GEHA Health Insurance Coverage for Addiction Treatment

The Government Employees Health Association (GEHA) provides health insurance and dental coverage specifically for federal employees and federal and military retirees.

Headquartered in Lees Summit, Missouri, GEHA has offered plans for federal workers since it was established shortly after the Great Depression. Now, the company partners with UnitedHealthcare to bring you an extensive medical network as well as Medicare Advantage plans for those who qualify. It serves all 50 states and Washington, DC.

Does GEHA Cover Addiction Treatment?

All of GEHA’s health insurance plans cover addiction treatment. However the extent of your coverage may vary. Before you start rehab or choose a treatment facility talk to the insurance company to ask about your plan and find out what types of treatment it may cover.

Insurance coverage is based on medically necessary care. The way you show what care is medically necessary is by having your doctor create a treatment plan based on your needs. This treatment plan will help you determine what types of treatment facilities to look for and will help with any preauthorization you may need.

What Insurance Plans Does GEHA Offer?

GEHA offers five primary plans, plus a Medicare Advantage plan and a Postal Service plan. All of its plans are preferred provider organization (PPO) plans including its Medicare Advantage and Postal plans. The five primary plans include:

Elevate: This plan works well with a tight budget because it has low premiums and copays. Usually, you pay $0 out of pocket for in-network preventive care, telehealth, and vision services.

HDHP: The High Deductible Health Plan has a low premium with a higher deductible. It offers $0 unlimited telehealth services that include mental health and $0 preventive, maternity, and dental care. The plan also comes with a health savings account (HSA), making it a good choice for those who want to save for future health needs.

Standard: The Standard plan supports your whole family with reasonable premiums and full coverage for preventive care, maternity services, and well-child visits.

Elevate Plus: This plan has higher premiums, but it also has low copays for non traditional care like chiropractic and acupuncture. You still get $0 preventive and telehealth as well as vision care with a low deductible and higher out of pocket maximums.

High: GEHA’s most expensive plan has high premiums, but it covers more services for those with more extensive medical needs. Many services come with a lower out of pocket cost to you, including inpatient care.

GEHA’s Medicare Advantage plan for those over 65 has additional benefits compared to Original Medicare. You get complete coverage for your healthcare needs with no deductibles or copays, enhanced Medicare Part D, and a premium subsidy for Part B up to $1,200.

The Postal Service Health Benefits (PSHB) plan was made exclusively for postal service employees. GEHA is an an approved Postal Service Health Benefits (PSHB) Program carrier for the 2024 Open Season. These plans offer similar coverage as what you would get with GEHA’s Federal Employees Health Benefits (FEHB) plans. The coverage start and end times are slightly different from FEHB plans, and it may require covered family members to enroll in Medicare Part B.

What Perks Are Included in GEHA Plans?

All GEHA plans offer perks and they vary between plans. With your plan you may be able to take advantage of rewards programs including health rewards and wellness programs for maintaining a healthy lifestyle and plan perks that come with fitness subscriptions and gift cards.

GEHA includes certain savings in all its plans. You can get discounts on many services including gym memberships and eyewear and even medical alert systems. Plan specific savings may include hearing aid discounts and fully covered lab testing as well as more vision benefits.

What Inpatient Addiction Treatment Does GEHA Cover?

GEHA covers medically necessary care including inpatient addiction treatment. You typically will have some out-of-pocket costs for inpatient care, so check with your insurance provider to find out how much of your care is covered.

Your treatment plan will help you understand if inpatient treatment is right for you. The ASAM assessment can help determine whether inpatient care is likely to help you. You will also need a diagnosis of substance use disorder and to be medically stable as well as having the emotional ability to go through residential treatment.

Many times inpatient treatment starts with medical detox. This process allows you to be monitored while the substances clear your system and you can get medical support and FDA approved medication to help with withdrawal symptoms.

During residential treatment you’ll experience individual and group therapy along with holistic approaches and recreation. You’ll also have peer support to help you keep a positive outlook. Residential treatment allows you to focus on recovery without any outside distractions.

What Outpatient Rehab Does GEHA Cover?

Your GEHA plan may cover partial hospitalization programs (PHPs), intensive outpatient programs (IOPs), and general outpatient treatment. These programs may include therapy and 12 step programs as well as sober living arrangements and other support.

PHPs typically include at least 25 hours of treatment each week but you don’t have to stay overnight at the facility. You’re often in treatment all day which is why PHPs are also called day treatment.

With an IOP you receive between 9 and 15 hours of treatment per week spread over three or more days. You can have these sessions in the mornings or evenings to make it easier to manage work and school.

General outpatient treatment meets for one or two hours a week. Aftercare support may also be available to help you connect to peer support and social services.

Does GEHA Cover Methadone & Suboxone (MAT)?

Medication-assisted treatment uses certain drugs—typically methadone and suboxone —to help you succeed on your recovery journey. These drugs are long release opioids that are safe to use with medical supervision. They cancel out the euphoric effects of illicit opioids and can reduce the severity of withdrawal symptoms and cravings.

With the stability these medications provide patients have a higher rate of long term recovery and a reduced rate of relapse. The medications give you a chance to adopt new mindsets and helpful habits to solidify your long term recovery.

Does GEHA Cover Other Mental Healthcare?

GEHA plans generally cover mental healthcare. The Elevate and Elevate Plus plans also offer unlimited telehealth visits for mental healthcare at $0 out of pocket. Each plan has its own limits and requirements for care, so be sure to check your coverage before starting mental health treatment.

Mental health treatment can involve counseling for concerns such as depression or anxiety as well as PTSD and a variety of other diagnoses.

Co occurring mental health disorders are common with substance use disorder. Many people with addiction also have anxiety or depression or bipolar disorder. They may also struggle with PTSD or ADHD or personality disorders that contribute to their substance use. By treating your mental health along with addiction you’ll have a much better chance of long term success because each condition affects the other.

How Long Will GEHA Cover Rehab?

Plan limits vary but the length of your rehab coverage is largely based on your medical needs. Other factors include your addiction severity as well as your progress and your treatment plan.

Inpatient treatment can last up to three months, and IOP programs often last 12 weeks as well. General outpatient treatment can vary because it’s supporting you in living out your habits long term.

Even more important than the length of treatment is that you are committed to the process. When you follow your plan and complete each step you’ll give yourself the best chance at long term recovery.

How to Verify Coverage With GEHA

You can verify your coverage by contacting GEHA directly using the customer service information on your insurance card. You can also log onto your insurance account online to get plan details and find in network providers. Contacting the company ensures that you speak to someone who understands your coverage in depth and can answer any questions you may have.

You can also contact your chosen treatment center to ask if they accept your plan. In this case make sure you provide your exact plan name and not only the name of your insurance company. Plans vary and a facility may not accept all plans GEHA.