GEHA Insurance Coverage for Addiction Treatment

Drug addiction is a major problem that destroys most families and communities. With the introduction of the Mental Health Parity Addiction Equity ACT 2010, addiction is now an illness. Therefore, insurance coverage companies must cover the cost of addiction treatment. The difference in coverage depends on a number of variables.

FAQ’s about GEHA addiction treatment coverage

The following questions are important to ask to understand your coverages:

  • What they cover?
  • How much do they cover?
  • How long do they cover?
  • What areas do they cover?
GEHA insurance coverage for addiction treatment

GEHA has different health plans. Some cover alcohol recovery only, while other plans cover substance abuse, rehab, and detox.

Before learning more about GEHA insurance, it is important to understand some important terms such as:

  • Out of pocket costs- costs paid directly by the policyholder
  • Out of pocket limit- it is the maximum fee that the policyholder should pay before the GEHA insurance covers the full cost of the treatment
  •  Premium- Payment made by the policyholder to maintain their subscription
  • Deductible- the total amount the policyholder must pay before the insurance cover starts working
  • Coinsurance- the total amount of fees the holder should cover after reaching the deductible threshold.

GEHA Alcohol and Drug Treatment Insurance Plans

Some GEHA policy plans will cover the cost of detox but will not cater to the rehab cost. Others may cater to specific activities of the rehab. Coverage limits depends on various factors, such as the type of facility and the plan you choose.

The plan you choose also decides on the length of treatment. Some plans cover the treatment for a limited time. Others only cater to some percentage of the total cost, while some cater to all recovery program costs.

Standard Plan

The standard plan of GEHA insurance covers certain costs in inpatient and outpatient treatment focused on substance abuse. The plan also caters to part of the prescription medication costs and rehab. However, it puts a limit to 60 visits yearly.

The individual plan under the standard option comes with a deductible of $350 and an out-of-pocket limit of $8500. Once you meet the deductibles, GEHA insurance covers 65% of the total costs for treatment at the facility.

GEHA standard plan covers:

  • Inpatient and residential addiction for up to 28 days
  • Drug and alcohol detox
High Plan

The High Option Plans have similar deductibles to the standard plan, but individuals pay more monthly premiums. It offers favorable out-of-pocket limits of up to $7000 for individual plans and, 25% coinsurance rate for the facility’s services. Once you meet your deductible, expect the GEHA insurance to cover almost 75% of the total costs of addiction treatment.

One must get a pre-certification under the high plan to avoid increasing the coinsurance rate or denial of services. The authorizations aspect is the dedicated caseworker’s responsibility at the rehabilitation center.

GEHA Policy Options and Their Costs

Drug treatment facilities are different in terms of the services they offer. These facilities offer different levels of services. Some also have a special treatment that would cost more than other facilities. Most special treatment centers provide more luxurious and executive services, such as private rooms in serene surroundings.

One of the things that makes GEHA Insurance stand out for the better is that they cap deductibles and coinsurance payments annually. The caps differ depending on the plan you choose, and people who require special treatment may pay more. However, your out-of-pocket will not exceed the following costs depending on your plan:

  • In-network standard plan- $5000
  • Out-of-network standard plan- $7000
  • In-Network high option plan- $4000
  • Out-of-network high option- $6000
  • Family plans HDHP- $10,000
  • Individual plans HDHP $5000

How Avenues Recovery can help navigate your GEHA Insurance Benefits

Addiction recovery fully depends on one’s decision. The moment you decide to end the addiction problem, you will go through a detoxification process. The detox process gets rid of all harmful substances from your body.

Avenues Recovery offers all the phases of addiction treatment covered by GEHA. After the detoxification process, you will decide on inpatient or outpatient rehab. For outpatient, you will need to stay at home and continue with your normal life, such as work. However, you will have to attend rehabilitation programs and therapy sessions. If you choose the inpatient option, you will stay within the facility and be part of a community. It will allow you to focus on the recovery journey.

GEHA insurance will cater to inpatient and outpatient treatment, and it will depend on the plan, need, and personal situation.   

Treating addiction problems is not an easy task. The introduction of drug addiction insurance cover helps reduce the cost of addiction treatment. Each rehabilitation center offers services that can cater to all your problems. Call Avenues Recovery today to help you understand your eligibility. One of our dedicated specialists will guide you through the the process and ensure that you or your loved one gets the addiction treatment that will change your lives.

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Brooke Abner,

Motivational Coach