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.
If you’re exploring different rehab facilities or confirming plan requirements, you can learn more about rehab options to look at programs compatible with your coverage.
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 👍
AlcoholismDrug AddictionMental Health And Substance AbuseOpioid AddictionSubstance AbuseDual Diagnosis
Adult ProgramProgram For MenProgram For WomenYoung Adult Program
Self-Pay OptionsPrivate insurance
The staff in the facility were amazing my counselor Jason changed my life for the better
Slow Poke
1 day ago
All In solution’s was the best decision I’ve ever made they helped me get my life back together. And got me back on the right track again. My counselor Jason was very helpful and was very supportive of my recovery. Even though I’ve completed the program ASI Still reaches out to me. Brandon my case manager was very helpful in getting all my paperwork done. I’m forever grateful to AIS and all the staff and techs.
Edward Seth
6 days ago
This place was such a blessing! When they say "they love you until you love yourself" they were not lying. Everyone was so welcoming and caring, a bit overwhelming in the beginning, but when you leave you realize how much you miss it. Highly recommend my counselor Jason. Might not be everyone's cup of tea, but if you need someone that doesn't sugarcoat and tells it how it is, he's the one for sure!
ICFR has been very necessary in my healing journey. The other patients I’ve met here have been the reason for my success. They have taught me so much and have been a support unlike anything I could’ve imagined. Do keep in mind, this is NOT a wellness retreat to the extent they make it out to be. It is nicer than a lot of facilities but there’s a lot of disorganization in an understaffed and underpaid environment. I do appreciate a lot of the resources, how often staff checks in with you, and some of the group classes they provide. It is not a very one on one healing experience with special treatment, so do expect a lot of down time and advocating for what you need and want. Overall I’m glad I came as it was essential to improving my mental health.
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.
Absolutely changed my life for the better. I went in arrogant and with my head on backwards. They supported me through every step of the process and when you leave you really do “get your power back”, the choice to make the right decisions. If I ever had to go to rehab again I would choose this place again immediately. Hats off to Lead RS Justin and my clinician Sandrea for they gave me the deepest level of support and I wouldn’t have made it the full program without them. Thank you Spring Hill.
nick capparella
6 days ago
This is one of the greatest recovery centers to regain control over your life. The groups are very informative and welcoming. The criteria was open and well covered. The RS go above and beyond to make the clients feel comfortable. I would highly recommend anyone to come here and experience the healing vortex that surrounds Springhill
Corey
1 week ago
I’ve never been in recovery, or in any form of rehab and being here / making this decision saved my life entirely.
As a first timer, I was overwhelmed with the amount of support that I received during my stay here, everyone is more than nice & outstanding individuals. From the staff, to the maintenance crew, to the phenomenal chefs AND Maybel the therapeutic pup everyone here is there to help you during your sobriety journey!
I didn’t want to leave, this place WILL change your life.
AlcoholismDrug AddictionDual DiagnosisMental Health and Substance AbuseOpioid Addiction
Adult ProgramYoung Adult Program
Private InsuranceSelf-Pay OptionsMedicaid
The program really helped me to put my life into perspective and get my recovery back on track
Michael Welty
3 weeks ago
I started at Washburn CSS for 30 days and then I transitioned to Washburn RRS and have been here for about 4 months and iam receiving the help I need to address my issues.
Chester Garland
4 weeks ago
I am alive because of the staff there and hands down one of the best recovery places I have been
This place is amazing. Amazing staff. Attractive facility. Very therapeutic. Attention to everyone's needs. Highly recommended. I wish I knew about this place 4 treatments ago.
Marco Hernandez
6 months ago
My experience at Banyan was great ,nurses and staff are great and the food is excellent 👍🏽.
I will be forever grateful for the amazing staff and fun-loving community that fostered my growth and change!
Megan Smith
3 weeks ago
Amazing facility very clean and well kept. Outstanding medical and clinical staff that truly care for your well being.
Walker Adams
3 weeks ago
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Frequently Asked Questions
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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