Optimum Healthcare Coverage for Drug & Alcohol Addiction Treatment
Discover how Optimum HealthCare’s Medicare plans cover addiction treatment. Learn about coverage options, verification process, and more.
Optimum Healthcare Coverage for Drug & Alcohol Addiction Treatment
Discover how Optimum HealthCare’s Medicare plans cover addiction treatment. Learn about coverage options, verification process, and more.
Optimum HealthCare provides Medicare Advantage plans to eligible individuals. Medicare Advantage Plans replace Original Medicare Parts A and B, offering benefits such as fewer bills, lower premiums and copays, and access to more benefits.Optimum HealthCare was founded over 15 years ago to deliver quality and comprehensive benefits that are affordable and meet the diverse needs of seniors and people with disabilities.
Optimum HealthCare operates under the umbrella of HealthSun Health Plans, which is part of Anthem, Inc (now Elevance). This is one of the largest health insurance companies in the U.S. This affiliation allows them to leverage the extensive resources and expertise of Anthem to deliver high standards of care and customer service to their members.
Does Optimum HealthCare Cover Addiction Treatment?
Yes, Optimum HealthCare policies are required to cover at least as much as Original Medicare. Original Medicare provides coverage for addiction and mental health treatment as an essential service defined by the Affordable Care Act. As a result, Optimum HealthCare will also have coverage for various mental health and addiction treatment services.
The specifics of this coverage will vary depending on your plan, so it’s important to verify your insurance before committing to a treatment program. Also, Medicare Advantage plans often require you to use the provider’s network, so you’ll want to make sure you choose the rehab center accordingly.
AlcoholismDrug AddictionOpioid AddictionSubstance AbuseDual DiagnosisMental Health And Substance Abuse
Adult ProgramYoung Adult ProgramProgram For MenProgram For Women
Self-Pay OptionsPrivate insurance
This place helped me when I felt like no one could, 5 stars to the techs, 5 to the therapists, and 5 to case management will love you guys for ever.
kyle Buchmaier
6 days ago
My experience at All in Solutions was absolutely the best it could be given the situation. The staff were absolutely amazing. With this course of recovery I've been given the keys for a bright future. It's up to me to put my training to work in in my life.
AlcoholismDrug AddictionMental Health And Substance AbuseOpioid AddictionSubstance AbuseDual Diagnosis
Adult ProgramProgram For MenProgram For WomenYoung Adult Program
Private InsuranceSelf-Pay Options
My experience at All In was amazing! I love all the staff. They were definitely wonderful to be around. Jess being one case manager for all the clients is beyond unbelievable and she is truly a God send!!! ❤️ 😍
Michelle Mullen
3 weeks ago
My experience with All in Solution was life changing. I went through detox and residential to prepare me for on going therapy. I had great nurses techs and patient support through tough days and such support for the family atmosphere I experienced. I am grateful for everyone that helped me there and would recommend to anyone that wants to get sober and learn how to stay sober through their program
Lisa Lunn Green
3 weeks ago
All in solutions is the best , if you need to get straight , it's the place to go , I highly recommend it 👍
Good people... Both the other clients and staff were supportive and caring...the food was terrible...and communication between departments could be improved. I feel my needs were met adequately and I was giving the tools and resources to continue in my recovery
This place gave me my life back! If you are ready to change & have a new chance at life this is the place to come.
Gabriel Lavigne
2 weeks ago
This place really does go above and beyond for people. I have never felt so understood and heard before. They made it feel so personal and real. They allowed me to find myself and really heal. Shout out the angel Cruz for all his help as well ✌️ I owe you guys my life.
Serenity Springs Recovery truly saved my life. When I went through their inpatient program, I gained the strength, guidance, and tools I needed to finally turn things around. I have been sober ever since my stay there, and I continue to use the lessons I learned every single day. The staff genuinely cared and went above and beyond to support me on my journey. I am extremely grateful for my time at Serenity Springs and for the new life it helped me build. I highly recommend them to anyone seeking real recovery.
Anthony Gomez
2 months ago
Beautiful Facility, Staff was mostly friendly, professional & helpful. Most patients were nice; few bad apples; but expected. Learned a lot & really glad I went. I would highly recommend it to others. 👍😎 Martin
Martin Dodge
6 months ago
This place was amazing it really changed my life 70 days sober now
The experience with Never Alone was a breath of fresh air. My 16 year old son completed his journey 11/19 and came home with a whole new perspective on life and his future. His clinical technician Karissa was a wonderful aide in the process dealing with my son. The family sessions were a great opportunity for me, my son and his mom to work on communicating with one another which was hard to accomplish before our sessions but Karissa helped navigate that and allowed us to grow through our sessions. The weekly parent groups were a very helpful resource and tool as well. I appreciate all the support and encouragement the staff at Never Alone gave to my son and salute them for taking their time to guide my son through his journey.
Simione Corbett
2 weeks ago
My daughter spent over 2 months at Never Alone on her recovery journey. We can't say enough great things about the staff and the facility. The staff communicated well and provide support for the entire family. They have been the biggest step and help in her recovery, they provided her with tools she can use in her daily life to stay on tack to help cope with hard things that happen in life. She says now that this was the best thing that could have been provided to her while in addiction.
Lucy Vilamaa
1 month ago
Never Alone brought back the child that was lost in drugs and addiction. We can't say enough about the staff and the facility. They loved and cared for her so well provide her with all the things she needed in her recover and helped her find herself again and provided her with the knowledge she needed to start her recovery. The staff cares about their jobs, care for the kids their wellbeing and their success in recovery and it shows in their dedication and interaction with the kids. Never Alone has provided her a new opportunity at life.
Serenity Springs Recovery truly saved my life. When I went through their inpatient program, I gained the strength, guidance, and tools I needed to finally turn things around. I have been sober ever since my stay there, and I continue to use the lessons I learned every single day. The staff genuinely cared and went above and beyond to support me on my journey. I am extremely grateful for my time at Serenity Springs and for the new life it helped me build. I highly recommend them to anyone seeking real recovery.
Anthony Gomez
2 months ago
Beautiful Facility, Staff was mostly friendly, professional & helpful. Most patients were nice; few bad apples; but expected. Learned a lot & really glad I went. I would highly recommend it to others. 👍😎 Martin
Martin Dodge
6 months ago
This place was amazing it really changed my life 70 days sober now
The faculty and staff are very helpful and caring!
jeremy batchelor
3 weeks ago
The Indy facility is the best rehab ever gone to outta more than I can count on my fingers. The staff there are super caring and will do everything they're allowed to help u get thru the process. The director there is one of the most understanding people I've ever met in all the rehab community. I would recommend going there. Most rehab I wouldn't send people I don't like to them but not here.
Seth Brown
3 weeks ago
Had an emergency they listened and willing to help. Thomas was great he called, sent text to make sure we were safe and able to make the next step.
John Paul, I had a great experience here at the haven west Memphis!!! If you need a quite therapeutic medical detox from alcohol or substance, I highly recommend this place!! You have your own room with privacy , tv, nothing is required your meals are brought to you they have a kitchen with 247 drinks snacks ect! Like I said this isn’t the “old days” where they lock you in a room with know meds .. you are medical detox you see a dr every day what else is there to say .. it truly is a therapeutic environment with the kindest staff I’ve met in any facility , also they got me lined out with a sober living home and php my 3 rd day !!! So if yall are struggling please contact the haven west Memphis they will even come get you and drop you off ! Thank you haven west Memphis John p
John Paul
2 weeks ago
This place really is a nice vacation if you let yourself see it that way. Great, friendly staff. Good food. Really helpful in learning healthy communication and coping skills, and learning how to utilize them in the real world going forward. Only 4/5 because I had some mix ups with my meds but nothing too serious. I highly recommend the Haven.
BRADLEY PEARSON
3 weeks ago
This an excellent place to come to if you are looking for a mental health place that has staff that actually cares for you! Great great place
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Frequently Asked Questions
What Are Optimum HealthCare Plans?
Optimum HealthCare offers Medicare Advantage HMO plans. These plans cover everything Original Medicare covers and include prescription drug benefits that Original Medicare members have to buy separately. The Advantage plans also generally have additional benefits not covered by Original Medicare, such as dental, vision, hearing, and fitness programs.
Other benefits of Optimum HealthCare plans include preventive services at no cost to you and a personal emergency response system that includes a monitoring device so you have access to help around the clock.
The Optimum Medicare Advantage plan may also include 30 hours each year of in-home support, offering technology assistance, virtual services and companionship.
Another key feature of Optimum HealthCare plans is their emphasis on preventive health measures. They encourage you to get regular health screenings, vaccinations, and wellness visits to maintain your health and detect problems early.
A strong emphasis is placed on this proactive approach and customer service, offering support to help you navigate the healthcare options in your area and make informed decisions about coverage. The Optimum HealthCare Medicare Advantage HMO plans are designed to provide you with comprehensive care while helping manage your costs effectively.
What Types of Rehab Treatment Are Covered By Optimum HealthCare?
All insurance plans focus on covering medically necessary care, so it’s important to get a treatment plan from your doctor. Some of the covered services in your Medicare Advantage plan from Optimum HealthCare could include:
Detoxification Services: Detoxification includes medical supervision to help you safely manage withdrawal symptoms. These programs often offer medical care which includes prescription drugs to help manage symptoms.
Inpatient Rehabilitation: These treatments are offered in a residential facility or inpatient facility where you receive around the clock care and support for addiction. You’ll get counseling, fun activities, and help creating new habits and mindsets.
Outpatient Programs: Outpatient programs allow you to receive treatment during the day and continue to live at home or in a sober living residence in the evening. Some programs are highly structured and have up to 20 hours of treatment, while less intensive programs might have nine hours or less per week of rehab. These programs include individual or group therapy sessions focused on helping you live out your recovery in daily life.
Medication Assisted Treatment (MAT): Medications can be prescribed to help manage cravings and withdrawal symptoms. This support is combined with counseling and behavioral therapies to help establish your recovery long term.
Where Does Optimum HealthCare Offer Coverage?
Optimum HealthCare primarily offers coverage to Medicare beneficiaries in 24 counties throughout Florida. The coverage areas include counties in the center of the state bordered by Marion County in the north and Collier County in the south. They also offer concierge services in eight counties, including Marion, Orange, Sarasota and St Lucie.
The concierge services may vary in each county and may include personalized care coordinators, transportation services, home visits, wellness programs, and medication management. These services help improve your overall experience by providing you with convenient and personalized support that goes beyond traditional medical care.
How to Verify Coverage with Optimum HealthCare
Your insurance coverage through Optimum HealthCare will vary depending on your Medicare Advantage plan. Before receiving addiction services or care for mental health conditions, it is important to verify your insurance coverage.
There are several ways to do this. When you purchase a Medicare Advantage plan, you are given a member Services book that documents what your policy covers. However, these can sometimes be confusing to read. Optimum HealthCare also has a member services phone number where you can ask questions about your coverage.
The easiest and sometimes fastest way to verify your insurance coverage for addiction treatments is to work with the addiction treatment center of your choice.
The financial counselors will generally verify your insurance coverage with Optimum HealthCare and provide you with more information about the treatment center, your treatment options and what you can expect after admission.
Does Addiction Treatment Need to Be In Network?
Optimum HMO provider networks use credentialed professionals to deliver care and in most cases you need to use in network providers to get coverage.
However, on rare occasions, Optimum will cover an out of network provider. An example of when out of network services can be used is when emergency care is necessary and delaying care would be dangerous. If an emergency happens outside of your network’s service area, then in network providers would of course be inaccessible. So you would access emergency services and then when you return to your home service area you would get any follow up care from an in network provider.
To request out of network services in non emergency situations, you must ask for special approval, and these are rare. Another possibility is that you can pay for out of network care yourself rather than using insurance.
What to Do if Optimum HealthCare Won’t Cover the Cost of Rehab
If your Optimum plan informs you that it won’t cover the cost of rehab, you are not out of options. You have the right to appeal your insurance company’s decision to deny treatment. To start the process, call Optimum Member Services. You’ll find more information about the appeals process in Chapter 9 of your Optimum Evidence of Coverage (EOC) document.
To get help covering the cost without insurance you can apply for a grant from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA). SAMHSA grants for addiction treatment are available in all states. You may also find financial assistance available through scholarships or grants from advocacy groups such as LGBTQ+ groups or through your church. Ask the rehab you are considering whether they accept these assistance program options.
Also ask if the rehab itself has a sliding scale which is a reduced fee option based on income. You can consider using a loan to pay for your addiction treatment. For example CareCredit is a company that specializes in providing credit to be used for healthcare needs. Or you could borrow money from family or friends. Because it is important to get rehab when you need it be diligent and creative when searching for your own funding options.
Calls to any general helpline will be answered or returned by a paid advertiser.
By calling the helpline you agree to the terms of use. We do not receive any commission or fee that is dependent upon which treatment provider a caller chooses. There is no obligation to enter treatment.
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