WellCare Health Insurance For Addiction Treatment

Wellcare has been in business for more than 20 years and they offer Medicare Advantage and Medicare Prescription Drug Plans (PDP). The company operates in all 50 states and helps you find affordable coverage that adds to or goes beyond Original Medicare. They are a fully owned subsidiary of Centene Corporation.

Wellcare serves 1.2 million members through Medicare Advantage and 4.1 million PDP plan members. They offer multiple benefits in their Advantage plan such as dental services and telehealth visits as well as in home support and more.

Does Wellcare Cover Addiction Treatment?

Medicare Advantage plans are required to cover at least as much as Original Medicare which means that there is at least some coverage for addiction and mental health due to the Affordable Care Act.

However because Medicare Advantage plans are offered by private insurers and not the government they may have different limits and requirements for coverage. Be sure to get the full details of your plan before committing to treatment. Also, you may need a referral or preauthorization and you may need to find a rehab that’s within the plan’s provider network.

Insurance focuses on paying for medically necessary care so be sure to work closely with your doctor to create a treatment plan that’s specific to your needs. That will allow you to look for the right kind of rehab program to start with and will provide proof of medical necessity to insurance.

What Plans Does Wellcare Offer?

Wellcare offers Medicare Advantage and Medicare Prescription (Part D) plans.

The Advantage options have four types. The plan can be an HMO or PPO. It may also be a D-SNP or C-SNP plan if you qualify.

The Medicare Advantage HMO plans focus on access to care and affordability and offer more benefits than the Original Medicare. Wellcare offers a variety of HMO plan options and all come with personal daily support. HMO plans provide coordinated care through a network of providers. You will need to designate a primary care provider who can make referrals to specialists such as addiction counselors on your behalf.

Wellcare PPO plans give you more flexibility than an HMO. Not only do you continue to get additional coverage beyond Original Medicare but you also don’t have to worry about a primary care provider or getting referrals to specialists. However certain types of care might still need preauthorization. With a wide network of doctors and providers as well as specialists and hospitals the PPO plans give you the freedom to choose the providers that work best for you. You can even get coverage outside the provider network but you will pay significantly more out of pocket.

D-SNP plans are a special type of Medicare Advantage plan specifically for those who qualify for both Medicare and Medicaid. With this specific plan, you may be eligible for the EXTRA HELP program which will provide cost support for prescription drugs. You don’t need referrals for in network specialists but you do for out of network care. Additionally with D-SNP you can receive extra coverage for mental health services because your benefits will be based on Medicaid coverage as well as Medicare.

Wellcare’s Chronic Condition Special Needs Plan (C-SNP) provides coverage to manage chronic conditions like diabetes or cardiovascular disease or congestive heart failure. This plan is designed to provide savings on medical necessities such as insulin or other prescriptions. You’ll also receive coordinated care to help manage your condition. With this plan, you will select a primary care provider who will get to know your needs and will coordinate your care with other providers. They will also help you develop a personal care plan. You’ll have access to a care manager who will help you overcome obstacles associated with your condition as well as day to day struggles.

What Inpatient Addiction Treatment Does Wellcare Cover?

Insurance will focus on what is medically necessary which is why it is important to have a referral and treatment plan from your primary care provider.

Each treatment program is different but most of them will require some form of pre assessment prior to admission. Some programs will complete an ASAM assessment with you to determine your needs and mindset regarding treatment. Residential care can be recommended if you’re actively using substances or need a medical detox process.

Often programs have a medical detox unit and residential services that go hand in hand. This helps provide a smooth transition as you work on building toward recovery. During treatment you’ll receive evidence based care in a secure environment where you can focus fully on treatment with no outside distractions.

What Outpatient Rehab Does Wellcare Cover?

There are different types of outpatient services for substance use treatment that may be covered by Wellcare.

A partial hospitalization program (PHP) offers a very structured outpatient program. They have therapy in group or individual settings and may also offer medication management and additional support services.

With intensive outpatient (IOP) services treatment is still structured but it’s less intensive than a PHP. An IOP still offers evidence based treatment to help you establish long term recovery. Once you finish treatment you may be set up with aftercare services. This will give you ongoing support through therapy and case management as well as medication management if needed.

Does Wellcare Cover Methadone & Suboxone (MAT)?

Some form of Medication Assisted Treatment (MAT) have been covered by Medicare plans since around 2006. MAT can be used for both medical detox and ongoing treatment of opioid and alcohol use.

During detox services MAT medications are used to help alleviate painful withdrawal symptoms and help you slowly wean off of drugs so the detox process is not such a shock to your body.

For ongoing treatment you can be prescribed a variety of different medications depending on your specific addiction. If you are dealing with an opioid or alcohol use disorder you may be prescribed Methadone or Buprenorphine or Naltrexone. Each of these medications helps stabilize you and manage cravings so you can fully focus on treatment. MAT usually coincides with therapy and additional support services. Over time you establish yourself in recovery and you can wean off the medication support to live a fully substance free life.

Does Wellcare Cover Other Mental Healthcare?

If you are struggling with a mental health disorder alone or alongside addiction concerns your Wellcare insurance plan will provide coverage. You will likely have the option to receive medication and therapy services to treat your specific diagnosis(es). There are also emergency options for treatment such as crisis services which may be covered under your specific plan.

It is common to have a co occurring disorder which is a mental health diagnosis coexisting with a substance use disorder. It is important to treat both of those together to be successful in long term recovery. This helps you address underlying issues that can be associated with your addiction.

Wellcare Medicare Advantage plans will cover mental health treatment because of the Affordable Care Act (ACA) however there may be limits on coverage and requirements you need to meet. Make sure you know the full details of your plan before starting treatment.

How Long Will Wellcare Pay for Rehab

Each person is different and your specific medical need(s) and the doctor’s treatment plan will determine how long your insurance will pay for rehab.

In some cases there are limits on the number of days treatment is covered but it varies from plan to plan. There are other things that can be taken into consideration as well such as the standard length of a treatment program and your progress in the rehab process.

Can I Travel Out of State For Treatment With Wellcare?

Traveling out of state can be enticing but whether you can get coverage out of state will depend on your specific plan. For Wellcare the HMO plans do require that you stay within the defined provider network which means out of state care is generally not covered. The only time this differs is for emergency care.

For the Wellcare PPO plans there is an option for out of network coverage but you will pay significantly more in your deductibles and copayments. It is best to stay in network for treatment if possible. This will maximize your benefits. It is equally important to verify your insurance details before committing to a specific program.

How to Verify Coverage With Wellcare

You can verify your coverage in multiple ways. You can contact the insurance company directly using the customer service number. You can also log into your online account to find coverage information and in network providers.

One other option is asking your desired treatment program if they take your insurance. It is important that you state your exact plan name due to the wide variety of plans. It is also a good idea to keep a copy of your card handy so providers can better serve you if you have questions or concerns regarding your coverage.

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

In most cases you will be able to find a provider within your network coverage. However if you want to do a treatment program out of the network and there’s no coverage you may need to figure out how to cover the cost of a rehab program. It is important that you get the care you need.

Some programs will offer different payment options such as sliding fee scales based on income or a payment plan that allows you to spread out the cost. You may be able to find a program that offers grants or scholarships.

There are also state and county funded programs or you might have friends and family that would help you pay for rehab. Additionally there are low cost or work based rehabs where you work in the program instead of paying for treatment.