Discover how Tufts Health Plan covers addiction treatment, including rehab options, medication-assisted therapy, and mental health services.
Tufts Health Plan Insurance
Discover how Tufts Health Plan covers addiction treatment, including rehab options, medication-assisted therapy, and mental health services.
Tufts Health Plan is a nonprofit insurance company that started in 1979 and operates out of Massachusetts. They provide health insurance to a half million residents of Massachusetts and Rhode Island. In 2021, Tufts Health Plan merged with the nonprofit Harvard Pilgrim Health Care and rebranded as Point 23 Health. They provide insurance to people of all ages and take part in community-based programs, such as food assistance initiatives.
Does Tufts Health Plan Cover Rehab?
Most Tufts Health plans cover mental health and substance abuse treatment, as required by the 2010 Affordable Care Act. This federal law requires most long term health insurance plans to cover 10 essential health benefits, which include mental health and addiction treatment.
However, there are exceptions to the law and insurance plans differ. As a result the options for covered treatment vary widely, so you should check with the insurance company about your specific plan.
The type of treatment(s) offered to you are usually based on your doctor’s assessment and recommendations, which help define what is medically necessary in your case. It’s a good idea to work closely with your doctor because you may also need a referral and/or preauthorization before you begin treatment.
AlcoholismDrug AddictionDual DiagnosisMental Health and Substance AbuseOpioid Addiction
Adult ProgramYoung Adult Program
Private InsuranceSelf-Pay OptionsMedicaid
Great people!
Andrew Cleveland
4 months ago
I went to Washburn house from December 27-January 7 to their detox program. I was 100 percent going to do their CSS but unfortunately there were not enough beds for women at that time. So I was sent to another CSS. My 12 days at Washburn completely transformed my life. This was my first time ever being in rehab before so I was beyond terrified. When I arrived at Washburn the Staff was amazing to me. They made me as comfortable as possible and let me know I could talk to them whenever I needed to. My caseworker LJ was absolutely amazing. She was so smart, compassionate and just supported me so much. As were all the other case workers. You could tell they really cared about their job and wanted everyone to succeed. The daily meetings at Washburn were great and they were the same as the meetings that I got at the CSS that I transferred to to be honest. And that is saying a lot because detox they know that you are sick and they are just trying to help you get through the day. But I got the best tools and ways to cope at my time at Washburn. The day to day floor staff was also so nice. They always checked in on you and made sure you were ok. When I went to the new CSS not a day went by that I didn t add Washburn to my gratitude list. I honestly believe if I didn t go to Washburn first I wouldn t have gotten the positive and life changing experience that I got. I am 27 days sober and I plan on staying sober for the rest of my life, with a lot of hard work ahead of me. My family and me will forever be grateful to Washburn and If you are ready to do the work then you can get so much out of this program. I mean there are hard to find the words to thank a place that you feel like helped give you your life back!
Jennifer Pontuso
4 months ago
The Washburne house is hands down the best DETOX/CSS In the State. I ve been to probably all of them and I ve never had a better experience. I went in October 2024 broken, lost my spouse of 20 yrs my business, my truck, and my apartment. I was negative about my future and ready to not even try. When I left I went to the facility I wanted to go, I was positive, and for the first time of many times trying in the past Im really serious and ready to stay sober. I can t say enough or express how much the BHTS CASEWORKER/CLINICIANS MDS/NURSING, and the kitchen and House Kitchen staff have made an impact on my stay. I would and will recommend anyone who wants to get there life together and seriously change the Washburn house is a place that will make you feel welcome and give you all the tools and support to continue and get you where you need to go on your journey to sobriety. On a final note I m going back in 6 months and apply to work part time as a BHT so I can give back the same experience and help to the next person in need also feel the same as the Washburn House made me feel. Thank you aWashburn House for everything Brian S.
I loved it here. Such a great experience!! They are so nice and very helpful!!
Hailey Pyenta
1 week ago
A wonderful experience, the entire staff attended to all of my needs so I could focus on me while I was here. ❤️🩹 I’m fortunate to have found Spring Hill, they helped guide me in my treatment and getting ready for the next step. Thank you all!!!!!
Ryan O'Connell
4 weeks ago
This is an excellent residential program where you are not locked onto a unit. There is full access to the absolutely stunning campus. The staff is kind and can relate as most are also in recovery. The food is fantastic with home cooking by Matt, Jon & Eric. I received the best treatment through group therapy, individual therapy, family therapy & case management. The nursing staff is top notch & available 24/7. I highly recommend Spring Hill for the best substance abuse recovery experience out there.
I feel very privileged to be able to spend 30 days at maple moon. I can t say enough on how the entire staff made me feel safe and comfortable and supported. The detox was as easy as can be and and I was given the tools and confidence to continue my journey after.
Darla Leonard
2 months ago
This is great place if seeking help with drug or alcohol abuse,the staff is awesome ,couldn't ask for a better treatment facility
Kevin Wheeler
2 months ago
When i first got here everyone is vary nice and caring and the food is amazing over all the care and the passion the staff shows in every client is super nice and welcoming and the food is so good it feels like a resort it s so nice the house is nice the people actually care about me I just loved being here and would recommend to anyone going in to treatment and I really appreciate the staff for making me feel welcome
Maple Mountain Recovery utilizes a unique environment of therapeutic care.The staff are trained, responsible, and show their commitment to provide clients with the best modalities to fit their needs.Clinical and Therapeutic staff encourage clients to process learned techniques, and the application they ll find accessible into the lifelong recovery process.The environment is clean and kept in order. A nutritious diet made easy to integrate through the use of professional chefs. An overwhelmingly positive atmosphere and support of peers and staff create motivation to improve upon the struggles of life.I highly recommend Maple Mountain to those seeking care for their mental wellbeing.
Hunter Reynolds
2 months ago
Maple Mountain has been an absolutely life changing experience for me. I was fortunate to have been assigned Sarah as my therapist. Her support and counselingA.R.T. sessions, thoughtful reflections and her exceptional abilities as a therapist have healed deep and traumatic experiences.Kevin and Vikki have given me a place of compassion, understanding and direction that are invaluable.The food is excellent, fresh and varied. Chefs are talented and accommodating, always going above and beyond.Beds are very comfortable and the facility is impeccably clean and welcoming. Maria in hospitality is warm and friendly offering uplifting conversations and makes you feel at home.And Angel, therapy doggo extradonaire is THE best support dog ever!The wound is the place where the light enters you - RumiWe help you walk through the dark and back to the healing light - the experience of Maple Mountain!
Gigi Crowe
2 months ago
The facility is beautiful and maintained very well. I came here feeling like I had changed into a person I wasn t proud of after experiencing intense traumas throughout life, I am leaving feeling lighter and brighter and much more like the best parts of myself. The chefs are great and accommodating at all times, my therapist Kevin helped me through things I didn t think were things I could work through. The techs Chay, Natalie, Chelsea, and Kailea are full of kindness and will make you feel at home and secure. On the negative side I do think the program lacks consistent communication at times which can be triggering, to be told one thing and it ends up being different.
SunCloud is fantastic! From intake to graduation the team is there to support you in whatever type of recover you need. Staff is kind, caring and adaptive to your needs. Dedicated doctors on site. Post treatment support and groups. Would and have recommended to family and friends.
Chris Salvador
2 months ago
I was scared and unsure going into this process but after the Community welcomed me with open arms I knew I was in the right place. Staff went above and beyond my expectations with how devoted their are to taking care of us. I felt safe and comfortable to start my healing process. The psychiatrist is the best doctor I have ever worked with. I am forever thankful for this wonderful place in giving me a second chance at life.
Rachael Granger
7 months ago
I found SunCloud by Googling different outpatient treatment centers Per the request of my therapist and went with them because of their ratings. I did not know what to expect when coming into SunCloud, but as soon as I walked in, I knew I was in the right place. I was in the Naperville location, and they have both an adolescent and adult side, which includes all ages. SunCloud provides food M, W, and F for lunch, which is highly convenient as it removes the stress of figuring out what you will eat and saves you money. The therapists, front desk, and RN staff are exceptionally kind and supportive. They all want the best for every person there and recognize even the most minor accomplishments. There is a daily 1.5-hour process group where it truly feels so safe and comfortable to share whatever is on your mind/you are going through.Peers provide feedback or listen if that is what you need. The therapists are good at prompting if you need them and always allow patients to choose whether they want to share. There are psych. Ed. Groups after lunch where we learn different DBT skills or play games to engage in mindfulness. You also meet with a therapist and psychiatrist once a week one-on-one in addition to groups. I have met some of the best people at SunCloud. There is nothing like being in a place full of people to recover or better themselves and accept each other with non-judgment and love. I created lifelong friendships, and being there even inspired me to get my masters in social work. I never wanted to leave. Whether you are struggling with substance abuse, grief, eating disorders, or complex trauma, the community is SO important. The support is unmatched. Once you graduate from the program, there is an alum and outpatient group, so the support never stops. I miss coming in every day! Thank you so much SunCloud!
Aftermath is an exceptional place, with a team that genuinely cares about their clients. They offer a diverse range of services, all carefully tailored to meet individual needs. Each person receives thoughtful, personalized attention, making sure they feel truly cared for. The facility itself is warm, inviting, and peaceful, providing an ideal setting for recovery. I wholeheartedly recommend Aftermath to anyone in search of top-tier care and a team that truly understands and supports you. A five-star experience through and through!
Zach Mcauliffe
2 months ago
Matt Ganem is a true inspiration in the world of addiction recovery. Having walked the path of sobriety himself, he has dedicated his life to giving back to the community in meaningful and impactful ways. As the leader of Aftermath Treatment Center, Matt has created a place where individuals struggling with addiction can find hope, healing, and a real chance at long-term recovery.
The center offers a comprehensive range of services, including medical detox, inpatient treatment, and outpatient programs, ensuring that clients receive the right level of care at every stage of their recovery journey. What sets Aftermath apart is its compassionate, community-driven approach—something that clearly reflects Matt’s deep understanding of what it takes to rebuild a life after addiction.
Beyond treatment, Matt is a mentor, advocate, and voice of encouragement for those seeking a better future. His dedication to giving back is evident in everything he does, from supporting individuals in recovery to raising awareness about addiction and mental health.
If you or a loved one are looking for a treatment center run by someone who truly understands and cares, Aftermath Treatment Center, under Matt Ganem’s leadership, is an outstanding choice. His work is changing lives, and his impact on the recovery community is immeasurable.
Robert Ellington
4 months ago
Aftermath Treatment Center saved my life! My time spent there opened my eyes to a new life I honestly didn't know I deserved. The groups were informational and gave me tools to work my program. The staff is hands on, relatable and encouraging. Thank you Aftermath for helping me find myself!
Just came home after four weeks at Serenity Treatment Center and it was a wonderful experience. I came home more with a better understanding of my condition and given great coping skills to deal with my anxiety and depression. I want to thank with all my heart two people in particular My clinitions Jack who gave me great one one one therapy with a kind and gentle heart and Rob...both true gemsne. Rob ran many of the group sessions always giving a lot of information and encouraged us to recognize our needs and work on coping skills that for me we're so important. Rob had a way of running groups and not making the groups boring with different approaches such as occasional an chuckle combined with many serious conversations. Anyone lucky enough to enter into the Serenity program is truly lucky. I would be wrong not to acknowledge the techs, nursing, cooking and cleaning staff all wonderful people.
Carolyn Abramek Stanke
1 month ago
I had an extremely great experience. My mental health, and my substance abuse were addressed and worked on every single day. With medication and daily therapy sessions, and a greatly structured environment I felt very confident in moving into a sober living phase--which is a part of the recovery process. The team at Serenity are amazing. Thank you all for your hard work!
-BooBoo
Siobhan Dilworth
1 month ago
This place was amazing . Home away from a home mid stay til end of end . What a journey . This place changed my life and opened my eyes . I want to thank Jessica C one of the techs for everything she did helping me better myself . Thank you guys for everything !
Great program!
Sadly, I have few been to quite a few recovery centers over the years. Within the first week I had learned more than I had in any other I had attended. Such a clean facility with staff that truly care. Colin is a top notch chef that made us the best meals. My wife is in trouble when I get home, as my taste buds have been accustomed to the best food(kidding). And from the people that run the show Andrew and Luke, to my counselor Matt, to all the techs that made it happen, all 5 STARS. I have formed a brotherhood here that I will stay connected with forever. Thank you so much!
Jack Armstrong
2 weeks ago
Best place to recover by far!! Great staff and nursing!
Clay Thomas
3 weeks ago
Great councilors and the other clients were awesome the food was kinda ok
I had a great experience here at Swift River. I detoxed else where, but when I arrived here I was very nervous how everything would play out. All of the staff and peers I had around me were very welcoming and comforting in my transition process. I completed the full program, and although I have a good form of nervousness to leave I am quite excited to continue on my sober journey.
Jack Langley
2 months ago
Beautiful location very helpful wonderful staff
Nina Marie
2 months ago
Had an awesome experience here! It wasn't my first rehab but it was definitely the best program, an enjoyable program and everyone was extremely nice! Would definitely recommend it to a person in search of recovery!
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What Are Tufts Health Plans?
Tufts Health provides a wide variety of insurance plans. You may get an individual or family plan through your employer or your state’s Insurance Marketplace. Tufts also offers Medicare and Medicaid plans to those who qualify.
An individual or family plan is generally one of two types. With a Preferred Provider Organization plan, (PPO), you can choose your own doctor and treatment facilities, with no referral needed. However you’ll generally pay a higher monthly premium for these plans.
A Health Maintenance Organization, or HMO, plan usually has lower monthly plan fees but they may have higher deductibles and copays. HMOs generally require you to use the provider network for care if you want insurance coverage. Often you will need a referral from your primary doctor to see a specialist, such as a psychiatrist or addiction specialist.
Tufts Health Plan offers Medicare Supplement and Medicare Advantage plans. Medicare supplement plans help you manage the costs of Original Medicare. Medicare Advantage plans (or “Medicare part C”) are a full replacement for Original Medicare and often include extra benefits, like prescription drug coverage and vision and dental care.
Medicare Advantage plans are offered as either a PPO or HMO, similar to the individual and family plans described above.
Tufts Health Plans has Medicaid plans in Massachusetts and Rhode Island. These state sponsored plans help provide coverage for lower income individuals and families. These plans cover addiction treatment along with doctor and specialists’ office visits and some additional benefits, such as eye exams and eyeglasses.
For people who have both Medicare and Medicaid, there are Special Need Plans that are based on age (21-64 or over 65) that include all the benefits of Medicare plus additional benefits such as a case manager if needed.
You can learn more about Tufts Health Plan’s coverage options on their website.
What Outpatient Addiction Treatment Does Tufts Cover?
During outpatient rehab you’ll live at home or in a sober living environment and attend treatment part time.
Outpatient programs include partial hospitalization (PHP), intensive outpatient (IOP), and regular outpatient (OP) programs. In a partial hospitalization program, you would attend treatment during the day and return to your home at night. PHP programs typically run for 4-8 hours a day, three or four days a week, and last for 30-90 days.
Intensive outpatient programs typically offer 9-20 hours of treatment each week, spread over 3 to 5 days per week. A total of 90 days of treatment is typically recommended for IOP programs.
In general outpatient programs, you would visit a clinic or rehab facility one or more times each week. Group counseling and education on addiction and relapse prevention are provided, and individual counseling sessions may be offered when needed.
What Inpatient Addiction Treatment Does Tufts Health Plan Cover?
Most insurance plans focus on medically necessary treatment, highlighting the importance of creating an individualized treatment plan with your doctor.
If the detox process is expected to be difficult you may undergo an inpatient detox process where a licensed healthcare professional oversees and monitors your progress, ensuring your safety. A group of therapists and nurses as well as doctors and clinical staff watch for complications. You may also receive medication to help with detox symptoms.
Inpatient or residential care is one of the most intensive ways to battle an addiction. With these programs you live in the rehab center and take part in targeted treatments to help address triggers and develop coping mechanisms. With inpatient treatment you benefit from peer support and a structured schedule as well as around the clock support and a reduced relapse rate. Inpatient centers often help ease your way back into society with sober living facilities after treatment ends.
Does Tufts Health Plan Cover Methadone & Suboxone (MAT)?
Over the last decade, much research has been done to develop medications that help people fight addiction through both detox and the ongoing treatment process. This is called medication-assisted treatment (MAT) and may involve the use of methadone or suboxone.
Methadone is used to treat opioid addictions. It helps reduce cravings and blocks the effects of opioids.
Suboxone is one of the most common medications used to treat addiction. To avoid misuse suboxone contains naloxone which blocks the euphoria that comes from getting high.
Studies show that MAT greatly reduces the death rate of those living with addiction, and a majority of patients maintain sobriety for two years. Every situation is unique so it’s important to discuss medication with your doctor and consult your specific healthcare plan to make sure medications are covered.
Does Tufts Health Plan Cover Other Mental Healthcare?
The Affordable Care Act requires that most insurance plans offer mental health care. However there are some exceptions so it’s important to always check your plan before you receive care.
Mental illness and substance abuse often go hand in hand and long term care is vital to staying healthy. With the right plan you can use your insurance to obtain an integrated treatment program that works to combat both problems. That may look like attending an integrated program or ensuring that your healthcare providers are communicating regularly.
Does Addiction Treatment Need to Be In Network?
HMO plans don’t cover out of network care. PPOs generally will but the cost is often higher for the patient, including higher copayments and deductibles. If possible you’ll want to find a provider within your network to get the most out of your insurance coverage. If you do opt for an out of network provider research your insurance policy thoroughly and speak with office staff and your doctor to make sure you fully understand how much of the treatment cost you will have to pay.
It may be worth the extra money if an out of network provider has a higher rate of success for treatment or you feel more comfortable with them, but make sure you understand the costs first.
How to Verify Coverage With Tufts Health Plan
To verify that you have coverage for specific treatments you can contact your insurance company directly. A treatment center’s staff may have general guidelines for what policies they take but they can’t guarantee exact numbers like your insurance company will.
You can verify coverage by logging into your online account or contacting the customer service number found on the website or your insurance card. Speak to a representative from the company about what is covered and what’s not before you start a program. Not only does this set you up for uninterrupted treatment, but it also relieves the stress that comes from unexpected bills when you’re trying to get back on your feet.
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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