Using Tufts Insurance to Pay for Addiction Treatment

Tufts Health Plan delivers high-quality, innovative health care coverage to more than 1.1 million members across Massachusetts, Connecticut, and Rhode Island.1 Based in Massachusetts, Tufts Health Plan boasts a network of over 110 hospitals and more than 51,000 health care providers.¹ Tufts offers a variety of coverage options, including plans that provide support for substance use disorders, encompassing both drug and alcohol addiction. Read on to learn more about Tufts Health insurance and how to use health insurance for addiction treatment.

Does Tufts Insurance Cover Substance Abuse Treatment?

Tufts Health Plan provides coverage for medications, office visits, and substance abuse treatment programs to members who need help recovering from addiction. With Tufts Health Plan, you have access to substance abuse specialists who can help you find a recovery program, answer any questions you have about the process, and provide information about insurance coverage.^2,3

The Mental Health Parity and Addiction Equity Act ensures that substance abuse treatment services are covered by insurance at similar rates to surgical and medical procedures.⁴ This means that with a Tufts Health Plan, you won’t have to worry about any barriers to treatment or additional costs. Tufts SUD treatment is aligned with their medical coverage; for example, you won’t have to pay a higher portion of costs for detox than you would for a medical surgery like an appendectomy.³

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

Types of Addiction Treatment Covered by Tufts Insurance

Tufts Health Plan may cover a variety of addiction treatment services, including:³

• Inpatient Medical Detox: You’ll undergo detoxification from drugs and/or alcohol under the careful supervision of medical professionals, who will administer medications as needed to alleviate symptoms and prevent complications.
• Inpatient Treatment: This approach offers a structured and supportive environment in a residential rehab setting, ensuring a substance-free atmosphere for recovery.
• Partial Hospitalization Program (PHP): This intensive outpatient treatment option involves numerous therapy sessions throughout the week, providing a high level of support.
• Intensive Outpatient Program (IOP): This program serves as a step down from PHP, requiring fewer hours of treatment per week while still offering intensive support.
• Outpatient Therapy: Regular outpatient therapy sessions allow you to focus on your recovery while managing personal responsibilities at home.
• Medication-Assisted Treatment: This approach uses medications alongside therapy, either short- or long-term, to reduce cravings and prevent relapse.

How to Use Tufts Insurance to Pay for Rehab

Enrollment in a SUD treatment program may vary based on your specific health plan. Some plans might require you to consult your primary care physician (PCP) for a referral before accessing treatment. Others may allow you to choose your treatment provider and schedule services independently, without needing a PCP’s involvement.⁵

If you’re uncertain about whether a PCP referral is necessary, you can contact the number on your insurance card for clarification. If a referral is required, be sure to obtain it before starting treatment to ensure your costs are covered.⁵

Additionally, Tufts may require prior authorization to approve your treatment and confirm it as medically necessary before you begin care. If you choose an in-network provider, they will typically handle the prior authorization for you. However, if you opt for an out-of-network provider, it’s your responsibility to ensure that they obtain this approval.⁵

Cost of Addiction Treatment with Tufts Insurance Coverage

The cost of addiction treatment can vary based on several factors, including:

• Your specific Tufts plan.
• The type of treatment you receive.
• Whether the rehab facility is in-network or out-of-network with Tufts.
• The length of your treatment stay.

Tufts Health Plan does provide some coverage for rehabilitation services, but out-of-pocket expenses may still apply depending on your specific plan. For example, you might be responsible for one or more of the following:⁶

• Copays: A fixed amount paid at the time of service.
• Deductible: The amount you need to pay out-of-pocket before your insurance starts covering services.
• Coinsurance: A percentage of the costs for covered services that you must pay.

Most health insurance plans have a yearly maximum for out-of-pocket expenses (excluding monthly premiums). Once you reach this limit, your insurance will cover any additional medical costs for the remainder of the plan year.⁶

If you don’t have insurance or are concerned about out-of-pocket costs, reach out to the staff at AdCare. They can assist you in exploring financing options, loans, and other payment solutions.

Benefits of Using Tufts Insurance for Rehab

Addiction is a significant issue across the United States, and many individuals in the New England region face challenges related to substance use disorders. In 2020, Rhode Island experienced the highest number of drug overdose deaths on record.⁷ Meanwhile, nearly 100,000 people in Massachusetts seek addiction treatment each year.⁸

AdCare operates treatment facilities throughout New England within the Tufts network. To initiate the rehab admissions process and use your Tufts coverage at an AdCare facility, you can quickly fill out the benefits verification form below. You’ll receive an email with your results within minutes.

Alternatively, you can contact our admissions navigators to explore various levels of care, including inpatient addiction treatment in Rhode Island and Massachusetts.