Using Tufts Insurance to Pay for Addiction Treatment

If you have Tufts Health Plan and you or someone you love is struggling with addiction, help may be more accessible and affordable than you think. Tufts Health Plan addiction treatment coverage includes inpatient rehab, detox, outpatient programs, and medication-assisted treatment at AdCare, an in-network provider across New England.

Addiction does not wait for a convenient moment. It touches people in every zip code, every family, every stage of life. If you have been putting off getting help because you are worried about cost or do not know where to start, this guide is for you. Tufts Health Plan covers substance use disorder treatment, and AdCare is here to help you use those benefits.

State of the art care for patients with substance/alcohol use disorder is delivered by a multidisciplinary team of providers to address physical/addiction, mental health and social determinants of health. Our coverage includes the key elements of that kind of care. It is essential that you confirm that with our staff and that of your addiction center to be sure you get the care that you need and it is covered by your plan.

Does Tufts Insurance Cover Substance Abuse Treatment?

Yes. Tufts Health Plan covers substance abuse treatment for its members. This includes office visits, medications, and structured treatment programs for both drug and alcohol addiction.

Two federal laws protect your right to this coverage. The Affordable Care Act (ACA) requires all marketplace health plans to include mental health and substance use disorder treatment as one of ten essential health benefits. 

The Mental Health Parity and Addiction Equity Act (MHPAEA) goes further, requiring that addiction treatment be covered at the same rate as medical and surgical procedures. That means Tufts cannot charge you more for a week of detox than for a comparable medical hospitalization.

Tufts has also partnered with Spectrum Health Systems to administer substance use disorder care. Spectrum specialists can help you navigate treatment options, find a program close to home, and understand your coverage before you commit to anything.

For more on how federal law protects your access to addiction care, see SAMHSA’s guide to the Mental Health Parity Act.

You can check your Tufts Health coverage for rehab by filling out our .

Is AdCare In-Network with Tufts?

Yes. AdCare Treatment Centers are in-network with Tufts Health Plan. That matters because in-network care is billed at a discounted rate that Tufts and AdCare have pre-negotiated. When you use an in-network provider, you pay less out of pocket, and your coverage goes further.

AdCare operates treatment facilities across Massachusetts and Rhode Island, including inpatient care in North Kingstown, RI, and Worcester, MA, plus outpatient locations throughout both states. Because AdCare is within the Tufts network, prior authorization is typically handled by AdCare on your behalf, which takes one more task off your plate during an already difficult time.

You can verify your coverage instantly at AdCare’s insurance verification page or by calling the admissions team directly.

What Types of Addiction Treatment Are Covered?

Tufts Health Plan may cover a range of treatment services depending on your specific plan and clinical needs. Here is a breakdown of what is commonly included:

You can verify your coverage instantly at


AdCare’s insurance verification page


or by calling the admissions team directly.

What Types of Addiction Treatment Are Covered?

Tufts Health Plan may cover a range of treatment services depending on your
specific plan and clinical needs. Here is a breakdown of what is commonly
included:

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You can verify your coverage instantly at


AdCare’s insurance verification page


or by calling the admissions team directly.

What Types of Addiction Treatment Are Covered?

Tufts Health Plan may cover a range of treatment services depending on your
specific plan and clinical needs.

Tufts also offers Naloxone (Narcan) with no prescription required and no copayment for covered members. This life-saving medication can reverse an opioid overdose and is an important harm-reduction resource for families.

Learn more about treatment levels at AdCare Rhode Island and AdCare Massachusetts.

How Much Will Treatment Cost with Tufts?

Your actual out-of-pocket cost depends on several factors tied to your specific Tufts plan. Here is what to keep in mind:

• Copays: A flat fee you pay at the time of service, such as $30 for an office visit.
• Deductible: The amount you pay before Tufts begins sharing costs. Once met, your costs drop significantly.
• Coinsurance: Your percentage share of covered costs after your deductible is met, typically 10 to 30 percent.
• Out-of-pocket maximum: A yearly cap. Once you reach it, Tufts pays 100 percent of covered services for the rest of the plan year.
• In-network vs. out-of-network: Using in-network providers like AdCare always costs less.

Because Tufts must follow the Mental Health Parity Act, your addiction treatment cost-sharing should mirror what you would pay for medical care. You should not face a higher deductible or coinsurance rate for rehab than you would for surgery.

If you are concerned about remaining out-of-pocket costs, AdCare’s team can walk you through financing options and payment plans. Cost should never be the reason someone does not get the help they need.

How to Use Your Tufts Insurance at AdCare

The process is designed to be simple. AdCare handles most of the insurance work for you.

• Call AdCare at 866-739-7692 or fill out the online benefits verification form at adcare.com.
• An admissions navigator will contact Tufts on your behalf to confirm your plan, coverage level, and any prior authorization requirements.
• You will receive a clear summary of estimated costs before you begin treatment.
• If a PCP referral is required by your specific Tufts plan, the team will flag that early so there are no delays.
• Once coverage is confirmed, AdCare works with you to schedule intake, which can happen the same day in many cases.

Some Tufts plans require a referral from your primary care physician (PCP) before accessing treatment. Others let you choose a provider directly. If you are unsure which applies to your plan, call the member services number on the back of your Tufts insurance card or let AdCare’s team check for you.

You can also review benefits online at Tufts Health Member Connect.

Tufts Coverage Comparison by Treatment Type

The chart below summarizes how Tufts Health Plan typically covers each level of addiction care and what to expect. Coverage details always vary by plan, so verify your specific benefits.

Why New England Families Need Access to This Care

Substance use disorder is one of the most pressing health challenges in Massachusetts and Rhode Island. The numbers are hard to look at, but they matter.

• Rhode Island recorded its highest number of drug overdose deaths in 2020, according to state health data.
• Nearly 100,000 people in Massachusetts seek addiction treatment each year.
• More than 8 million American adults live with both a mental health condition and a substance use disorder simultaneously.
• Untreated addiction drives higher rates of job loss, family disruption, and preventable death.
• Research shows that treatment lasting at least 90 days significantly improves long-term outcomes.

Behind every statistic is a real person and a real family. Getting help early matters. Having insurance coverage that works matters. AdCare has served New England communities for decades because people here deserve a local, trusted option for recovery.

Find addiction resources in your state through SAMHSA’s treatment locator or the Massachusetts Help Line, a free and confidential statewide resource.

Get Help Today

You made it to the end of this page. That matters. It means part of you is ready to take the next step, even if another part is still unsure. That is exactly where most people are when they call AdCare.

You do not need to have everything figured out before you reach out. The admissions team is trained for this moment. They will answer your questions, check your Tufts benefits, and help you understand what comes next, without pressure and without judgment.