Using Humana to Pay for Addiction Treatment

Do you have a Humana insurance plan and wonder whether Humana covers rehab for drug or alcohol addiction? We’ll help you understand what you need to know and even help you verify your plan benefits today. Continue reading to learn more about Humana insurance and how to use it to pay for treatment.

Does Humana Insurance Cover Substance Abuse Treatment? 

Yes. Humana covers substance use disorder treatment.^1,2 Humana offers insurance plans both on and off the insurance marketplace.

If you purchased a Humana plan on the marketplace, the Affordable Care Act requires the plan to cover addiction treatment. The ACA mandated that each of the following be considered “essential health benefits”:³

• Behavioral health care (e.g., psychotherapy).
• Mental and behavioral health inpatient services.
• Substance use disorder treatment.

Addiction treatment coverage in both marketplace and group plans must be no more restrictive than coverage for primary health services.³ The exact amounts of coverage will vary according to your specific Humana plan. Typically, only services deemed “medically necessary” will be covered. Humana defines medical necessity as the type of care that a qualified medical professional deems necessary or appropriate.⁴

AdCare Rhode Island, located in North Kingstown, RI, is in-network with Humana. To verify your coverage and find out what types of care your plan may cover, you may fill out our .

How to Use Humana to Pay for Rehab

When using Humana to pay for rehab at AdCare, you can begin by providing some very basic information, which includes:

• Your name.
• Phone number.
• Email.
• Insurance carrier and member ID.

Once you’ve input this information in our online benefits verification form, you’ll receive a response within minutes that will verify your coverage and let you know what kinds of treatment you may receive at our facility.

If you would like immediate help, you can also skip this step and call us now at to speak to an admissions navigator, who will help you understand and explore your treatment options and understand your benefits. Our caring and knowledgeable staff will go over all the details with you and help you through the process—all you need to have on-hand is your insurance card.

Be aware that treatment may require pre-authorization. When a covered service requires pre-authorization (or pre-approval), receiving treatment without first going through this step may result in a denial of coverage. The facility from which you receive treatment can help you receive pre-authorization before admitting you into a program.

How Much Does Addiction Treatment Cost with Humana? 

The cost of substance use disorder treatment will depend on factors such as:

• Your specific Humana plan.
• The type of treatment you receive.
• The duration of your treatment.

Staying in network will minimize your out-of-pocket costs, or the treatment costs that your insurance won’t cover. Out-of-pocket costs are influenced by such factors as:⁵

• The deductible. This refers to the amount you must pay for a covered service before your insurance kicks in and begins to pay.
• Copays: The amount you pay at a treatment provider or pharmacy at the time of service.
• Coinsurance: The percentage of costs you’ll be responsible for paying after you’ve met your deductible. For example, if your insurance pays for 80% of an inpatient stay, you’ll be responsible for the remaining 20%.
• Out-of-pocket maximum: The maximum amount you will have to pay in a plan year, including deductibles and copays. Once this maximum is reached, Humana will pay 100% of costs for covered services.

Insurance can be confusing, but we’re here to help. You can contact us any time to speak with someone who can help you understand your costs and what your plan covers.

Which Types of Rehab Does Humana Cover?

Humana plans differ, and your coverage will be based on both your plan and what treatment is “medically necessary” for you. Types of substance use disorder treatment that may be covered by Humana include: 

• Medical detox (withdrawal management).
• Inpatient rehab.
• Outpatient treatment, such as:
  • Partial hospitalization.
  • Intensive outpatient program.
  • Outpatient therapy (in-person or telehealth).

AdCare has treatment programs across Rhode Island and Massachusetts, with one inpatient facility in each state with medical detox available for those who need it.

Benefits of Using Humana to Pay for Addiction Treatment 

Substance misuse is a problem for many New Englanders, as illustrated by the following statistics: 

• There were more than 2,000 confirmed opioid overdose deaths in Massachusetts in 2020.⁶
• Accidental overdose deaths in Rhode Island reached a record high of 384 in 2020. The record number was driven by increasing cocaine use, adulteration of drugs such as heroin with fentanyl, and alcohol.⁷
• In 2020, New Hampshire saw more than 25 overdose deaths per 10,000 residents.⁸
• Vermont had one of the highest rates of alcohol consumption among adults 18 years old and older of all states in 2019 at nearly 64%. That year, more than 18% of adults engaged in binge drinking, and more than 9% met the criteria for heavy drinking.⁹
• Massachusetts, New Hampshire, Connecticut, and Rhode Island were also among the top states with regard to the rate of alcohol consumption among adults in 2019.⁹

Fortunately, Humana insurance provides you with an avenue to seek help when you need it. If you’re struggling and you need help, your Humana benefits may cover you for lifesaving treatment. To start the process and verify your benefits today, simply fill out the form below and we’ll contact you in a matter of minutes.