CareSource in Georgia, Indiana, Michigan, and Ohio. These are designed for lower income families and individuals and often have $0 care, including addiction treatment.

Dual plans help those who qualify for both Medicare and Medicaid. These plans help you coordinate these two programs without any confusion about who is covering what care. These are available from CareSource in Michigan, Ohio, Georgia, and Indiana.

Finally, CareSource has insurance plans that help those who qualify for Medicaid and have complex health needs in Arkansas.

What Inpatient Rehab is Covered By CareSource?

Insurance focuses on covering addiction treatment that’s medically necessary, so make sure to work with your doctor to create a treatment plan. The plan will tell you what type of rehab to look for and will show what is medically needed in your specific case.

Many people start with medical detox. The process of letting substances leave your system can be very difficult, and medical detox ensures you have the care you need to manage withdrawal symptoms and stay safe. During the detoxification process, one of three FDA-approved medication-assisted treatment (MAT) medications–methadone, buprenorphine, or naltrexone–are typically used. Detox usually lasts 10 days or less. During detox you may receive some therapy and help with treatment planning so you’re ready to start the road to recovery.

During inpatient or residential treatment you have a chance to focus entirely on your recovery without any distractions from daily life. You’ll receive individual and group therapy along with holistic treatment that may include meditation, art therapy, and more. You’ll also have recreation options and other activities. The goal is to focus on creating new habits and mindsets that will allow you to live a substance free lifestyle.

Does CareSource Cover Methadone & Suboxone (MAT)?

During outpatient treatment you live at home or in sober living and attend rehab during the day. There are multiple kinds of outpatient care and they have different intensity.

Partial hospitalization programs (PHPs) are also sometimes called day programs. Most PHP sessions last for 4 to 8 hours a day and run three to five days a week. At least 20 hours of treatment per week, over 3 to 4 weeks, is common in PHP programs. Treatments including individual, group, and family counseling, and addiction and relapse prevention education, as well as mental health medication, if needed, are provided.

Intensive outpatient programs (IOPs) typically offer 9 to 20 hours of treatment per week, with the hours spread across 3 to 5 days. 90 days of treatment are usually recommended for IOP treatment.

General outpatient care meets only once or twice a week for about an hour each time. This is generally focused on individual or group therapy and helps you connect to community resources that keep you strong in your recovery goals. There may also be telehealth options where you can attend treatment remotely.

Does CareSource Cover Other Mental Healthcare?

The Affordable Care Act requires most plans to cover both mental health and substance use treatment. But since there are exceptions it’s important that you verify that your plan includes this coverage.

There are a wide variety of mental health treatments that are commonly covered by plans like CareSource. These include intensive treatments like psychiatric hospitalization and crisis stabilization as well as less intensive treatments like outpatient counseling.

It’s common for those who struggle with substance use to also have a mental health diagnosis. If you have co occurring disorders it’s important to treat them together to ensure you are able to establish long term recovery. You can work with your insurance company to find a treatment center that offers this integrated care.

Does Addiction Treatment Need to Be In Network?

Most CareSource plans will require you to get your care from within their provider network but this ultimately depends on your specific type of plan. If your plan type does allow for care from outside their provider network the added freedom will likely come with added costs. The copay and deductible along with the out of pocket maximum are all typically higher in plans that allow you to go out of network for care.

If you can find a high quality provider within the provider network that’s the best way to maximize your insurance coverage and keep your personal costs down.

How to Verify Coverage With CareSource

If you would like to know what treatment providers your plan covers CareSource gives you a couple of ways to check. You can either give them a call on their customer service line or check their service provider directory through their website.

You also have the option to call the service provider who you would like to see and ask them to verify that your benefits cover their services. For the most accurate result use the exact name of your plan when checking your benefits. You can’t just use the company name as CareSource has many different types of plans.