Optimum Healthcare Coverage for Drug & Alcohol Addiction Treatment

Discover how Optimum HealthCare’s Medicare plans cover addiction treatment. Learn about coverage options, verification process, and more.

Optimum Healthcare Coverage for Drug & Alcohol Addiction Treatment

Discover how Optimum HealthCare’s Medicare plans cover addiction treatment. Learn about coverage options, verification process, and more.

Optimum HealthCare provides Medicare Advantage plans to eligible individuals. Medicare Advantage Plans replace Original Medicare Parts A and B, offering benefits such as fewer bills, lower premiums and copays, and access to more benefits. Optimum HealthCare was founded over 15 years ago to deliver quality and comprehensive benefits that are affordable and meet the diverse needs of seniors and people with disabilities.

Optimum HealthCare operates under the umbrella of HealthSun Health Plans, which is part of Anthem, Inc (now Elevance). This is one of the largest health insurance companies in the U.S. This affiliation allows them to leverage the extensive resources and expertise of Anthem to deliver high standards of care and customer service to their members.

Does Optimum HealthCare Cover Addiction Treatment?

Yes, Optimum HealthCare policies are required to cover at least as much as Original Medicare. Original Medicare provides coverage for addiction and mental health treatment as an essential service defined by the Affordable Care Act. As a result, Optimum HealthCare will also have coverage for various mental health and addiction treatment services.

The specifics of this coverage will vary depending on your plan, so it’s important to verify your insurance before committing to a treatment program. Also, Medicare Advantage plans often require you to use the provider’s network, so you’ll want to make sure you choose the rehab center accordingly.

What Are Optimum HealthCare Plans?

Optimum HealthCare offers Medicare Advantage HMO plans. These plans cover everything Original Medicare covers and include prescription drug benefits that Original Medicare members have to buy separately. The Advantage plans also generally have additional benefits not covered by Original Medicare, such as dental, vision, hearing, and fitness programs.

Other benefits of Optimum HealthCare plans include preventive services at no cost to you and a personal emergency response system that includes a monitoring device so you have access to help around the clock.

The Optimum Medicare Advantage plan may also include 30 hours each year of in-home support, offering technology assistance, virtual services and companionship.

Another key feature of Optimum HealthCare plans is their emphasis on preventive health measures. They encourage you to get regular health screenings, vaccinations, and wellness visits to maintain your health and detect problems early.

A strong emphasis is placed on this proactive approach and customer service, offering support to help you navigate the healthcare options in your area and make informed decisions about coverage. The Optimum HealthCare Medicare Advantage HMO plans are designed to provide you with comprehensive care while helping manage your costs effectively.

What Types of Rehab Treatment Are Covered By Optimum HealthCare?

All insurance plans focus on covering medically necessary care, so it’s important to get a treatment plan from your doctor. Some of the covered services in your Medicare Advantage plan from Optimum HealthCare could include:

Detoxification Services: Detoxification includes medical supervision to help you safely manage withdrawal symptoms. These programs often offer medical care which includes prescription drugs to help manage symptoms.

Inpatient Rehabilitation: These treatments are offered in a residential facility or inpatient facility where you receive around the clock care and support for addiction. You’ll get counseling, fun activities, and help creating new habits and mindsets.

Outpatient Programs: Outpatient programs allow you to receive treatment during the day and continue to live at home or in a sober living residence in the evening. Some programs are highly structured and have up to 20 hours of treatment, while less intensive programs might have nine hours or less per week of rehab. These programs include individual or group therapy sessions focused on helping you live out your recovery in daily life.

Medication Assisted Treatment (MAT): Medications can be prescribed to help manage cravings and withdrawal symptoms. This support is combined with counseling and behavioral therapies to help establish your recovery long term.

Where Does Optimum HealthCare Offer Coverage?

Optimum HealthCare primarily offers coverage to Medicare beneficiaries in 24 counties throughout Florida. The coverage areas include counties in the center of the state bordered by Marion County in the north and Collier County in the south. They also offer concierge services in eight counties, including Marion, Orange, Sarasota and St Lucie.

The concierge services may vary in each county and may include personalized care coordinators, transportation services, home visits, wellness programs, and medication management. These services help improve your overall experience by providing you with convenient and personalized support that goes beyond traditional medical care.

How to Verify Coverage with Optimum HealthCare

Your insurance coverage through Optimum HealthCare will vary depending on your Medicare Advantage plan. Before receiving addiction services or care for mental health conditions, it is important to verify your insurance coverage.

There are several ways to do this. When you purchase a Medicare Advantage plan, you are given a member Services book that documents what your policy covers. However, these can sometimes be confusing to read. Optimum HealthCare also has a member services phone number where you can ask questions about your coverage.

The easiest and sometimes fastest way to verify your insurance coverage for addiction treatments is to work with the addiction treatment center of your choice.

The financial counselors will generally verify your insurance coverage with Optimum HealthCare and provide you with more information about the treatment center, your treatment options and what you can expect after admission.

Does Addiction Treatment Need to Be In Network?

Optimum HMO provider networks use credentialed professionals to deliver care and in most cases you need to use in network providers to get coverage.

However, on rare occasions, Optimum will cover an out of network provider. An example of when out of network services can be used is when emergency care is necessary and delaying care would be dangerous. If an emergency happens outside of your network’s service area, then in network providers would of course be inaccessible. So you would access emergency services and then when you return to your home service area you would get any follow up care from an in network provider.

To request out of network services in non emergency situations, you must ask for special approval, and these are rare. Another possibility is that you can pay for out of network care yourself rather than using insurance.

What to Do if Optimum HealthCare Won’t Cover the Cost of Rehab

If your Optimum plan informs you that it won’t cover the cost of rehab, you are not out of options. You have the right to appeal your insurance company’s decision to deny treatment. To start the process, call Optimum Member Services. You’ll find more information about the appeals process in Chapter 9 of your Optimum Evidence of Coverage (EOC) document.

To get help covering the cost without insurance you can apply for a grant from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA). SAMHSA grants for addiction treatment are available in all states. You may also find financial assistance available through scholarships or grants from advocacy groups such as LGBTQ+ groups or through your church. Ask the rehab you are considering whether they accept these assistance program options.

Also ask if the rehab itself has a sliding scale which is a reduced fee option based on income. You can consider using a loan to pay for your addiction treatment. For example CareCredit is a company that specializes in providing credit to be used for healthcare needs. Or you could borrow money from family or friends. Because it is important to get rehab when you need it be diligent and creative when searching for your own funding options.

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Addiction Centers That Accept Optimum Healthcare

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Serenity Springs – Men’s Residential

1555 Cow Creek Road Edgewater FL, 32132
4.5(49 reviews)
The Serenity Springs Recovery Center is located in Edgewater, Florida. The center is accredited by CARF and The Joint Commission. They’re also LegitScript certified. Their inpatient residential treatment for men is on 38 acres of a lakefront property. Men struggling with a substance use disorder, mental health disorder and a co-occurring disorde
Patrick Harris
Amazing. Serenity Springs is a first class facility. From the staff to the facilities and the compassion that everyone displays, this place is second to none. To those who are struggling or have family members in need, please reach out. Serenity Springs will change your life.
Serenity Springs - Men’s Residential FL 32132 The facilities at Serenity Springs - Men���s Residential in Edgewater, FL 1 The facilities at Serenity Springs - Men���s Residential in Edgewater, FL 2

Serenity Springs – Intensive Outpatient Program

1555 Cow Creek Road Edgewater, FL 32132
5.0(1 reviews)
Serenity Springs – Intensive Outpatient Program in Edgewater, Florida, provides 12 Step focused addiction treatment to adult men. They offer individual and group counseling and dual diagnosis care. You can also get experiential therapy, EMDR, and holistic treatments, such as amino acid IV therapy. They accept a variety of insurance plans, includ
Patrick Harris
Amazing. Serenity Springs is a first class facility. From the staff to the facilities and the compassion that everyone displays, this place is second to none. To those who are struggling or have family members in need, please reach out. Serenity Springs will change your life.

Serenity Springs Recovery Center

1555 Cow Creek Rd Edgewater, FL 32132
4.4(47 reviews)
For many who choose the Serenity Springs Recovery Center, it is seen as a place of not only drug and alcohol addiction recovery but also self-discovery. The center is CARF-accredited and carries accreditation from the Joint Commission. It can be found in Edgewater, Florida, and treats men who need residential treatment, intensive outpatient treatme
Patrick Harris
Amazing. Serenity Springs is a first class facility. From the staff to the facilities and the compassion that everyone displays, this place is second to none. To those who are struggling or have family members in need, please reach out. Serenity Springs will change your life.
The facilities at Serenity Springs Recovery Center in Edgewater, FL 5 The facilities at Serenity Springs Recovery Center in Edgewater, FL 1 The facilities at Serenity Springs Recovery Center in Edgewater, FL 2

Fifth Street Counseling Center

4121 NW 5th Street Suite 206 Plantation FL, 33317
4.3(150 reviews)
Located in Plantation, Florida, Fifth Street Counseling Center is a private mental health and substance use disorder facility that provides intensive outpatient (IOP) services. Other services include medication-assisted treatment (MAT) and drug testing. They treat adolescents and adults, with a special focus on families and couples. MAT includes
Shreya Mehta
As an attorney, I referred my client to Fifth Street Counseling and the results were outstanding. They worked towards providing a tailored program for my client and my client consistently praised the staff s professionalism, empathy, which provided a safe and transformative environment for growth. It is rare to encounter a facility so committed to excellence in care with the kindness they show. The communication with my office was seamless and prompt with any outstanding or follow up questions I had. Both Garry and Adam were a pleasure to work with. I wholeheartedly recommend Fifth Street to anyone seeking professional and compassionate counseling and treatment services.
Fifth Street Counseling Center FL 33317 The facilities at Fifth Street Counseling Center in Plantation, FL 1 The facilities at Fifth Street Counseling Center in Plantation, FL 2

Mobile Metro Treatment Center

1924 Dauphin Island Parkway Suite C Mobile, AL 36605
4.1(36 reviews)
Mobile Metro Treatment Center is an alcohol and drug rehab center in Mobile, Alabama providing addiction treatment to adult men and women. They offer medication-assisted treatment on an outpatient basis. Medication Assisted Treatment (MAT) MAT uses FDA-approved medications in conjunction with mental health therapy to treat addiction. Individuals en
Angela Macon
I ve been on the program for 12 years, I ve had 3 awesome counselors. I stayed with one for 9 years, without her I wouldn t have made it. She was in recovery herself, so She understood me. It is pretty bad right now, with the employee turnover rate, and organization with the Hurricane season. But with anything there is good and bad. I am sure they will get it back together soon.People need to understand that they are highly critiqued by federal laws. But as long as you do what your supposed to, you will not have any problems.
Mobile Metro Treatment Center AL 36605 The facilities at Mobile Metro Treatment Center in Mobile, AL 1 The facilities at Mobile Metro Treatment Center in Mobile, AL 2

UChicago Medicine AdventHealth Bolingbrook

500 Remington Blvd Bolingbrook, IL 60440
3.9(1448 reviews)
UChicago Medicine AdventHealth Bolingbrook, located in Bolingbrook, Illinois is a private alcohol and drug rehab that offers treatment for a variety of substance abuse addictions including co-occurring mental health disorders. They offer supervised medical treatment to safely manage withdrawal symptoms during detoxification, residential care provid
Sandra Johnson
I was very pleased with the patient care that I received from the doctors and nursing staff. Housekeeping was always friendly when they came into my room. After my dietary allergies were discussed the staff helped with my daily menus.
AMITA Health Adventist Medical Center Bolingbrook IL 60440

Peace River Center – 1239 East Main Street

1239 East Main Street Bartow, FL 33830
3.7(33 reviews)
Peace River Center – 1239 East Main Street is a mental health clinic headquartered in Bartow, Florida. They provide trauma-informed and evidence-based mental health care and addiction treatment for adults. They offer 34 programs in 24 locations. Peace River Centers have sober living facilities, short-term crisis rehabilitation, outpatient addict
Cathy White
My son is in the beginning stages of his treatment and so far our experience has been nice.
Peace River Center - 1239 East Main Street FL 33830

AMITA Health Resurrection Medical Center Chicago

7435 W. Talcott Ave Chicago, IL 60631
3.7(292 reviews)
AMITA Health Resurrection Medical Center Chicago has a team of specialists who focus on treating the 'whole you' through various residential or inpatient addiction treatment programs. This center is found in Chicago, Illinois. They predominantly treat adults with cardiovascular and cancer issues. But they also tackle behavioral care that includes s
Lisa Clow
Very clean ER, very professional & attentive to my health issues. Staff very friendly & knowledge. Drs were great. Intend to return back if need be.
AMITA Health Resurrection Medical Center Chicago IL 60631

AMITA Health Adventist Medical Center GlenOaks

701 N. Winthrop Ave. Glendale Heights, IL 60139
3.7(728 reviews)
AMITA Health Adventist Medical Center GlenOaks, located in Glendale Heights, Illinois is a private alcohol and drug rehab that offers treatment for a variety of substance abuse addictions including co-occurring mental health disorders. They offer residential care providing long term support for addiction recovery, as well as flexible outpatient add
Naseha Khan
Very friendly and trusted staff.
AMITA Health Adventist Medical Center GlenOaks IL 60139

Family Center for Recovery

7051 Seacrest Boulevard Lantana FL, 33462
3.6(204 reviews)
Family Center for Recovery is a dedicated rehab for drug and alcohol addiction in Lantana, Florida. With residential and outpatient programs for adolescents and adults, they can help clients of almost any age take back their lives after addiction. They have the notable distinction of being the only rehab that’s owned and operated by a four-time b
Vlada Bazylevska
Our daughter is there for 3 weeks now and is showing more signs of improvement than we saw in years. Dr. Moran and the team really know what they are doing and have tools and desire to make a difference. Plus now we are more equipped then ever to keep on track for recovery once she comes back home, thanks to all education we received from FCRF. I finally have hope! I know if you are reading these reviews, you are desperate, same as I was a month ago. You don t need to be, don t wait! I recommend this place without reservation!Update: it has been almost 2 months after my daughter left FCFR and it s the healthiest 2 months we ve seen in a long while. She hasn t used any substances, found a part time job which she loves, graduated her failing semester with As and Bs and about to get her drivers license! It s not all rainbows and butterflies, we still need to work hard daily on keeping things on track, but now the hope is getting more real every day!10 months update: FCFR has truly been a game changer for us! Now my daughter is just a difficult (normal) teenager, but the disaster and desperation is so far behind, it s almost hard to recall how it has been. Now she is committed to getting better and going on with her life, and that s the most important part. Of course there will be ups and downs, but the terror of being constantly afraid for her and of her is far behind and I never ever want to go back. If we ever go back (it gives me anxiety to even write those words), we know who to call.One last thing. There are a lot of comments about lack of tender, love and care at the facility. TLC FCFR does not provide indeed. But they provide something better: treatment THAT WORKS. I m sure every story is different, but I m also sure a lot of people have experienced the same thing I did: TLC does not treat psychiatric illness.
Family Center for Recovery The facilities at Family Center for Recovery in Lantana, FL 1 The facilities at Family Center for Recovery in Lantana, FL 2

Halifax Health Medical Center

304 N Clyde Morris Blvd Daytona Beach, FL 32114
3.3(1107 reviews)
Halifax Health Medical Center, located in Daytona Beach, Florida is a private alcohol and drug rehab that offers treatment for a variety of substance abuse addictions including co-occurring mental health disorders. They offer residential care providing long term support for addiction recovery, as well as flexible outpatient addiction therapy allowi
Leandra Gonzalez
To be honest I had an amazing birthing experience here in the sense that your labor nurses are so caring and always making sure that you and your baby are okay and taken care off. I would definitely think about having your baby at this facility and doing research if you are pregnant. My labor nurse Tiffany was such a blessing.
The facilities at Halifax Health Medical Center in Daytona Beach, FL 2

Ascension Holy Family

100 N. River Rd. Des Plaines, IL 60016
3.2(143 reviews)
Ascension Holy Family Medical Center is a varied healthcare center in Des Plaines, Illinois that offers outpatient addiction treatment. The facility is actually primarily a long term acute care hospital for people who need a long hospital stay for medical conditions. But their outpatient substance use treatment program is an excellent resource for
Shivon Thurmon
Taking care of my brother nurses are very nice Housekeeping keep his room very clean
AMITA Health Holy Family Medical Center, Keys to Recovery IL 60016

The Bougainvilla House Family Therapy Center

1721 SE 4th Ave Fort Fort Lauderdale, FL 33316
3.8(13 reviews)
The Bougainvilla House Family Therapy Center, located in Fort Lauderdale, Florida is a non-profit alcohol and drug rehab that offers treatment for a variety of substance abuse addictions including alcoholism, co-occurring mental health disorders, and opiate addiction. They offer flexible outpatient addiction therapy allowing patients to live at hom
Ophik Parmat
Cici and Veronica are the best ...bottom line! If anyone feels any different contact me
The Bougainvilla House Family Therapy Center FL 33316

Peace River Center – 1260 Golfview Avenue

1255 Golfview Avenue Bartow, FL 33830
3.0(99 reviews)
Peace River Center - 1260 Golfview Avenue in Bartow, Florida, is a behavioral health center that provides substance use treatment to adults and adolescents. They are licensed and certified by the State of Florida to provide substance user services. They offer assistance to individuals who are struggling with addictions to illegal drugs, alcohol and
Michelle Meisinger
Karen Stewart is caring, she she helps you strategize a plan to help us get through issue we are dealing with at the moment
Peace River Center - 1260 Golfview Avenue FL 33830

The Institute for Family Health – Access Community Health Center

1420 Ferris Place Bronx, NY 10461
3.6(11 reviews)
The Institute for Family Health is in Bronx, New York. They provide full healthcare services with specialized treatment and care programs for those with behavioral, mental health and addiction issues. Their facility on Ferry Place in the Bronx is dedicated to behavioral health. They offer support, therapy, and programming for children, youth, and a
NADYA ORTIZ
Great, fast and polite staff. It s my first time being there and was very satisfied and happy that now I ll be a new patient in this center.

AMITA Health GlenOaks School, West Campus

940 Mooseheart Rd North Aurora, IL 60542
3.6(11 reviews)
In North Aurora, Illinois, residents can find AMITA Health GlenOaks Day School – West Campus, a drug and alcohol treatment center that supports adolescents with substance use disorders. AMITA Health (part of Ascension) also provides valuable community resources, such as primary care, psychiatric services, adult treatment, and family support servi
Shyanne Amour
Glen oaks really help me through my struggles and if your looking to send your kid here I highly recommend the staff were very supportive and they help me graduate on time..When I came to them I was at a freshman level which was 2019 and I graduated on time in 2021 as I was supposed to so I can highly say they are the best

Kingsbrook Jewish Mental Health

585 Schenectady Avenue Brooklyn, NY 11203
2.7(220 reviews)
Kingsbrook Jewish Mental Health, located in Brooklyn, New York is a private alcohol and drug rehab that offers treatment for a variety of substance abuse addictions including co-occurring mental health disorders. They offer residential care providing long term support for addiction recovery. Specialty rehab programs at Kingsbrook Jewish Mental Hea
Emily Mcclure
Kingsbrook took great care of a friend that was in need of emergency care. The staff was so attentive and compassionate to her needs and advised on a future plan of care to help address her ongoing battle with chronic pain.
Kingsbrook Jewish Mental Health Center NY 11203

UChicago Medicine AdventHealth GlenOaks School Pheasant Ridge Campus

43 E. Stevenson Dr. Glendale Heights, IL 60139
2.6(47 reviews)
The GlenOaks School and Transition Program is part of the University of Chicago Medicine and AdventHealth network. They’re an education campus for kids and teens with mental and behavioral learning difficulties. It’s located in Glendale Heights, Illinois. To be admitted, you’ll have to be diagnosed with a social and emotional disability. Thei
Lars H
Glen Oaks understands the needs of students with mental disabilities that might prevent them from accessing their education in a traditional way. They provide support and education in a setting that is suitable to the student. All our interactions with the staff and administration have been positive.
AMITA Health GlenOaks Day School - Pheasant Ridge Campus IL 60139

BayCare Behavioral Health- Life Management Center (Clearwater)

1106 Druid Rd S #201 Clearwater, FL 33756
2.5(58 reviews)
Located in Clearwater, Florida, BayCare Behavioral Health – Life Management Center (Clearwater) offers outpatient substance abuse and mental health treatment for young people and adults. They accept all Medicare supplement plans, many Medicare Advantage plans and many commercial insurance plans. The clinic is open on weekdays and works with c
Lauren F
I could not be happier with this facility. The front staff is always helpful and kind. My therapist is Ben. Ben is wonderful. He is very professional, gentle and he always has the right thing to say. Since I have been going here, I feel much better with my mental health. Thank you!
Baycare Behavioral Health Life Management Center - Clearwater FL

Ascension Saint Joseph – Joliet

333 N. Madison St Joliet, IL 60435
2.4(926 reviews)
Ascension Saint Joseph – Joliet, located in Joliet, Illinois is a private alcohol and drug rehab that offers treatment for a variety of substance abuse addictions including co-occurring mental health disorders. They offer supervised medical treatment to safely manage withdrawal symptoms during detoxification, residential care providing long term
Rosanne Leonard
I had excellent nurses. One that went above and beyond was Candy.very concerned with me and did things that weren t even her job. Everyone was very good that I had as far as nurses and rehab.
AMITA Health Saint Joseph Medical Center Joliet IL 60435

BayCare Behavioral Health – King Helie Adult Treatment Center

8002 King Helie Boulevard New Port Richey, FL 34653
2.3(66 reviews)
BayCare Behavioral Health – King Helie Adult Treatment Center in New Port Richey, Florida, offers recovery services for adults. They promote your physical and mental health by helping you make wise decisions. Outpatient counseling for mental health and substance abuse issues is provided on weekdays by appointment. They also offer group and indivi
DRIFT with me
This place treated me with respect and helped me literally every second of the dayThese people before me must have entitlement issues thinking these people have to help you or whatever listen just like promising if u don t like the facility don t do drugs the food ahh it wasn t the best but who cares ur not there to have fun it s a place to get ur life backIn my opinion this facility is doing a great job at helping people and I would deff send someone here for treatmentDr William is the shit nicest guy I ve ever met.Good job Baycare !!!!!4.5 stars only cause the food was 3.5 outa 10 but the treatment was 100%
BayCare Behavioral Health King Helie Adult Treatment Center FL 34653

BayCare Behavioral Health

7809 Massachusetts Avenue New Port Richey, FL 34653
3.0(16 reviews)
BayCare Behavioral Health in Port Richey, Florida offers mental health treatment, dual diagnosis treatment, and drug rehab services. Clients engage in a wide variety of programs that support them in mind, body, and spirit. BayCare Behavioral Health offers a person-centered approach to treatment. All individuals are treated with respect and provided
Crystal M. Burnside
Crowded at times but really nice staff
BayCare Behavioral Health FL 34653

Morton Plant North Bay Recovery Center

21808 State Highway 54 Lutz FL, 33549
2.0(111 reviews)
Morton Plant North Bay Recovery Center is an inpatient psychiatric facility in Lutz, Florida. They welcome voluntary and court ordered adults battling mental health conditions and dual diagnosis disorders. You can access a highly structured living environment with 24/7 care. Their facility offers short term care for people experiencing mental healt
Joselins LIFE
Hello, at the moment I have my daughter in that place, and the truth is she told me that she doesn't like the food, but it is part of the place, as I told her, they do activities, and other things, and I see that it helps her to be there, there is already taking his medications, and the truth is I think he learned his lesson.
Morton Plant North Bay Recovery Center FL 33549

The Coleman Institute

15101 E. Iliff Avenue Suite 250 Aurora, CO 80014
5.0(1 reviews)
The Coleman Institute is dedicated on providing a rapid detox to help those individuals detoxify from alcohol and opiates including Suboxone. They utilize Naltrexone Therapy. The Coleman Institute is located at Aurora, Colorado. The Coleman Institute is dedicated to developing treatments that are safe, comfortable and affordable for individuals, h
The Coleman Institute CO 80014

Memorial Hospital of Tampa :Psychiatric Treatment Center

2901 West Swann Avenue Tampa, FL 33609
5.0(1 reviews)
Memorial Hospital - Behavioral Health is located in Tampa, Florida. They provide inpatient and outpatient treatment programs to help adults overcome a range of conditions, including drug and alcohol addiction. Something that strikes me about this facility is the comprehensive nature of their inpatient program. This is a 67 bed unit that focuses on
Kenny Wetter
Because they loved me first....
Memorial Hospital - Behavioral Health FL 33609
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