Using Tufts Insurance to Pay for Addiction Treatment

Tufts Health Plan provides high-quality, innovative health care coverage to its over 1.1 million members in Massachusetts, Connecticut, and Rhode Island.¹ Headquartered in Massachusetts, Tufts Health Plan has over 110 hospitals and 51,000+ health care providers in its network.¹ Tufts offers a wide range of coverage options for its members, and plans do provide at least some coverage for substance use disorder (drug and alcohol addiction).

Read on to learn more about how Tufts Health insurance can help you or your loved one pay 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

Addiction treatment services that Tufts Health policies may cover include:³

• Inpatient medical detox. You’ll detox from drugs and/or alcohol under the safe supervision of medical staff who will provide medications as necessary to ease symptoms and prevent medical complications.
• Inpatient treatment. This form of treatment entails intensive structure and support in a live-in rehab environment free from substances.
• Partial hospitalization program (PHP). This high intensity outpatient treatment type involves many hours of therapy most days of the week.
• Intensive outpatient program (IOP). Another intensive form of outpatient treatment, this is a step down from a PHP and requires fewer hours of treatment per week.
• Outpatient therapy. Regular visits to outpatient therapy can help you keep your focus on recovery while living at home and attending to your personal obligations.
• Medication-assisted treatment. Combined with therapy, medications are used on a short- or long-term basis to lower cravings and prevent relapse.

How to Use Tufts Insurance to Pay for Rehab

Depending on your specific health plan, there may be different expectations for enrolling in a substance use disorder treatment program. Some plans may require you to see your primary care physician (PCP) first for a referral.  Other plans may allow you to pick your own treatment provider and schedule services yourself without PCP involvement. ⁵

If you’re unsure whether you need a PCP referral, you can call the number on your insurance card. If you do need a referral, make sure to get one before starting treatment or your costs may not be covered. ⁵

Tufts may need to approve your treatment and deem it medically necessary before you begin your care. This is called prior authorization. If you stay in network, the provider will obtain prior authorization for you. If you go out of network, you may be responsible for ensuring your provider obtains this approval.⁵

Cost of Addiction Treatment with Tufts Insurance Coverage

The cost of addiction treatment varies, depending on a number of factors such as:

• The specific Tufts plan.
• The type of treatment.
• Whether the rehab facility is in-network or out-of-network with Tufts.
• Duration of time spent in treatment.

Tufts Health Plan will provide some coverage for rehab, but there may be some out-of-pocket expenses you are responsible for paying, depending on the plan you have. For example, you may be responsible for one or more of the following:⁶

• Copays: a predetermined amount that is paid at the time services are provided.
• Deductible: the amount that needs to be paid by the member before insurance begins paying for covered services.
• Coinsurance: A percentage of covered services you are responsible for paying.

Most health insurance plans have a yearly maximum for out-of-pocket expenses (not including monthly premiums). This means that if you reach this amount, insurance will cover all additional medical costs until the end of your plan year. ⁶

If you don’t have insurance or are worried about out-of-pocket costs, reach out to the staff at AdCare. They can help you explore financing, loans, and other payment options.

Benefits of Using Tufts Insurance for Rehab

Addiction is an epidemic throughout the United States, and many individuals in the New England area struggle with substance use disorders. Rhode Island saw more drug overdose deaths in 2020 than any year on record.⁷ In Massachusetts, nearly 100,000 people in Massachusetts enter addiction treatment each year.⁸

AdCare has treatment facilities in New England in the Tufts network. To begin the process of using your Tufts coverage to enter an AdCare facility, you can take just a few seconds to fill out the benefits verification form below. You will get an email with results within minutes of completing the form.