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.
By Gayle Morris
Gayle Morris, BSN, MSN has over two decades of nursing practice with a clinical focus on rehabilitation medicine. She has published and lectured throughout her nursing and writing career. In the last 15 years, she has directed her energy and passion to create content that informs and educates readers with the goal of improving overall physical and mental health.
Medically Reviewed by Eli Wood
Eli Wood is a content writer and content strategist specializing in healthcare, mental health, and LGBTQ+ sexual health and wellness. They have written for American Addiction Centers providing health insurance resources and information, as well as writing and reviewing detailed medical insurance and product pages for various platforms.
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Our Rehab Score is designed to make it easier for you to find the best treatment centers. We combine overall ratings with recent feedback to create a score that reflects a center's quality right now.
AlcoholismDrug AddictionMental Health And Substance AbuseOpioid AddictionSubstance AbuseDual Diagnosis
Adult ProgramProgram For MenProgram For WomenYoung Adult Program
Private InsuranceSelf-Pay Options
I’m so happy I choose to come here. I’ve learned so much being here about my addiction and myself in general. The staff, the nurses the group therapy were all amazing. I’m going to miss the people in here I met. Thank you Kristina, KERMIT, Kate thank you Carlos, Theresa, LACEY, RICKY, CiCI, SAM, JESS nurses Chris Ashley ALL OF THEM! God bless yall!! Love you all I’ll miss you
Nisha Lacondrata
1 month ago
I had a great experience at All In Solutions Treatment Center. The staff was incredibly caring, supportive, and genuinely invested in my recovery. I learned a lot about myself and gained tools I can carry with me moving forward.
The facility was comfortable, the care was excellent, and the overall environment made it easy to focus on getting better. I also have to give a huge shoutout to the chef—the food was outstanding.
I’m very grateful for my time at All In Solutions and would absolutely recommend it to anyone looking for compassionate, high-quality treatment.
Matthew Bomgaars
1 month ago
My experience at All In Solutions exceeded my expectations. I was treated with respect, honor and dignity. I was kept comfortable while detoxing.
Our Rehab Score is designed to make it easier for you to find the best treatment centers. We combine overall ratings with recent feedback to create a score that reflects a center's quality right now.
AlcoholismDrug AddictionMental Health And Substance AbuseOpioid AddictionSubstance AbuseDual Diagnosis
Adult ProgramYoung Adult ProgramProgram For MenProgram For Women
Private InsuranceSelf-Pay Options
Once you settle in it’s great. Very positive environment and the staff are great.
T.eandah
1 week ago
Staff and counselors were absolutely phenomenal and helped me tremendously. Would highly recommend if you need help with your addiction.
Shaun Sellers
1 week ago
Awesome experience. Staff is accommodating to all your needs from top to bottom. Groups are engaging and promote confidence in sharing. I required extra attention because of a medical issue and I was provided transportation to all of my appointments. Top notch!!
Our Rehab Score is designed to make it easier for you to find the best treatment centers. We combine overall ratings with recent feedback to create a score that reflects a center's quality right now.
AlcoholismDrug AddictionOpioid AddictionSubstance AbuseDual DiagnosisMental Health And Substance Abuse
Adult ProgramYoung Adult ProgramProgram For MenProgram For Women
Self-Pay OptionsPrivate insurance
Wonderful place , case management was wonderful, therapy was great, couldn’t be happier with my stay . I would highly recommend to anyone especially if you have faith in Jesus Christ. Got me put on the right direction
Justin Caines
4 weeks ago
Great staff that actually care about clients. Definitely the best treatment center in Florida.
Cody Morgan
4 weeks ago
This is a great facility and great program a lot of great people work here that care about helping others !!!!!
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Our Rehab Score is designed to make it easier for you to find the best treatment centers. We combine overall ratings with recent feedback to create a score that reflects a center's quality right now.
AlcoholismDrug AddictionOpioid AddictionSubstance AbuseDual DiagnosisMental HealthMental Health And Substance Abuse
Adult ProgramSeniors ProgramLGBTQ Program
Private insuranceSelf-pay options
Todo fue especial. Muy agracecido con todo el personal. Todos muy amables comprometidos. Muchas gracias
Michael Gordillo
1 month ago
Haven Detox ha sido un lugar de bendición para nuestro familiar. Todos sus empleados, desde terapias, trabajadores sociales, médicos, los cocineros y todo el personal en general tiene la vocación y la empatía para hacer más q su trabajo, hacen que se sientan en familia. No tengo como agradecer el cambio q hemos obtenido.
Es el mejor lugar para tratar la adicción de un ser querido! Que DIOS los siga usando de forma poderosa!!! Gracias Josefina por ser la persona que nos ayudó a llegar a este lugar!
BlancaPor Perez
2 months ago
El mejor lugar para tratar la adiccion de un ser querido. Un excelente grupo de profesionales que hacen mas q su trabajo, es su vocacion. Recomendado al 100% El mejor centro en Puerto Rico. Mi agradecimjento a Josefina q fue la persona contacto en Puerto Rico, quien con mucha paciencia y amor nos facilito llegar a este lugar maravilloso
Our Rehab Score is designed to make it easier for you to find the best treatment centers. We combine overall ratings with recent feedback to create a score that reflects a center's quality right now.
Very nice staff and people. Organizing needs some work, but otherwise, it’s a very great place. Open and welcoming community. Peers are kind and most here voluntarily. I have met some great people here and some lifelong friends.
Landon Dougherty
1 week ago
I can't say enough great things about this recovery center. From day one to day 30 I was given the best information and care. I can't imagine a better place for the help I needed.
Anthony Casada
2 weeks ago
ICFR was just what I needed to learn about my addiction and learn about ways to recover successfully. The clinical staff and support staff are outstanding in every way. The accommodations are comfortable and they do everything they can to address your needs.
Our Rehab Score is designed to make it easier for you to find the best treatment centers. We combine overall ratings with recent feedback to create a score that reflects a center's quality right now.
The facility is fantastic! Very clean and organized. The staff is wonderful, esp: Ms. Janell, Desmond and Meachi. Honestly the staff was always helpful and chipper when you are at your worst. I would definitely go back again and recommend it to anyone. I appreciate all the help I received. <3
Libbi Witcher
4 days ago
Tina Moore and all of the staff here are wonderful people. The facilities are next level. Very clean very nice! I really enjoyed the tour and meeting everyone! They really care here!
Geremy Wilkerson
1 week ago
A wonderful facility with wonderful staff. The team here truly cares about the community they serve.
Our Rehab Score is designed to make it easier for you to find the best treatment centers. We combine overall ratings with recent feedback to create a score that reflects a center's quality right now.
This place has completely changed my life and for the better I came in high as a j bird and I hated my life and when I got here I really just wanted to do the detox portion but here I am 26 days later and I’m still here the classes they we do are amazing dbt classes helped me out a lot and I learned I can live a life that does not involve using drugs like meth or fentanyl and that I can honest be happy done the staff are wonderful very helpful and they really are here to help change lives there not after a paycheck heck they even take you to your appointments and they also make sure your safe when you leave and they find after care for you so you can continue to stay sober and live the life of a sober person and the best part is when you wake up in the morning you can go out side with your coffee and a smoke and watch the sun rise over the lake and sunset as well I’m truly going to miss this place and if I ever relapse again I know where I will come back to
Thank you to all the staff at HAVEN DETOX
Nathan Schibline
3 weeks ago
The haven has been one of the greatest experiences I’ve ever had the pleasure of going to. From the staff to the clients I’ve been here since September and I coin out on Thursday. Every step of the way I have learned something new. I wouldn’t trade my experience for anything. I highly recommend the haven detox for detoxing or residential treatment.
Our Rehab Score is designed to make it easier for you to find the best treatment centers. We combine overall ratings with recent feedback to create a score that reflects a center's quality right now.
First and foremost I would like to take the time and thank all of the staff at the West Palm Beach phacility for being so kind, caring and understanding of my needs during my time in detox and residential. From clinical to the therapist, chefs, nursing and senior staff, my time did not go unattended or unnoticed. If you're in need of help and looking for a treatment center that truly cares, please don't hesitate and give The Haven Detox a call.
Sincerely...Thomas F.
Thomas Fallis
6 days ago
Learned so much about myself. It was a blessing. And David is the best!!!
William Grappy
1 week ago
Treatment and continued support here was very helpful
Our Rehab Score is designed to make it easier for you to find the best treatment centers. We combine overall ratings with recent feedback to create a score that reflects a center's quality right now.
I wanted to share my quick experience with the facility and the team. First I want to thank James ( first contact) for his kindness, guidance and professionalism. He is very helpful and always here for people. The place is perfect for people looking for quietness and relaxation, the scenery is beautiful. The team is lovely, polite and welcoming with full discretion. They make you feel comfortable right away without any pressure and judgement.
I highly recommend this rehab facility for any person in distress, you will love it!
I am very grateful for your help and support
sebastien piquemal
1 month ago
Ira (the Admissions Coordinator) saved my life today and I can’t thank him enough for his patience, guidance and explanations as he assisted me in getting into their PHP program. I have nothing but GREAT things to say about him and this program.
I’ll never forget what he taught me today:
“Take life one day at a time because an inch is a cinch but a yard is hard”.
Thank you Ira!!!!
-Trojan
Trojan
4 months ago
Beyond grateful that I found this place. There is a solution!! This isn't a rehab focused on how many people they stuff into treatment, the quality of care is wonderful. My life is much better and I owe it to Serenity Springs
Our Rehab Score is designed to make it easier for you to find the best treatment centers. We combine overall ratings with recent feedback to create a score that reflects a center's quality right now.
This place did so many things for my emotional health. Not only that but every staff member and facilitator were knowledgeable people who give a warm welcome to anyone who comes to the door, definitely helped turn my life around. In my personal opinion my favorite thing about launch was the groups because I felt like I what I had to say mattered, and for some people, that means the world!
Cody Roberts
2 days ago
An Incredible, Life-Changing Experience
My partner and I came to Healthy Living Residential in a very dark place. After a severe relapse and a massive fight, I wasn't sure if we would stay together. Addiction had completely changed our relationship, and we were terrified of entering rehab. However, the exact second we walked through the door, we were welcomed with warm, loving arms.
Our experience here was amazing. This place is completely different from most rehabs because they never force anything down your throat. Instead, they provide a safe, high-quality environment where you can drop your guard and just heal. The rooms and bathrooms are incredibly clean and comfortable, the food is excellent, and the therapists and group facilitators are outstanding. I felt entirely comfortable being myself in groups and learned so much.
The staff genuinely treats you like a person, not a client. They always make time to talk and go above and beyond for your comfort. They seamlessly supported my boyfriend when he felt restless, and they even helped me figure out my next steps for school. Through their guidance, we worked deeply on our relationship, started going to church, and grew closer to God.
I originally planned to stay for two weeks but extended it to 30 days because of how much I was growing. Healthy Living Residential saved my life, saved my relationship, and pointed us in a brand-new direction. I am truly, deeply grateful.
Brittany Russ
4 weeks ago
In my opinion Healthy Living is the best, gold standard for treatment. They have a good program and everything about the place meets or exceeds all standards, but there are allot of places that applies to. The thing that sets this place appears is the people, the owners, the administration, the staff. Every single one of them actually care and they will all go above and beyond to do any and everything they can to help you and make sure you succeed. Izzy is awesome, who deals with admissions, the owner and his son will do anything to help you and they keep their word, if they say they'll do something they do it. I won't list all the staff but all them make this place the great place that it is.
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.
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.
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.
Calls to numbers on a specific treatment center listing will be routed to that treatment center. Calls to any general helpline could be forwarded to SAMHSA or a verified treatment provider.
If you wish to connect with non-sponsor centers, you can browse top-rated listings, visit our homepage and browse by state, or visit SAMHSA.
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