Meridian Health Insurance for Drug Rehab

Meridian was founded in 1997 as the “Health Plan of Michigan.” The company was renamed Meridian Health Plan in 2012. Meridian Health was acquired by WellCare in 2018 and WellCare was acquired by Centene Corporation in 2020. Both companies operate as separate subsidiaries of Centene under their own brand name.

Today the company offers Medicaid and Medicare-Medicaid plans in Illinois and Michigan. They also offer Health Insurance Marketplace plans in Michigan under the Ambetter from Meridian brand.

Does Meridian Cover Drug and Alcohol Rehab?

Be careful not to confuse Meridian Health Plans with Meridian Health Services, a Michigan-based healthcare provider that offers mental health and addiction treatment.

All Meridian Health insurance plans are subject to the 2010 Affordable Care Act (ACA), so all plans offer at least some coverage for mental health and addiction treatment. The ACA requires insurance companies to cover certain essential health benefits, which include mental health and addiction treatment. However the level of coverage can very from plan to plan, so it’s important to get the full details before you start treatment.

If you receive Medicaid through Meridian, you will need to talk with your PCP about any drug or alcohol rehab treatment you need, so they can help direct you to the appropriate program or organization.

For those who get Meridian insurance coverage through the Insurance Marketplace, you should review the details of your plan to find out your level of coverage and whether you are required to get a referral or preauthorization for addiction treatment.

Coverage will also depend on if the care you need is medically necessary. Getting a treatment plan from your doctor will help show medical necessity and can help ensure your care is covered.

What Are Meridian Plans?

Meridian offers multiple plans in Illinois and Michigan. The primary focus of the company is their Medicaid plans but they also have Medicare-Medicaid combination plans and Insurance Marketplace plans.

The Medicaid plans are offered in accordance with the state’s decisions on what is covered and for how long. You’ll want to talk to your primary care provider (PCP) to set up a treatment plan for your specific needs and to get referrals to the appropriate treatment programs. In Michigan you don’t need a referral to see a behavioral health specialist but you will need approval to start a long term addiction treatment plan.

Medicare Medicaid plans are for those who qualify for both programs. Having a specialty plan that combines both allows for easier coordination between the agencies and ensures that you get the low cost or no cost care you qualify for. Having both Medicaid and Medicare will also allow you to access services that Medicare doesn’t generally cover.

In Michigan Meridian offers Insurance Marketplace plans in partnership with Ambetter. These plans will all cover mental healthcare and addiction rehab but the level of coverage may vary. You may also need to stay within the provider network to get covered care.

Be sure to review your full plan details before you commit to a treatment program. That way you can get the referrals and preauthorization that may be needed and not face unexpected surprises during treatment.

What Inpatient Addiction Treatment Does Meridian Cover?

All Meridian health plans will cover some level of addiction treatment, but it’s important to check the specifics of your insurance coverage. A comprehensive treatment plan from your doctor can show that your care is medically necessary, helping you get the coverage you need.

Medical necessity is usually determined through an assessment, such as the ASAM (American Society of Addiction Medicine) Criteria, which evaluates the severity of your substance use and any co-occurring mental health disorders.

The treatment typically starts with a medical detox and is followed by inpatient/residential care. Medical detox provides you with a safe environment and helps manage your withdrawal symptoms with round-the-clock care. Residential treatment allows you to learn new skills and lay the foundation for long-term recovery without any distractions.

What Outpatient Rehab Does Meridian Cover?

Your doctor may recommend several types of outpatient rehab care. Partial hospitalization programs (PHPs) offer treatment at a facility for 4-8 hours during the day, but you return home in the evening. This treatment may take place up to five days a week for up to three months.

Intensive outpatient programs (IOPs) provide treatment on a more flexible schedule. It typically involves 9 – 20 hours of therapy for three to five days each week for up to 90 days.

General outpatient programs require you to attend rehab therapy sessions once or twice a week. This treatment usually focuses on individual or group counseling, addiction education, and relapse prevention. It can help you gradually progress into aftercare, where you receive ongoing support and treatment to help you maintain sobriety, avoid relapse, and support your long-term recovery.

Does Meridian Cover Methadone & Suboxone (MAT)?

Medications such as methadone and Suboxone are used in medication-assisted treatments for opioid and alcohol addiction. MAT can used during the detox process to help ease your withdrawal symptoms, letting your body gradually adjust to being free of substances.

MAT is also used longer term to help you manage cravings and avoid relapse during treatment. This allows you to lay a firm foundation for recovery without worrying about cravings, and then you can eventually taper off the medication support for a truly substance-free lifestyle.

Does Meridian Cover Other Mental Healthcare?

Meridian insurance plans will also cover other mental health care to some extent. This can help you get counseling and care for diagnoses like depression, anxiety, PTSD, and more.

This coverage also applies if you have co-occurring mental health concerns and substance use disorder. Addiction often comes hand-in-hand with mental health issues, and your recovery in the long term depends on receiving treatment for both at the same time.

Check the details of your specific plan before receiving treatment to ensure you know the requirements and details of your coverage.

How Long Will Meridian Cover Rehab?

Meridian’s coverage of rehab treatment depends on the limits of your specific plan and the medical necessity of your care. The average inpatient/residential treatment length ranges from one to three months (30 to 90 days). Outpatient programs run an average of 10 to 12 weeks but can be longer if needed.

The key to your recovery success is your commitment to the treatment process and your embrace of all required steps along the way.

Does Addiction Treatment Need to Be In Network?

It would be best if you used in-network providers whenever possible to make the most of your Meridian health plan coverage. Some plans may not cover out-of-network providers. If it does, the cost of deductibles and copayments will be significantly higher than if you used network providers.

If you have a Meridian Medicaid plan, you generally need to use providers that accept your plan. You may be referred for out-of-network care if in-network providers aren’t available or can’t provide you with care promptly. However your medical providers and plan will make that decision.

How to Verify Coverage With Meridian

If you are unsure if Meridian covers the specific treatment you require, call the company’s customer service line or contact insurance representatives through the company’s website.

You can also ask the treatment center where you plan to seek care if it accepts your Meridian insurance plan. Just make sure to use the exact insurance plan name rather than just the insurance company’s name because there are a variety of different plans.