HealthSun Insurance Coverage for Alcohol & Drug Rehab

HealthSun is a managed care organization that offers Medicare Advantage insurance plans to Florida residents living in Miami Dade, Broward, and Palm Beach counties. It’s headquartered in Miami. HealthSun was founded in 2005 and was acquired by Anthem in 2017. It’s now a wholly owned subsidiary of Anthem, now known as Elevance Health.

HealthSun sells HMO (health maintenance organization) insurance plans. As an HMO, HealthSun utilizes its own network of 8,200 doctors and specialists to provide services to its approximately 50,000 members.

Approved Medicare benefits are available through HealthSun for people who are eligible for Original Medicare due to age, health condition, or disability. HealthSun has maintained Medicare’s highest rating of 5 stars for seven consecutive years, from 2018-2024, for its Medicare Advantage plans.

Does HealthSun Cover Addiction Treatment?

HealthSun HMO insurance covers mental health and substance abuse treatment as well as other medical treatments. Substance abuse treatment options differ depending on the individual policy chosen. Copays may apply, and some policies have limits on certain services.

It’s important to keep in mind that you’ll need to choose in network providers in order to use your HealthSun coverage. HMO plans do not offer coverage outside the network except for emergency care.

What Types of Inpatient Addiction Treatment Does HealthSun Cover?

Inpatient drug rehab treatment options that may be included in SunHealth’s behavioral health Medicare Advantage HMO insurance policies are the following:

Medically assisted detox that helps keep you comfortable and safe as substances leave your system may be covered if medically needed. Medical detox may use FDA-approved medication assisted treatment medications, such as methadone, naltrexone, and buprenorphine. The medication helps manage withdrawal symptoms. Detox would likely be administered during inpatient hospitalization.

Inpatient drug rehab in a clinic or a hospital, if medically necessary, may be covered by HealthSun. This feature is standard, as the same service is available through Medicare Part A. However your cost sharing is likely to be different with a HealthSun plan than it would through Part A.

Also, you’ll need to use a treatment clinic that’s part of the HealthSun plan’s network. Before you begin inpatient treatment, make sure you have checked your coverage details so there are no surprises when you’re supposed to be focused on your recovery.

What Types of Outpatient Rehab Are Available From HealthSun?

Outpatient rehab allows you to live at home or in a sober living environment while you attend treatment during the week.

Partial hospitalization, also known as day programs, are delivered as outpatient treatment in community mental health centers or community mental health hospitals.

Partial hospitalization programs using Medicare guidelines require direct supervision by a physician, and treatment must follow an individualized care plan that’s ordered by the doctor.

Patients enrolled in these programs typically attend sessions during the day and return home at night. Typical sessions last 4-8 hours a day, three to five days a week. A total of 20 or more hours of treatment each week for 3-4 weeks are common. However, treatment can last several months, depending on your specific needs. Programs usually include individual, group, and family counseling, as well as addiction and relapse prevention education. It may also include mental health medication, if needed.

Intensive Outpatient Programs (IOPs) often involve 9-20 hours of treatment a week, with the hours spread across 3 to 5 days. A typical recommendation is for 90 days of intensive care. Treatment includes individual, group, and family counseling sessions. Addiction and relapse prevention education are included as well.

Some intensive outpatient programs are medication assisted treatment (MAT) clinics, which treat opioids and/or alcohol use with FDA-approved medications while also providing addiction treatment counseling. MAT has been covered by Medicare since 2020.

Medicare Advantage plans also cover telehealth (phone or internet) services if these are provided by a physician or mental health counselor with a Medicare contract. Telehealth services such as mental health and substance use treatment can be accessed anywhere, including in your home. Other types of telehealth may require you to be in a rural medical clinic.

Are There Additional Benefits Available From HealthSun?

Healthsun Medicare Advantage plans provide additional benefits for you intending to keep you healthy and lower your healthcare costs. HealthSun offers several Medicare Advantage plans including different types of Health Maintenance Organization (HMO) plans and Special Needs Plans (SNPs). Premiums start from as low as $0 and several offer monthly premium reimbursement for Medicare Part B.

You also get a monthly allowance on a prepaid credit card so you can pay for groceries, home and pet care supplies, and utilities. You also get an allowance to use for over the counter items. Many plans also provide a yearly allowance for vision care and hearing aids. The amount of the allowance varies depending on the Medicare Advantage plan you choose.

Thousands of gyms and community centers participate in the SilverSneakers program. With your Medicare Advantage Plan you receive a basic membership at participating gyms so you can use the cardio and strength equipment and other amenities such as pools and walking tracks. The program requires you to download the app to your phone to access your digital membership card.

Each Medicare Advantage Plan also includes dental care and prescription drugs. Drug coverage levels are based on the plan’s drug formulary which is a list of medications the insurance plan covers.

Added benefits if you are part of a special supplemental program if you are chronically ill may include therapeutic massages, a monthly Healthy Meals Program, and transportation to medical appointments.

What Should I Do if HealthSun Won’t Cover the Cost of Rehab?

Not all alcohol and drug rehabilitation centers accept Medicare Advantage plans. You may also choose to use an out of network provider for your plan or may want to pay out of pocket. Whatever the reason if you do not have insurance coverage for addiction treatment there are several avenues you can explore to pay for drug and alcohol rehabilitation.

Sliding Scale Fees: Some addiction treatment centers offer sliding scale fees. This helps adjust the cost you pay based on your income and your financial situation. Typically you must submit documentation demonstrating your income and ability to pay. The programs vary depending on the facility and your eligibility requirements.

Payment Plans: When a treatment center lets you set up a payment plan, that means you don’t have to pay the full amount right away. Instead, you can break up the costs into multiple payments that make it more manageable. This can be a great way to get the care you need.

Grants and Scholarships: You might not realize it, but there are a lot of grants and scholarships available for rehab. You can get them from local, state, or national organizations. Sometimes a treatment center will offer scholarships directly. Scholarships and grants are helpful because you don’t have to repay them.

Financing/Loans: Finding some way to finance your rehab such as getting a loan can let you get started on treatment right away. Some treatment centers partner with third party lenders that specialize in medical financing and offer flexible repayment terms. Explore personal loans from your bank or credit unions and consider personal loans from friends and family. Finally programs like CareCredit can spread your payments out over time with a low interest rate.

Faith Based Programs: Local faith based programs may offer low cost or scholarship funded drug rehabilitation that usually emphasizes spiritual growth, prayer, and community support as part of your recovery. Many are provided by churches or religious organizations.

Community Based Programs: Community based programs are designed to provide addiction treatment and support within your community. They often partner with non profit organizations, government agencies, or health care providers. They may offer a range of services including therapy, counseling, peer support, and medical detox.