Simply Healthcare Insurance Coverage for Drug Rehab

Simply Healthcare began as a minority owned HMO and pioneered Medicaid specialty plans for those living with HIV/AIDS. It is now a wholly owned subsidiary of Anthem that continues to operate in Florida, contracting with the state government to offer Medicare and managed Medicaid plans. In addition to these, there are a few specialty plans you can get from them.

They have a Healthy Kids plan you can use to insure your non-Medicaid eligible children for affordable rates. If you’re eligible for Florida Medicaid and living with HIV, you can get a specialty plan from them through Clear Health Alliance.

Does Simply Healthcare Cover Addiction Treatment?

Simply Healthcare subcontracts their behavioral health benefits to a company called Carelon Behavioral Health. Through this arrangement, if you or your family have Simply Healthcare insurance, you’ll also have coverage for addiction treatment.

Both Medicare and Medicaid plans through Simply Healthcare provide access to addiction rehab and mental health treatment. The specific details of your coverage, including any deductibles or other out of pocket costs, will vary depending on your plan. It’s important to verify your coverage before committing to a treatment program.

Is Simply Healthcare Accredited?

Yes, many of their programs have been accredited by the NCQA. All of their Medicare Advantage programs have received accreditation. Accreditation extends to their Medicaid programs, including the Clear Alliance program for folks living with HIV.

The NCQA evaluates health insurance plans and accredits them if they reach certain quality benchmarks. They do that by looking at how their network measures up to industry and government standards in many different areas, including behavioral health.

What Type of Plans Does Simply Healthcare Offer?

Simply Healthcare offers a variety of Medicaid and Medicare plans to meet the unique needs of people living in Florida. The Medicaid plans include Managed Medical Assistance and long term care plans if you come from a low income family or are elderly or disabled. The plans provide health coverage for essential services like physician visits and hospital care along with prescription drugs.

Simply Healthcare also offers several Medicare Advantage plans to people who qualify for Medicare. These Medicare Advantage plans combine Medicare Part A and Part B with additional coverage. Many include benefits like dental and vision coverage along with prescription drugs. You can also get a Silver Sneakers fitness membership and coverage for hearing tests and hearing aids.

These Medicare Advantage plans include Health Maintenance Organizations and Preferred Provider Organizations along with Special Needs Programs.

Medicare HMO: Anyone eligible for Original Medicare can sign up for a Medicare Advantage HMO plan from Simply Healthcare. The program offers a stable and reliable network of doctors and care providers. You work with a primary care provider to help save money on visits and costs. Your primary care physician can help coordinate your care so you don’t make unneeded visits to specialists. HMO plans generally restrict coverage to the provider network except in an emergency. This structured approach helps control costs and ensures your care is well coordinated.

Medicare PPO: A Preferred Provider Organization offers more flexibility than an HMO. Members of a Medicare Advantage PPO can see any health provider but using an in network doctor or hospital will help reduce cost. You don’t need a referral to see a specialist. This makes it easier to access medical services but a PPO plan typically has higher premiums and out of pocket costs than an HMO.

Medicare SNP: Special Needs Plans are tailored to help when you have specific healthcare needs including chronic illnesses or dual eligibility for Medicare and Medicaid. These Medicare Advantage plans provide specialized coordination including access to a network of healthcare providers with experience treating your specific condition. SNP provides benefits like care management and additional support services to help improve your health.

Does Simply Healthcare Offer Specialty Coverage For Those Living with HIV/AIDS?

Yes if you have HIV/AIDS and qualify for Medicaid you can get Clear Alliance Health Plan by Simply Healthcare. The program offers a team approach to care and has been helping members since 2010 get access to services. When you qualify for the program you get a personalized treatment plan designed by a highly trained physician. You also work with one of the case managers to develop a customized plan to meet your health goals.

The plan benefits include those commonly found in Medicaid including medical care and vision care along with non emergency transportation services. The program also includes expanded benefits such as the Healthy Behaviors rewards program and the Taking Care of Baby and Me Healthy Rewards program. The Healthy Rewards program allows you to earn reward dollars when you complete certain activities, including weight management and smoking cessation.

What Types of Inpatient Rehab Does Simply Healthcare Cover?

Simply Healthcare provides coverage for inpatient rehab when it’s medically necessary. Your first step is to see your healthcare provider to ensure that not only is substance use disorder treated but also any underlying health conditions that may be associated with addiction. Your physician may include screenings for depression and other mental health conditions as well as assessments for alcohol and substance use.

Many times the next step is medical detoxification in an inpatient or residential care setting. Medical detox includes 24/7 monitoring and support alongside medications that help reduce the symptoms of withdrawal. This can help make you more comfortable and can reduce the potential for dangerous side effects that can occur during the withdrawal of certain substances.

Your inpatient or residential care is customized based on a comprehensive assessment of your addiction and drug use taking into account the severity of symptoms and the presence of any co occurring mental health conditions. Simply Healthcare typically offers coverage for co occurring disorders. Treatment is specialized and both mental health and substance use are addressed together to maximize your chance of recovery.

Your out of pocket expenses depend on the length of your treatment and insurance coverage. Many times substance use disorder treatment centers help verify your insurance coverage with Simply Healthcare. They can also estimate your potential out of pocket costs based on an initial assessment.

What Type of Outpatient Rehab Does Simply Healthcare Cover?

Coverage for outpatient rehab will be based on your medical need and treatment plan. There are multiple kinds of outpatient programs that can help you address substance use disorder and co occurring mental health conditions. Therapies can include cognitive behavioral therapy and motivational interviewing. You may also get dialectical behavior therapy and trauma informed care.

Your out of pocket cost will depend on several factors. Chief among them are your policy benefits and limitations. Other factors that affect your cost include the length of your treatment plan and the types of treatment you receive. Your insurance plan will focus on covering medically necessary care so it’s crucial you work with your primary care physician to develop a care plan that includes substance use disorder treatment.

Does Simply Healthcare Cover Methadone & Suboxone (MAT)?

Medication assisted treatment is a therapeutic approach to reducing symptoms of withdrawal from opioids or alcohol by using prescription medication to help control cravings and other drug triggers. These MAT programs help create a foundation for sustainable recovery and lower the chances of relapse.

Both Medicaid and Medicare plans offer some coverage for medication assisted treatment. MAT can be used during the detoxification process and throughout inpatient and outpatient therapy. Methadone and Suboxone are two commonly prescribed medications for opioid addiction.