Magellan Health Coverage for Drug & Alcohol Rehab

Magellan Health is the parent of two companies: Magellan Healthcare and Magellan Federal. Both offer behavioral health and support services for clients. Magellan Healthcare serves health plans and employers along with states. Magellan Federal is focused on serving men and women in the military.

In 2022 Magellan Health was acquired by Centene Corporation. However the company continues to operate as a separate subsidiary and maintains their name and brand. Magellan employs over 5,000 people and their services impact millions of Americans.

Does Magellan Health Cover Drug and Alcohol Rehab?

Magellan Health provides behavioral health solutions and care management services to insurance plans and employers along with states and federal agencies. However Magellan doesn’t determine what is covered or how much coverage you have — the insurance plan determines that.

That’s why it’s so important to verify your coverage details before you start treatment. You may find that you need a doctor’s referral or preauthorization to get insurance coverage.

Also insurance plans focus on covering medically necessary care. Working with your doctor to create a treatment plan for your addiction diagnosis will not only give you direction on what programs to look for but will help prove medical necessity as well.

What Insurance Services Does Magellan Health Offer to Clients?

Magellan Health offers a wide range of insurance solutions that are tailored to each client’s needs.

For health plans Magellan offers behavioral health services that include coordinated care for anxiety and depression along with substance use disorder and autism and more. There are digital behavioral health services as well.

Other services that health plans can use include care management assistance and a pharmacy program to make it easier to provide prescription medications to members. They also have a program called Magellan Autism Connections® to help families care for children with autism.

Employers can take advantage of Magellan’s eMbrace employer solutions. This includes Employer Assistance Programs (EAPs) along with behavioral health care. They also have specialized solutions that augment those programs by giving additional support to young adults and adolescents along with parents and caregivers and more.

For states Magellan provides behavioral healthcare and children’s services. They also give state programs access to peer support for recovery.

Finally for federal agencies and the military Magellan Federal offers mental health and substance use services and care management along with family support services and administrative support.

Does Magellan Health Cover Mental Healthcare?

All of Magellan Health’s solutions include behavioral health services which includes mental healthcare. However Magellan doesn’t decide exactly what is covered or how much coverage is available — your insurance plan does that. So it’s important to talk to your insurance company or employer’s benefits specialist to get the details of your plan before you begin a program.

Mental health services include crisis support as well as therapy and counseling. You may be able to get peer support from those who have gone through the same issues. Whether you struggle with depression or anxiety or other mental health concerns most insurance plans will provide at least some coverage.

One thing to keep in mind is that many people with substance use disorders also have mental health diagnoses. Having both together is called a co occurring disorder or a dual diagnosis. If you have a dual diagnosis is essential to get integrated treatment that addresses both issues so you can maximize your chance of long term recovery.

What Inpatient Addiction Treatment Does Magellan Health Cover?

Because insurance companies focus on medically necessary care, you must have a treatment plan created by your physician from the beginning. Your doctor may rely on the ASAM criteria to determine whether inpatient treatment is best.

As you go through the detoxification process, it’s often safer to do it under the care of a physician and additional healthcare workers. Inpatient treatment allows you to medically detox safely as the first step to your recovery. Magellan Health has many resources for inpatient treatment, but the treatment available is based on your specific plan, so it’s always a good idea to talk to someone about your policy.

After detox you may have inpatient or residential treatment where you live at the treatment facility and focus fully on your recovery.

What Outpatient Rehab Does Magellan Health Cover?

Outpatient rehab comes in several forms. The most intensive is a partial hospitalization program or PHP. This option allows you to live at home while still receiving treatment. It’s ideal for those who need more than a regular therapist or doctor can offer but don’t need 24-hour care.

The next level is intensive outpatient programs or IOPs. This is a comprehensive, intense form of treatment that still allows you to meet outside obligations to things like work and family. You generally have treatment three hours at a time, a few days a week.

Outpatient treatment focuses on psychoeducation, relapse prevention, group and individual counseling, and teaching coping and recovery skills.

Before you commit to any type of treatment plan, make sure you discuss the specifics with your insurance company.

Does Magellan Health Cover Methadone & Suboxone (MAT)?

Some providers will recommend medication-assisted treatment, also known as MAT. This occurs when medication is combined with traditional forms of rehab, like counseling, to increase the chances of success.

Two medications often used in this process are methadone and suboxone. They are often used to treat opioid addiction and help reduce cravings while blocking highs that come from mood-altering substances. Specialists have found medication to be a valuable tool in the arsenal used to treat addiction.

If your doctor recommends any type of MAT, speak to your insurance company to ensure it’s covered before you start because coverage amounts and requirements vary per policy.

How Long Will Magellan Health Cover Rehab?

Recovery usually consists of a combination of things. Your doctor will determine your treatment plan and how long it should last. Every case is individualized to help every patient have the best chance of success.

The first step may be detox. The second step may be inpatient or outpatient treatment. The third step is often a program that allows you to integrate back into society slowly. The final step is aftercare and upkeep.

Every step is just as important as the one before it and to reach long term recovery you’ll need to complete each one.

Insurance plans each have their own limits and requirements for treatment. You’ll want to make sure you understand your full plan benefits to ensure you get coverage for your full medically recommended treatment plan.

Does Addiction Treatment Need to Be In Network?

Many plans don’t cover providers that are out of network. Even if the plan covers some costs, the deductibles and copayments are usually higher for the patient. It’s best to stay in-network if possible when choosing a treatment center or provider.

If you prefer an out-of-network provider, discuss the costs extensively before you enter treatment. Magellan Health has providers for specific services, but your individual insurance plan defines the overall medical network.

How to Verify Coverage With Magellan Health

You can check the details of your insurance policy by logging into your online account, contacting a customer service representative, or discussing your options with a specific treatment center you’re considering. Because there are a wide variety of plans, make sure you know your specific plan name.

Always verify your overall insurance details and the benefits available so you have a complete picture. If you are prepared to go into treatment with all the information, your chances of recovery greatly increase.