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.
This place was amazing it really changed my life 70 days sober now
John Dasher
5 months ago
Thee best experience in recovery I've ever had. If anyone needs help with drug or alcohol addiction please call Serenity Springs. Their staff is amazing.
Daniel Flesch
5 months ago
Amazing. Serenity Springs is a first class facility. From the staff to the facilities and the compassion that everyone displays, this place is second to none. To those who are struggling or have family members in need, please reach out. Serenity Springs will change your life.
This place was amazing it really changed my life 70 days sober now
John Dasher
5 months ago
Thee best experience in recovery I've ever had. If anyone needs help with drug or alcohol addiction please call Serenity Springs. Their staff is amazing.
Daniel Flesch
5 months ago
Amazing. Serenity Springs is a first class facility. From the staff to the facilities and the compassion that everyone displays, this place is second to none. To those who are struggling or have family members in need, please reach out. Serenity Springs will change your life.
As an attorney, I referred my client to Fifth Street Counseling and the results were outstanding. They worked towards providing a tailored program for my client and my client consistently praised the staff s professionalism, empathy, which provided a safe and transformative environment for growth. It is rare to encounter a facility so committed to excellence in care with the kindness they show. The communication with my office was seamless and prompt with any outstanding or follow up questions I had. Both Garry and Adam were a pleasure to work with. I wholeheartedly recommend Fifth Street to anyone seeking professional and compassionate counseling and treatment services.
Shreya Mehta
5 months ago
Very good place nice staff
Becky I
7 months ago
The staff there are amazing. great costumer service. Mk and Adam are the best helpful and just all around amazing.
I was helped by Courtney! She was awesome and the Doctor as well ! I will be setting uo my primary care here
Gustavo Hernandez
2 months ago
I was helped right way- professional, efficient, I ve been there twice, and with my lungs, I will be back soon haha.
Olga Chavez
2 months ago
I was there on March 3, 2025, with severe pain in my foot because a shelf fell on it, and I stepped on a screw. I can say that they helped me they did various examinations, relieved the pain, and prescribed me more medication to continue treatment at home. I m grateful for the help, but it took way too long. I arrived at 11 p.m. and left at 6 a.m., even though there were hardly any other people seeking medical attention. I feel like they could have done everything much faster. Overall, the service was very good, but just too slow.
I ve been on the program for 12 years, I ve had 3 awesome counselors. I stayed with one for 9 years, without her I wouldn t have made it. She was in recovery herself, so She understood me. It is pretty bad right now, with the employee turnover rate, and organization with the Hurricane season. But with anything there is good and bad. I am sure they will get it back together soon.People need to understand that they are highly critiqued by federal laws. But as long as you do what your supposed to, you will not have any problems.
Angela Macon
4 years ago
The best way to detox off the streets
Faith Kerr
6 years ago
It really helps people maintain a normal life free from opioid addiction.
This place was amazing it really changed my life 70 days sober now
John Dasher
5 months ago
Thee best experience in recovery I've ever had. If anyone needs help with drug or alcohol addiction please call Serenity Springs. Their staff is amazing.
Daniel Flesch
5 months ago
Amazing. Serenity Springs is a first class facility. From the staff to the facilities and the compassion that everyone displays, this place is second to none. To those who are struggling or have family members in need, please reach out. Serenity Springs will change your life.
Our daughter is there for 3 weeks now and is showing more signs of improvement than we saw in years. Dr. Moran and the team really know what they are doing and have tools and desire to make a difference. Plus now we are more equipped then ever to keep on track for recovery once she comes back home, thanks to all education we received from FCRF. I finally have hope! I know if you are reading these reviews, you are desperate, same as I was a month ago. You don t need to be, don t wait! I recommend this place without reservation!Update: it has been almost 2 months after my daughter left FCFR and it s the healthiest 2 months we ve seen in a long while. She hasn t used any substances, found a part time job which she loves, graduated her failing semester with As and Bs and about to get her drivers license! It s not all rainbows and butterflies, we still need to work hard daily on keeping things on track, but now the hope is getting more real every day!10 months update: FCFR has truly been a game changer for us! Now my daughter is just a difficult (normal) teenager, but the disaster and desperation is so far behind, it s almost hard to recall how it has been. Now she is committed to getting better and going on with her life, and that s the most important part. Of course there will be ups and downs, but the terror of being constantly afraid for her and of her is far behind and I never ever want to go back. If we ever go back (it gives me anxiety to even write those words), we know who to call.One last thing. There are a lot of comments about lack of tender, love and care at the facility. TLC FCFR does not provide indeed. But they provide something better: treatment THAT WORKS. I m sure every story is different, but I m also sure a lot of people have experienced the same thing I did: TLC does not treat psychiatric illness.
Vlada Bazylevska
9 months ago
The police ministry at this center has been a blessing for my life. The guest speakers they bring in every month have nurtured me spiritually and everyone at this place is so welcoming and kind. The head minister Jorge is a great man of God and he works very hard to spread the Gospel of Jesus Christ that is so wonderful.
Christian Fernandez
1 year ago
I love the school. My daughter can read and write her name. Very happy with the school
Had a great experience. Adam is everything you want and need in a counselor. Would recommend to family and friends. Thanks for services.
Mary
3 months ago
The support I received at peace River has helped me tremendously during my recovery. Thank you.
Christine TreanorJohnson
3 months ago
Peace River is a great place to go if you need a substance abuse evaluation for probation Adam was a great evaluation counselor to have to do my evaluation and I'm happy to say that Polk Healthcare is taking care of any costs Peace River at Gilmore avenue next to tiger Town is a great place and I appreciate it
The people have always been great for me .and the 2 ladies I see and her one nurse are awesome a group you can count on for the answers .ty peace river
Dar Bullis
3 months ago
Everything nice clean the staff are friendly and professional as well the therapist. I went with my 12 year old daughter as a walking they talk to her and we when the next day as they told us they just talk again about the same question and give a appointment but I don t understand why my daughter need to wait 2 weeks for the intake and then wait to see the psychiatric. When her psychologist send her for emergency treatment or stay hospitalized. I will update my review to see how goes.
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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:Â 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:Â 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):Â 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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